ENROLLEE REGISTRATION FORM Spam protection, skip this field Gender M F Marital Status Single Married Pick Preferred Plan Precious Individual Diamond Individual Star Individual Olive Individual Olive Executive Indiv. Precious Family Diamond Family Star Family Olive Family Olive Executive Family Nothing found Blood Group A+ A- AB+ AB- B+ B- O+ O- ? Genotype AA AS SS Have you or anyone mentioned in this form been diagnosed with any of these medical conditions below? Sickle Cell Disease Diabetes Mellitus Hypertension Hepatitis Kidney Disease Asthma Cataract Glaucoma Epilepsy HIV/AIDS Goiter Tuberculosis Cancer (Prostate, Cervical) Surgeries Peptic Ulcer Hemorrhoids
