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Culture Documents
Infant 2
Infant 2
Infant 2
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-
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-
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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