Professional Documents
Culture Documents
7 Case Study Proforma
7 Case Study Proforma
3. Medical History
ii._____________________________________________________
iii. ____________________________________________________
iv. ____________________________________________________
v. _____________________________________________________
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4. Family Background
A. Parent's Information
Father's Name:____________________________ Mother's Name:_________________________
Occupation:_______________________________ Occupation:_____________________________
Education:________________________________ Education:______________________________
Address:________________________________________________________________________________
B. Total Monthly income of the Family (In INR):______________________________________________
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5. Pre- Natal Background
Cause__________________________________
Disease Name_________________________________
Type of Disorder_______________________________
I. Any Other Cause ________________________________________________
Cause________________________________
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C. Malnutrition Yes No Unknown
Cause________________________________
9. Level of Skills
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H. Subject knowledge
B. Cause of Non- Participation Poor Sports Environment Low peer group interaction