The document provides details about conducting a family survey. The objectives are to familiarize students with community health concepts, understand environmental and family factors influencing health, and provide comprehensive healthcare to families. The survey collects general family information, child health records, assessments of the physical, biological and meteorological environment, nutritional status, health records of family members, schedules for eligible couples and antenatal cases. Comprehensive information is gathered to understand health issues facing the family and provide appropriate recommendations.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Clinico-social case format for diarrhoea, demographic details, chief complaint, history of presenting illness, treatment history, past history, brief antenatal history, birth historym postnatal history, developmental history, nutrition history, immunisation history, personal history, family history, socio-economic / psycho-social history, environmental history, KAP about the disease, general examination, systemic examination, local examiantion, investigations, summary and case management.
Health: “a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”.
Health is fundamental human right and nation has a responsibility for the health of its people.
The health problems of India may be conveniently listed under the following heads:
1. Communicable disease problems
2. Noncommunicable disease problems
2. Nutritional problems
3. Environmental sanitation problems
4. Medical care problems
5. Population problems
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
Clinico-social case format for diarrhoea, demographic details, chief complaint, history of presenting illness, treatment history, past history, brief antenatal history, birth historym postnatal history, developmental history, nutrition history, immunisation history, personal history, family history, socio-economic / psycho-social history, environmental history, KAP about the disease, general examination, systemic examination, local examiantion, investigations, summary and case management.
Health: “a state of complete physical, mental and social well being and not merely an absence of disease or infirmity”.
Health is fundamental human right and nation has a responsibility for the health of its people.
The health problems of India may be conveniently listed under the following heads:
1. Communicable disease problems
2. Noncommunicable disease problems
2. Nutritional problems
3. Environmental sanitation problems
4. Medical care problems
5. Population problems
A Rare topic of Community Medicine, also Rarely asked.
A follow would be much appreciated.
Contact if you find any mistake or you want to suggest topic for next upload.
Contact - sonechashyam10@gmail.com
-3rd Year Student, GMERS Medical College, Junagadh.
Publish Date - 28/11/2019
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
From the introduction of new diagnosing technique Gene Xpert , diagnosing & treating TB has been a lot easier. So Nepal Govt. has adapted few changes in past t/t. This slide consists of slides on new case as well as MDR t/t.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
A Rare topic of Community Medicine, also Rarely asked.
A follow would be much appreciated.
Contact if you find any mistake or you want to suggest topic for next upload.
Contact - sonechashyam10@gmail.com
-3rd Year Student, GMERS Medical College, Junagadh.
Publish Date - 28/11/2019
RMNCH+A approach has been launched in 2013 and it essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages.
The RMNCH+A appropriately directs the States to focus their efforts on the most vulnerable population and disadvantaged groups in the country. It also emphasizes on the need to reinforce efforts in those poor performing districts that have already been identified as the high focus districts.
From the introduction of new diagnosing technique Gene Xpert , diagnosing & treating TB has been a lot easier. So Nepal Govt. has adapted few changes in past t/t. This slide consists of slides on new case as well as MDR t/t.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
Planning sheet for the Classical ArgumentName______________.docxmattjtoni51554
Planning sheet for the Classical Argument
Name:_______________________________________________________Section:
Planning a Classical Argument:
1. Selected Topic (broad):
2. Narrowed Topic:
3. List Your General Underlying Assumptions About the Topic:
4. Describe your audience:
5. List their underlying assumptions they hold in common with you:
6. Describe your issue – the two sides of the argument:
7. State your claim – (your position and your reasons):
8. List your first reason:
9. List your underlying assumption for this reason:
10. List your second reason:
11. List your underlying assumption for this reason:
12. List your third reason:
13. List your underlying assumption for this reason:
14. Read and summarize your opposing argument.
15. Concede (admit and list) any strong and logical aspects of the opposing argument:
16. Identify the weak aspects of the opposing argument and refute (argue against them) in your essay.
17. Cite your three (3) sources and include a summary, evaluation and reflection on each source you will use in your Classical Argument essay.
(1) Citation: Pollan, Michael. “An Eater’s Manifesto.” In Defense of Food. Penguin, 2008, pp. 1-15.
