Family 1

General
information

1 Name of place : Bagaluru

2 Name of PHC: Bagaluru PHC
3 Taluk: Bangalore North
4 Head of family: Rahul K
5 BPL/APL: BPL
6 Family members: Male : 2. Female 1
7 Adults: 1. Adult 1
8 Children 1. Children 0
 Particulars of individual of family

Relations
sl.no Name to Head of DOB Age Sex Education Occupation
Family
1 Rahul K Head of the family 24/06/1986 38 years Male PUC Farmer

2 Mahalakshmi K Wife 3/08/1990 34 years Female SSLC House wife

3 Mohan K Son 19/01/2020 4 years Make

Health status

Acute illness Chronic illness

Sl. No. Name BP
(fever, ( TB, DM,
Cough,cold ) Cancer )
Rahul K No No 118/80

Mahalakshmi K No No 110/70

Mohan K No No
 Out come
Name of No. Of No of of Current
Family welfare & maternal health
Sl no.
eligible
Age
living times Pregnancy Pregnancy
Couple Children Pregnant LB SB. D A.B

Rahul K 38 years 1

Mahalakshmi K 34 years 1 1 1 0
 Clinical health of child ( 0-5 years )

Sl .no . Name of child DOB Sex Birth weight Mile stone Immunisation

1 Mohan K 18/1/2020 Male 2.6 kg Attained till date Up to date

Vital events ( dating last one year )

Birth OUT COME NO . OF CAUSE

DEATH SEX AGE OF MARRIAGE
LBM LBF SBM SBF ABORTION DEATH

0 0 0 0 0 0