FORM ‘A’: FORM FOR RECORDING THE RESULT OF MEDICAL EXAMINATION OF CHILDREN ATTENDING CRECHES
Date, Month and Year of Examination
Sl. No. | Name of Child | Age (date of birth, if available) | Mother’s name and occupation | Weight of child on the date of last examination | Weight on the date of examination | Disease or abnormality found, if any | Treatment suggested, if any | Remarks |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
‘ | ‘ | ‘ | ‘ | ‘ | ‘ | ‘ | ‘ | ‘ |
( Signature of the qualified medical practitioner )