(1) Summary:
(1) Evaluation
(1) Reflection:
(2) Citation:
(2) Summary:
(2) Evaluation
(2) Reflection:
(3) Citation:
(3) Summary:
(3) Evaluation
(3) Reflection:
18. Plan to use ONE of the following appeals in your essay. Decide if and where (within the context of your essay) you will use each appeal:
a. Pathos – (See p. 328)
b. Ethos – (See p. 327)
c. Logos – (See p. 48-50)
Food for thought
COVER STORY
It's possible to have a diet that is good for you and the planet. But would you want to eat it? Bob Holmes finds out
LOW fat, low salt, wholegrain, heart healthy, vegan, organic, free-range, grassfed, low carb, no added sugar. All these buzzwords, combined with shape-shifting guidelines, befuddling labels and fad diets wrapped up in pseudoscience, can make buying groceries these days fraught. That's partly why anything that claims to cut a clear path through the confusion has ready appeal: witness the rise of the "clean eating" movement in the past few years. The rigid rules set out by self-appointed blogger gurus have since been shouted down as nonsensical notions of purity rather than coherent nutritional science. But the clean eating evangelists found a following because they promised to simplify, to make decisions about food less overwhelming - and to provide a world view to match.
I may have avoided the nonsense peddled in the blogosphere, but, like many people, I find the current world of food bewildering at times. My goals are simple enough: I want to come home with the ingredients for tasty meals that will make my family healthier, without spending a fortune. And while I'm at it, I'd also like to minimise any harm I might cause to the environment and my fellow humans. That shouldn't be so hard, right?
I decided to take a close look at my f.
Composting in a Zero Carbon Footprint SystemReinbottt
This presentation gives an overview of composting and the project at the University of Missouri Bradford Research Center where food waste and horse bedding is being converted to compost to grow vegetables for Campus Dining and doing it all with a Zero Carbon Footprint
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...
Family survey
1. FAMILY SURVEYFAMILY SURVEY
OBJECTIVESOBJECTIVES
To familiarize with the concept of communityTo familiarize with the concept of community
medicine/community health.medicine/community health.
To know about the role of environmental hostTo know about the role of environmental host
factors in health and disease with specialfactors in health and disease with special
reference to family.reference to family.
To provide comprehensive health care to theseTo provide comprehensive health care to these
families under the supervision of departmentalfamilies under the supervision of departmental
staff.staff.
2. Main HeadingsMain Headings
1.1. General information including Family composition.General information including Family composition.
2.2. Child health record (Immunization status of all under five)Child health record (Immunization status of all under five)
3.3. Physical environment with special emphasis on –Physical environment with special emphasis on –
Housing Condition:Housing Condition:
Water supplyWater supply
Sewage disposalSewage disposal
Refuse disposal etc.Refuse disposal etc.
4.4. Biological environmentBiological environment
5.5. Meteorological environmentMeteorological environment
6.6. Nutritional/Dietary assessmentNutritional/Dietary assessment
7.7. Health status of Family member (Individual health record) withHealth status of Family member (Individual health record) with
personal hygiene.personal hygiene.
8.8. Schedule for Eligible couple with their contraceptive historySchedule for Eligible couple with their contraceptive history
9.9. Schedule for antenatal caseSchedule for antenatal case
Obstetric history with high risk approachObstetric history with high risk approach
History of previous pregnancyHistory of previous pregnancy
Obstetric examination progress of pregnancy)Obstetric examination progress of pregnancy)
Summary of family details and recommendationSummary of family details and recommendation
3. GENERAL INFORMATION SCHEDULEGENERAL INFORMATION SCHEDULE
a.a. Family no.:-………… b.Family no.:-………… b. House hold no.:-……….House hold no.:-……….
c.c. Name of the head of family:-………..Name of the head of family:-………..
d.d. Address:-………………………..Address:-………………………..
e.e. Religion:-……………. f. Caste:-………..Religion:-……………. f. Caste:-………..
