Matchmaking — USIDNET

You can use this form to describe a patient with a rare or undiagnosed immunodeficiency. Based on the information you provide, USIDNET will review the registry for similar cases and inform you of any potential internal matches.

Please do not include any protected health information (PHI).

Submitter Name

Submitter Information

First Name

Last Name

Institution/Affiliation

Submitter Information

Role (e.g., Attending Physician, Resident/Fellow, Researcher, Other)

Submitter Information

Interested In:

Suspected or Known Diagnosis

Case Information

Genetic Variants (if known)

Case Information

Major Clinical/Laboratory Findings (list 3 most important ones)

Case Information

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