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