g.g. Occupation of head:-……………Occupation of head:-……………
h.h. Type of family:-Single/Nuclear/JointType of family:-Single/Nuclear/Joint
i.i. Monthly income…………..Monthly income………….. Rs./monthRs./month
j.j. Per capita income…………Per capita income………… Rs /monthRs /month
k.k. Amount spent on food…….Amount spent on food……. Rs. /monthRs. /month
l.l. Amount spent on education…Amount spent on education… Rs./monthRs./month
m.m. Amount spent on housing…..Amount spent on housing….. Rs/monthRs/month
n.n. Spent on medical care………Spent on medical care……… Rs/monthRs/month
o.o. On clothingOn clothing ……………… Rs/monthRs/month
p.p. On otherOn other ……………… Rs/monthRs/month
q.q. Monthly savings……………..Monthly savings…………….. Rs/monthRs/month
4. GENERAL INFORMATION SCHEDULEGENERAL INFORMATION SCHEDULE
FAMILY COMPOSITION / INDIVIDUAL SCHEDULEFAMILY COMPOSITION / INDIVIDUAL SCHEDULE
S.No.S.No. 11 22 33 44 55 66 77 88
NameName
AgeAge
Sex M/FSex M/F
RelationRelation
With headWith head
EducationEducation
OccupationOccupation
IncomeIncome
Type of workType of work
(Sedentary/(Sedentary/
Moderate/Moderate/
Heavy)Heavy)
5. 2.2. CHILD HEALTH RECORDCHILD HEALTH RECORD
Name………. Dt. Of birth…. Sex….age….. father`s name………Name………. Dt. Of birth…. Sex….age….. father`s name………
Birth weight…….. Birth order……..Date of weaning……Birth weight…….. Birth order……..Date of weaning……
Ht.in Cms…….Congenital defect if any……….Ht.in Cms…….Congenital defect if any……….
Immunization statusImmunization status
VaccineVaccine ageage datedate
BCGBCG
DPTDPT I/II/IIII/II/III
OPVOPV O/I/II/IIIO/I/II/III
MeaslesMeasles
MMRMMR
Vit.A supplementationVit.A supplementation
Booster OPV/DPTBooster OPV/DPT I/III/II
Completely Immunized / Partially Immunized / UnimmunizedCompletely Immunized / Partially Immunized / Unimmunized
7. 3.3. PHYSICAL ENVIRONMENTPHYSICAL ENVIRONMENT
a.a. Locality – very congested / moderate / openLocality – very congested / moderate / open
b.b. Type of house – Pucca /semi Pucca/ katchaType of house – Pucca /semi Pucca/ katcha
- Roof- Roof - thatched/tiled/concrete………...- thatched/tiled/concrete………...
- Walls- Walls - mud/brick/stone……….- mud/brick/stone……….
- Floor- Floor - mud/ brick/concrete/…….- mud/ brick/concrete/…….
c.c. white washwhite wash - every year/occasional/…..- every year/occasional/…..
d.d. DampnessDampness - absent / present- absent / present
e.e. Number of rooms:…………..Number of rooms:…………..
-- Area of each room:1….2….3…Area of each room:1….2….3…
-- Total area of rooms…Sq. meter.Total area of rooms…Sq. meter.
-- Total area:……….per personTotal area:……….per person
f.f. No. of windows:…..Screened:- yes / noNo. of windows:…..Screened:- yes / no
g.g. Cross ventilations: present/ not presentCross ventilations: present/ not present
Cross ventilations present in…roomsCross ventilations present in…rooms
h.h. Ventilations:- adequate / not adequateVentilations:- adequate / not adequate
Adequate only in……….roomsAdequate only in……….rooms
Door window to floor space ration………Door window to floor space ration………
8. 3.3. PHYSICAL ENVIRONMENTPHYSICAL ENVIRONMENT
i.i. Lightings:- adequate/ not adequateLightings:- adequate/ not adequate
j.j. Kitchen: separate / not separateKitchen: separate / not separate
k.k. Chula (fuel): smoky / smokelessChula (fuel): smoky / smokeless
l.l. Drainage: - adequate / not adequateDrainage: - adequate / not adequate
m.m. Bath room (private): - present / not presentBath room (private): - present / not present
n.n. Water supply (drinking):-Water supply (drinking):-
Source-Source- open well Kutcha or pucca / sanitary well / hand pump / tank /open well Kutcha or pucca / sanitary well / hand pump / tank /
piped.piped.
Source present in houseSource present in house – yes / no.– yes / no.
