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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 )



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