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CoRDS Screening Form

Introduction

Please answer a few questions to help us create your participant account.
If you have any questions, please contact cords@sanfordhealth.org or 1 (877) 658-9192.

Participant Type

Participant Information

Please provide your basic information.

Please provide your child’s basic information.

Please provide the participant’s basic information.

Red asterisk (*) indicates a required field.

I have a middle name

Uncheck this box if you do not have a middle name

Legal Given name of the participant at birth(as per birth certificate).

DO NOT INCLUDE STATE or COUNTRY

Parent/Guardian/LAR Information

As the participant's LAR, you will be our primary contact. Please provide your own information in this section.

As the participant's Parent/Guardian, you will be our primary contact. Please provide your own information in this section.

Diagnosis

Use the arrows to add or remove the participant’s diagnosis from the “Selected Diseases” section. If you are not diagnosed with a rare disease, please search for Undiagnosed or Unaffected Carrier (along with a rare disease) if applicable to the participant. If you cannot find your disease search for Other and add your diagnosis.

Other Information

Continue
Are you sure Parent/LAR information is the same as Participant?
Your session will be terminated within a few seconds and you may lose unsaved data.
Press OK to avoid termination.