PROFILE of the PARTICIPANT

 
6% of survey complete.

Goal:  To learn more from those who have been diagnosed with Glucose-6-phosphate dehydrogenase (G6PD) Deficiency in order to provide data and information to researchers.
Survey Population: This survey focuses only on those who have already been diagnosed with G6PD Deficiency (G6PDD). 
Survey Participant: Refers to the person diagnosed with G6PD Deficiency, though someone else might complete the survey for them. For example an adult might complete for a child. In reports of this survey,
Participants will be referred to  anonymously ("a survey participant") and identified by their first name and/or birthdate. All Participants in this survey are guaranteed complete anonymity and confidentiality.

Survey Participant First Name (Remember that the Participant is the person diagnosed with G6PD Deficiency, even though someone else might be filling out the questionnaire for them.)

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* 1. Survey Participant First Name (Remember that the Participant is the person diagnosed with G6PD Deficiency, even though someone else might be filling out the questionnaire for them.)

Survey Participant  Birthdate    (mm/dd/yyyy)

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* 2. Survey Participant  Birthdate    (mm/dd/yyyy)

Survey Participant's sex:

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* 3. Survey Participant's sex:

Who is filling out this form?

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* 4. Who is filling out this form?

First Name of person filling out the survey, if other than Participant.

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* 5. First Name of person filling out the survey, if other than Participant.

Contact email address (your address, or the person who is filling out the form).

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* 6. Contact email address (your address, or the person who is filling out the form).

What country was the Survey Participant born in?

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* 7. What country was the Survey Participant born in?

What city was the Survey Participant born in?

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* 8. What city was the Survey Participant born in?

What state (or province or region) was the Survey Participant born in?

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* 9. What state (or province or region) was the Survey Participant born in?

What best explains your (the Survey Participant’s) ethnic background? Examples: Asian, English, Italian, Polish, Kurdish, African American, Polynesian, Spanish, Irish, Italian. Please be as thorough as possible.

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* 10. What best explains your (the Survey Participant’s) ethnic background? Examples: Asian, English, Italian, Polish, Kurdish, African American, Polynesian, Spanish, Irish, Italian. Please be as thorough as possible.

Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Mediterranean Anemia?

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* 11. Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Mediterranean Anemia?

Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Favaism?

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* 12. Have you (Survey Participant) or someone in your (participant) family been diagnosed of having Favaism?

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