Infant 2

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Name: -
2. Age:-
3. Name of Father:-
4. Address:-
5. Religion:-
6.Feeding pattern:- Breast feeding (Yes/No)
7. Growth and Development:-

 Weight-
 Head circumference-
 Chest circumference-
 Mid-arm circumference-
 Height-

Milestone Age Remarks


Holding hand
Sitting
crawling
Standing
Walking
Walking up stairs
Development speech
Bladder control
Bowel control

8. Immunization status:-
PENTA POLIO Measles JE
HEP IPV IPV DPT TT
BCG Vit
-B I II Booster Booster
I II III O I II III BD I II I II -A
Physical Examination:-

 Temperature-

 Respiration-

 Pulse-

 BP-

Anterior Fontanelle:- Open/Close

Posterior Fontanelle:- Open/Close

Scalp:- Healthy/Lice/Dandruff

Hair:- Normal/Thin/Radish

Ear:- Normal/Discharge

Nose:- Normal/Discharge

Face:- Normal/Oedema

Lip:- Normal/Dry/Cracked/Stomatitis

Tongue:- Normal/Dry/Glossitis

Throat:- Normal/Patchy

Teeth:- Normal/Carries/Denture

Gum:- Healthy/Bleeding/Spongy

Neck:- Normal/Prominent/Swollen

Skin:- Healthy/Dry/Rash/Pallor

Muscles:- Normal/Abnormal

Finger:- Normal/Deformity
Infancy deformity (specify): - Nil
Past H/O illness (specify): - Nil

Advice: -

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Signature of sister tutor Signature of student

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