If no………If no……… meter away from housemeter away from house
Quantity –Quantity – adequate / not adequateadequate / not adequate
Approximately……Approximately…… liters/personliters/person
Storage –Storage – sanitary / not sanitarysanitary / not sanitary
o. Refuge disposalo. Refuge disposal -indiscriminate / burning / dumping /-indiscriminate / burning / dumping /
compostingcomposting
p. Disposal of night soilp. Disposal of night soil - septic tank / service privy / open- septic tank / service privy / open
field/otherfield/other
9. 4.4. BIOLOGICAL ENVIRONMENTBIOLOGICAL ENVIRONMENT
a.a. Animal – Present/Not;Animal – Present/Not;
Type of animal…….Type of animal…….
Animal keepingAnimal keeping -- present/absentpresent/absent
Separate/attachedSeparate/attached
b.b. Breeding place of house fly / mosquito inBreeding place of house fly / mosquito in
the compound – present / absentthe compound – present / absent
c.c. Rodent – present / absentRodent – present / absent
10. 5.5. METEOROLOGICAL ENVIRONMENTMETEOROLOGICAL ENVIRONMENT
High temperatureHigh temperature
II Local effects:Local effects:
-Darkening of skin, prickly heat, sun burn, dermatitis-Darkening of skin, prickly heat, sun burn, dermatitis
IIII General effects:General effects:
- Heat stroke- Heat stroke
- Heat exhaustion- Heat exhaustion
- Heat cramps- Heat cramps
Low temp. or cold climateLow temp. or cold climate
- Frost bite, Trench foot- Frost bite, Trench foot
- Cold, bronchitis, pneumonia etc.- Cold, bronchitis, pneumonia etc.
HumidityHumidity
- It makes the warm climate warmer and- It makes the warm climate warmer and
- cold climate colder- cold climate colder
Movement of airMovement of air
11. 6.6. NUTRITIONAL / DIETARY SURVEYNUTRITIONAL / DIETARY SURVEY
Intake of Food in gramsIntake of Food in grams
Food ItemsFood Items Weekly/Weekly/ Total dailyTotal daily Protein(gm)Protein(gm) Calorie cal)Calorie cal)
averageaverage averageaverage
Cereals – Rice / Wheat / othersCereals – Rice / Wheat / others
PulsePulse 1./ 2./ 3.1./ 2./ 3.
Roots & TuberRoots & Tuber
Leafy vegetablesLeafy vegetables
MilkMilk
Meat, fishMeat, fish
EggEgg
Sugar & jeggarySugar & jeggary
Oil & GheeOil & Ghee
FruitsFruits
MiscellaneousMiscellaneous
a.a. Food habits – Vegetarian / non-vegetarian(regular/occasionalFood habits – Vegetarian / non-vegetarian(regular/occasional
b.b. Total no. of consumption unit………Total no. of consumption unit………
c.c. Daily Protein Consumption…Daily Protein Consumption…
d.d. Daily Calories Consumption…Daily Calories Consumption…
e.e. Per Consumption unit protein used…Per Consumption unit protein used…
f.f. Per consumption unit Calories used…Per consumption unit Calories used…
g.g. Protein excess / deficient…gm/ Consumption/dayProtein excess / deficient…gm/ Consumption/day
h.h. Calories excess / deficient….K. cal /Consumption unit / dayCalories excess / deficient….K. cal /Consumption unit / day
12. 6. Health Status of Family Member6. Health Status of Family Member
(Individual Health Record)(Individual Health Record)
Name…..Age….Sex…..Occupation……Name…..Age….Sex…..Occupation……
H/O of Past illness / Injuries if any……H/O of Past illness / Injuries if any……
Present complaint if any………Present complaint if any………
H/O of Present illness……….H/O of Present illness……….
Personal history – addiction/diet/hobbiesPersonal history – addiction/diet/hobbies
Weight…..Wt….Temp…. Skin & Hair…….Patches…..Weight…..Wt….Temp…. Skin & Hair…….Patches…..
ENT & mouth : (tonsils), oral hygieneENT & mouth : (tonsils), oral hygiene
Eye conditionsEye conditions
CVS: Heart, blood vessels, B.P.CVS: Heart, blood vessels, B.P.
