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First Name *
Last Name *
Email Address *
Phone Number
Username *
Role *
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Doctor
Medical Receptionist
Nurse
Patient
Pharmacist
Branch/Hospital *
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Central Hospital Windhoek (CHW)
Katutura Hospital (KTH)
Oshakati Hospital (OSH)
Rundu Hospital (RDH)
Walvis Bay Hospital (WBH)
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