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Rhesus Negative Database
Contact Information
* Indicates required question
Email
*
Your email
Full Name (as on ID)
*
Your answer
Blood Type
*
Choose
O-
A-
B-
AB-
O+
A+
B+
AB+
Phone Number (Preferably Whatsappable)
*
Your answer
Nationality
Your answer
KTP/KITAS/Passport Number
Your answer
Address
*
Your answer
Gender
*
Choose
Male
Female
Others
Date of Birth
*
MM
/
DD
/
YYYY
Have you donated blood before?
Yes
No
Can't Remember
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Last Date of Donation
MM
/
DD
/
YYYY
Red Cross/PMI Member Number
Your answer
Past Medical History
Your answer
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