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Contact Labour (Regulation and Abolition) Act, 1970

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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