Online Case Report Submission

Presenting Author’s Information

Information entered here will be used by the organiser to communicate with the presenting author.  All information with an asterisk * are mandatory.

Last/Family Name:*
First/Given Name:*
Mailing Address:*
Contact No.:*
Case Report Title:
Upload a File:*


By submitting my case report, I confirm that patient confidentiality has been respected and PDPA guidelines have been met.

If identifiable patient information appears in the case for SIIDC reviewers, I confirm that this has been submitted with the patient's consent and that a signed consent form according to PDPA guidelines has been obtained and is on file.

If an image of a physical finding is present (even if it is not identifiable), I confirm that the patient or their legal representative has signed a consent form for the image or images to be published for medical education, and that the consent form is on file.

Word Verification: