SCD Registry | Activity Reporting

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unique identifier of activity

Province*

kenyan region

County*

county where patient comes from

Subcounty*

subcounty where patient comes from

Venue*

venue where acriviry is carried out

Date*

Name of group/organization

Description of the group carrying out the activities

Physical Address

Phone Number

Category of the group

what best defines the category of the group

Specify the activities carried out

check all that apply

Describe the specific activities carried out

Number of people taking part in the activity

Contact Name for the Group/Organization Personell

Contact Email for the Group/Organization Personell

Contact Phone Number for the Group/Organization Personell

Contact Designation for the Group/Organization Personell