Respiratory (chest):Respiratory (chest):
Alimentary (Abdomen):Alimentary (Abdomen):
Lymph glandsLymph glands
CNS examinationCNS examination
Positive findings of nutritional deficiency disease if any.Positive findings of nutritional deficiency disease if any.
Laboratory examinationLaboratory examination
13. 6. Health Status of Family Member6. Health Status of Family Member General ExaminationGeneral Examination
Chest circumferenceChest circumference………Mid upper arm circumference………Mid upper arm circumference
General appearanceGeneral appearance – Normal/Thin/Sickly/fatty– Normal/Thin/Sickly/fatty
Hair sign-Hair sign- Normal/dull & dry/ Dyspigmentation/Sparse/ easily plukable/flagNormal/dull & dry/ Dyspigmentation/Sparse/ easily plukable/flag
Eyes-Eyes- - Conjunctiva – normal/dry on exposure/ dry & wrinkled/ bittot`s spot/ angular- Conjunctiva – normal/dry on exposure/ dry & wrinkled/ bittot`s spot/ angular
conjunctivitis / pale conjunctivaconjunctivitis / pale conjunctiva
- Cornea- Cornea - Normal/dry / hazy or opaque- Normal/dry / hazy or opaque
LipsLips- Normal/ angular stomatitis / cheilosis- Normal/ angular stomatitis / cheilosis
TongueTongue - Normal/ pale and flabby/ red & raw / fissured/ geographic- Normal/ pale and flabby/ red & raw / fissured/ geographic
GumGum - Normal/ bleeding- Normal/ bleeding
GlandsGlands - Normal/enlargement ( name)- Normal/enlargement ( name)
SkinSkin - Normal / dry and scaly / Follicular hyperkeratosis- Normal / dry and scaly / Follicular hyperkeratosis
NailsNails - Normal / koilonychias / pale- Normal / koilonychias / pale
OedemaOedema - Absent / present on dependent part- Absent / present on dependent part
RachiticRachitic - Knock-knee or bow leg/ Epiphyseal enlargement/Beading of changes- Knock-knee or bow leg/ Epiphyseal enlargement/Beading of changes rib/rib/
Pigeon chest/ nonePigeon chest/ none
AbdominalAbdominal .- Hepatomegaly / Splenomegaly.- Hepatomegaly / Splenomegaly / other…/ other…
CVSCVS - Cardiac enlargement / tachycardia / others…- Cardiac enlargement / tachycardia / others…
OthersOthers - Psychomotor changes / mental confusion / sensory loss / motor weakness /- Psychomotor changes / mental confusion / sensory loss / motor weakness /
loss of position sense / loss of vibration sense / loss of ankle & Knee jerks /loss of position sense / loss of vibration sense / loss of ankle & Knee jerks /
calf tendernesscalf tenderness
Any other abnormalityAny other abnormality………….………….
14. 6. Health Status of Family Member6. Health Status of Family Member Personal HygienePersonal Hygiene
S. No.S. No. 11 22 33 44 55
Name….Name….
Skin Clean Y/NSkin Clean Y/N
Nail cutNail cut Y/NY/N
Hair LouseHair Louse Y/NY/N
Hair cleanHair clean Y/NY/N
BathBath daily / irregulardaily / irregular
Use of soap Y/NUse of soap Y/N
TowelTowel Separate/mixedSeparate/mixed
Oral HygieneOral Hygiene Good/poorGood/poor
Foot wearFoot wear Y/NY/N
ExerciseExercise Y/NY/N
15. 7. Schedule for Eligible Couple7. Schedule for Eligible Couple
Name of Wife……………………………….Age…Name of Wife……………………………….Age…
Name of Husband………………………….AgeName of Husband………………………….Age
Obstetric HistoryObstetric History
Date of Marriage…………Para……….Gravida……….Date of Marriage…………Para……….Gravida……….
Age at first delivery……Age at last delivery……..Age at first delivery……Age at last delivery……..
Total no. of abortion………….Total no. of abortion………….
Total no. of living children – male / femaleTotal no. of living children – male / female
Additional children wanted….Additional children wanted….
Gynecological HistoryGynecological History
LMP….Menarche….yrs Cycle…..daysLMP….Menarche….yrs Cycle…..days
Dysmenorrhoea – Y/N (if yes take detail H.)Dysmenorrhoea – Y/N (if yes take detail H.)
