Wicanja Health

Chronic Condition Registration

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1 — Member

Identity Number

Enter the member's full 13-digit identity number.

2 — Chronic Condition

Condition *

ICD-10 Code (optional)

3 — Referring Doctor

Doctor / Practice Name *

Practice Number *

Doctor Email (optional — for decision notifications)

Diagnosis Notes

4 — Supporting Documents (optional)

Attach blood test results, specialist letters, or any other documentation to support this registration. Accepted formats: PDF, JPG, PNG. Max 10 MB per file.

Click to browse or drag & drop files here

PDF, JPG, PNG — up to 10 MB each