PATIENT ID CARDS | Rare Diseases SA

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SUPPORT GROUP |

order form

Discussion Groups

Patient ID Cards

Patient's Name and Surname

Patients Phone Number

Patients Email Address

Street Address for card deli

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Date of Birth

Diagnosis

Medical Aid

Medical Aid Number

Blood Type

A+

A-

B+

B-

AB+

AB-

O+

O-

Uknown

Allergies

Doctors Name

Doctors Contact Number

List Of Medication that you are taking

Medical Information (Ie: any important info that an Emergency Department will need to know)

Next of Kin Name

Next of Kin contact Number

Registered Organ Donor?

Yes

No

Select an item (R)

1 Card (collection from RDSA Office) - R100

3 for 2 special (Collection from RDSA office) - R200

1 card (Incl. R75 Delivery charge)r) - R175

3 for 2 Special (Incl R75 delivery charge) - R275

Thanks for your order! We will let you know as soon as your card is ready.

for a better tomorrow

Contact us

Telephone +27 10 594 3844
Hotline 072 476 7552
hello@rarediseases.co.za

Physical Address

The Station Bryanston,

63 Peter Place, Bryanston, Sandton, 2021

Postal Address
Suite 135, Private Bag X43, Sunninghill, 2157

NPO: 120-991 NPC: 2016/071131/08 PBO: 930060119

© 2021 Rare Diseases South Africa NPC | Rights reserved

RDSA Privacy Policy

Rare Diseases South Africa

NPO 120-991

Block 7, Ground Floor Stratford Office Park, Valley Road, Broadacres, 2021

(“the Organisation”)

MANUAL PREPARED IN ACCORDANCE WITH SECTION 51 OF THE PROMOTION OF ACCESS TO INFORMATION ACT NO. 2 OF 2000