Sam Children

Child ID :

Child Details

Insert Child Record

Select Process Type:

Coupon Not Required

*Current Height:

*Current Weight:

*Current MUAC:

*OEDEMA:

Remarks on OEDEMA:

Exceeding 200 characters

Lactation Failure:

YesNo

Remarks on Lact:

Visible Wasting:

YesNo

Inpatient Date:

*Discharge Date:

Discharge Before 12 pm

Discharge Reason:

*Next Followup Date:

*District:

*Block:

*FPS Selection:

Government of West Bengal

WB Health Department

NRC,Discharge Certificate

Nutrition Rehabilitation Centre :

Registration No : SAM No :

Name Of the Child :

Father's Name : Mother's Name :

Caste : Age : Sex : Address

Tehsil/Block/Municipality : District :

Date Of Admission : Date Of Discharge :

Admission Time : Weight : MUAC : Length

W/L : --------------------------------- Remark(s) :

Discharge Time : Weight : MUAC : Length :

W/L : --------------------------------- Remark(s) :

Prescribed Treatment

Prescribed Diet

   Multi Vitamin Drops :

   Folic Acid :

   Iron :

   Other :

What to feed(include recipes if needed)
--------------------------------------------------------
---------------------------------------------------------
--------------------------------------------------------
How much and how often ?---------------
--------------------------------------------------------
--------------------------------------------------------
---------------------------------------------------------

OPD Card For Severe Acute Malnourished Children
Reg. No	Date
Referred By	Block	AWC	SubCenter
Reason for Referral MUAC(cm)	W/A :	or Oedema Y/N :
Patient Name :
Gurdian Name :
Date of Birth	Age in Month		Sex:M/F
Address
Breast Feeding:Y/N	Complementary Feeding: Y/N	Type
Major Problem:
Immunization Card:Y/N	Update Immunization:Y/N
Vitamin A-Bring child for a dose in every six months		Immunization Given

Next Dose Vitamin-A		Record for Doses Received
Date	Place	Date	Place

FOLLOW-UP Card
SAM No	Name of the Child
Father's Name

	Follow up-1	Follow up-2	Follow up-3	Follow up-4
Date
Weight(kg)
Length(cm)
W/L
MUAC(cm)
Remarks

Sign of Doctor
Sign of Nutrition Counselor


Prescribed Medicine(s):

Prescribed Diet:

This website is designed and developed by National Informatics Centre ,Government of India.

All information used in this website is provided by Health Department, Govt, of West Bengal