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2023年07月22日臺北榮總血友病病友會報名表
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未命名標題
姓名
( 響應環保，請攜帶環保水杯、筷子，謝謝您！)

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是否需要領藥？ 為要 方便就診領藥作業，請您回覆是否需要。謝謝您！
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是否需要注射藥物？(限使用北榮領取藥物，因醫師人員法規定注射需要有醫囑，若請醫師開立注射他院藥物醫囑即可以協助注射，請見諒！)
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連絡電話
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連絡-email
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餐點
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參加者2姓名
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參加者3姓名
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參加者4姓名
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參加者5姓名
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報名截止日期: 2023/07/21
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