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 )