Vaginal discharge – Y/N (if Y take detail H.)Vaginal discharge – Y/N (if Y take detail H.)
Previous Pelvic infection – Y/NPrevious Pelvic infection – Y/N
16. 7. Schedule for Eligible Couple7. Schedule for Eligible Couple
Contraceptive historyContraceptive history
Practicing Currently – none/condom/IUD/OP/Practicing Currently – none/condom/IUD/OP/
Sterilization (M/F)/other...Sterilization (M/F)/other...
Ever practiced – none/ condom/IUD/OP/ other...Ever practiced – none/ condom/IUD/OP/ other...
If ever practiced reason for discontinuity….If ever practiced reason for discontinuity….
Reason for family planning:Reason for family planning:
Limitation/spacing/undecided/other….Limitation/spacing/undecided/other….
Type of coupleType of couple: eligible/target: eligible/target
17. 8.8. SCHEDULE FOR ANTENATAL CASESCHEDULE FOR ANTENATAL CASE
Name…………….Age………Name of husband……..Age……Name…………….Age………Name of husband……..Age……
Obstetric historyObstetric history
Amenorrhoea……wkAmenorrhoea……wk Date of marriage…………Para…..Gravida……Date of marriage…………Para…..Gravida……
Age at first pregnancy / delivery………….Age at first pregnancy / delivery………….
Age at last pregnancy / delivery…………..Age at last pregnancy / delivery…………..
Total n. of abortion………..Total n. of abortion………..
Total no. of living children Male……….female………Total no. of living children Male……….female………
Additional children wanted………. Give reason…………….Additional children wanted………. Give reason…………….
LMP………….EDD………..LMP………….EDD………..
Immunization – TTImmunization – TT I dose date…II dose date…I dose date…II dose date…
Additional nourishment Y/NAdditional nourishment Y/N
ComplaintComplaint Y/NY/N
18. 8.8. SCHEDULE FOR ANTENATAL CASESCHEDULE FOR ANTENATAL CASE
Obstetric examination progress of pregnancy)Obstetric examination progress of pregnancy)
Date………Date………
Height of fundus……. Foetal heart sound…..Height of fundus……. Foetal heart sound…..
Position presentation…..Position presentation…..
Foetal head:- floating / engagedFoetal head:- floating / engaged
Weight…. BP….. Hb%…..Weight…. BP….. Hb%…..
Urine:-Urine:- Albumin…… Sugar……Albumin…… Sugar……
Oedema:-Oedema:- absent / presentabsent / present
Blood group:-…..Blood group:-…..
VDRLVDRL +ve / -ve+ve / -ve
19. History of Previous PregnancyHistory of Previous Pregnancy
Pregnancy no.Pregnancy no. 1/2/3/…1/2/3/…
Date of delivery:……….Date of delivery:……….
Antenatal careAntenatal care Y/NY/N
Antenatal care byAntenatal care by Doctor/LHV/ANM/TBA/untrained daiDoctor/LHV/ANM/TBA/untrained dai
Place of deliveryPlace of delivery Home/hospitalHome/hospital
Attended byAttended by
Doctor/LHV/ANM/TBA/untrained daiDoctor/LHV/ANM/TBA/untrained dai
Result of birth – full term/pre-mature/still birthResult of birth – full term/pre-mature/still birth
AbortionAbortion
Birth weight….Birth weight….
Any complication ……..Any complication ……..
8.8. SCHEDULE FOR ANTENATAL CASESCHEDULE FOR ANTENATAL CASE
20. 9. SUMMARY AND RECOMMENDATION9. SUMMARY AND RECOMMENDATION
a.a. Summary of the health need of the familySummary of the health need of the family
Physical:Physical:
Environmental:Environmental:
Meteorological:Meteorological:
Mental:Mental:
Socio Economic:Socio Economic:
Behaviour:Behaviour:
Disorder:Disorder:
b.b. Summary of the health status of familySummary of the health status of family
c.c. Summary of nutritional status of familySummary of nutritional status of family
d.d. Recommendation for improving the Socio-Recommendation for improving the Socio-
economic, environmental, and health status ofeconomic, environmental, and health status of
familyfamily