Select Health Need*

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Malaria / Fever and Pain*

Malaria TreatmentFever and/or pain

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Cough and Pneumonia*

CoughSevere Cough with Fast BreathingSevere Cough with Indrawn Chest

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Diarrhea*

Diarrhea/DehydrationIntestinal Worms

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Pregnancy*

Malaria PreventionSupplementsOral ContraceptivesYeast Infection

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Other Health Issues*

Red (Pink) EyeEar PainRingworms / ScabiesHeartburn, Peptic Ulcer

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How old is the patient?*Value not allowedThis field is required