Clinical Trials

Logo RMI *	Max file size (Mb): 1000 Max number of files: 1
Patient Full Name *
Email *
Address *
Age *
Patient Code *
City *
Your Phone or Whatsapp Number *
Your Conditions *	Chronic Hepatitis B Chronic Hepatitis C Co-Infection HBV/HCV Liver Cirrhosis with Viral Hepatitis B Hepatocellular Carcinoma with Viral Hepatitis B/C Co-Infection HBV/HCV/HIV Liver Cirrhosis with Viral Hepatitis C Liver Cirrhosis without Viral Hepatitis B or C Hepatocellular Carcinoma without Viral Hepatitis Non Alcohol Fatty Liver Disease (NAFLD) Liver Fibrosis Gastrointestinal Cancers Gastrointestinal Disorders
Blood Pressure (mmHg) *
Saturation SPO2 *
Cardiac Frequency *
Body Mass Index *
Your Clinical Manifestations *	Hematemesis Melena Portal Hypertension Hepatorenal Syndrome (Kidney Failure) Hepatopulmonary Syndrome Coagulopathy (Legs Swelling - Godet) Hepatic Encephalopathy Syndrome Cardiac Liver Hepatomegaly Spleenomegaly Extreme Fatigue Aneamia Abdominal Mass Hernias Abdominal Distension Hyperactive Bowel Sounds Anorexias Bloating Flatulence Eructation Pyrosis GERD Jaundice Legs Swelling Godet Hernias
Purposes *	Treatment New Consultation Patient Follow - Up
List of Last Exams Done *
Last Exams Done *	Max file size (Mb): 2 Max number of files: 1
Message *
Name of Specialist who enrolled patient *
Terms and Conditions *	I agree to the Terms and Conditions