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Contact Information
* Title:
MR.
MRS.
MS.
MISS
MR & MRS.
DR.
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Case Information
Name of Invokana User:
Date of birth of Invokana patient (mm/dd/yyyy):
Age of patient when Invokana was prescribed:
Diagnosis of Flesh Eating Infection or Fournier's Gangrene?
Yes
No
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