Sickle Cell Federation Of Kenya LOGO

SICKLE CELL FEDERATION OF KENYA
P.O. Box 19676 -00202, Nairobi Kenya
Email: sicklecellfederationkenya@gmail.com
Phone numbers:-+254 710 141 121 & +254 733 731 731
REGISTRY FORM
SICKLE CELL FEDERATION OF KENYA(SFK) MEMBERSHIP

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Demographics

Name
Gender

Current Resicence

(Nearest School/Hospital/Church):

Home Details

(Nearest School/Hospital/Church):
Highest level of education

DESIGNATION

(Tick all that apply)
Checkboxes
What is your Sickle cell status (Haemoglobin variant)?

PLWSCD

Details for people living with sickle cell disease
Have you filled the Registry Initial Encounter Form for PLWSCD?
Are you a member of any other organization that deals with SCD?
Do you belong to any support group/s?
Are you under any Medical Cover?
Enrollment mode to insurance cover?

CARE TAKER

Details for care takers
What is your relationship to PLWSCD?
Selected Value: 0
Employment status?

HEALTH CARE PROVIDER

Details for health care providers
Place of work:
Area of specialization

CATEGORIES OF MEMBERSHIP

Membership Type
The Sickle Cell disease Registries and Control programme (SCDRCP) team also known as the Sickle Cell Federation of Kenya (SFK) Data and Registries Team. Carries out its activities on an SFK platform under the supervision of the Ministry of Health (MOH)

Pay via mpesa
Pay Bill No: 522522
Account Number 7588760

Account Name: Sickle Cell Federation of Kenya

Forward message to Mobile Number Airtel: 0736739739 OR Safaricom: 0794928928. We will contact you concerning registration and certifications after payment confirmation