Privacy protection inquiry


Due to personal privacy laws you are requested not to enclose any personal medical information.
* Required field
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Including the check digit; for inquiries pertaining to disabled child, the child's ID number must be entered.
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Copy paste function is disabled for this input field, please enter information manually.
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Please note, the content length of this message is limited to 1500 characters and some characters are not available, such as: < > &