Jawahar Bala Aarogya Raksha School Health 2013 Children Holistic Improvement programe(CHIP)-2013

Name of the District:_________________ Name of the CHNC/Contact N0________________ Name of the School/ Address:

level:School Name of the PHC/UHC/Contact No::

Category:PS/UPS/HS/Colleges Name of the Mandal/MEO Contact No:

Date of visit /Screened:

Classes/PS(1st -5th) : Enrolled: Boys: Girls: Total: Attended: Boys: Girls: Total:
No.of students Treated Boys Girls Total DISEASE DERMATOLOGY No. of students Reffered

Classes/UPS(1st to 7th/8th) Enrolled : Classes/HS(6th to 10th/12th) : Boys: Girls: Total: Enrolled: Boys: Girls: Total: Attended: Boys: Girls: Total: Attended: Boys: Girls: Total:
No.of students Treated Total No. of students Reffered Boys Girls Total No.of students Treated Boys Girls No. of students Reffered Total

Code

Morbidity

Boys Girls Total Boys Girls

Total Boys Girls

D1
D2 D3 D4 D5

pyodermat
Scabies Ringworm Leprosy Pediculosis OPHTHOLOMOLOGY

O1 Xeroptholomology O2 Bitot spots

O3 O4 O5 O6 O7 O8 O9 OR1 Conjuctivitis Refractive errors stye Squint Congenital anomalies Night blidness Others-Specify

ORO Dental
Dental Carries Oral OR2 Ulcers,glossitis,chelitics,an gular Stomatitis OR3 Cleft Lip OR4 Cleft Palate OR5 Pyorrhoea Otorhinolaryngology (ENT) & Dentistry OTI Tonsillitis OT2 Defective Hearing OT3 Speech defects OT4 Otitis media OT5 Others-Specify RESPIRATORY SYSTEM R1 ARI Chronic Respiratory R2 infections R3 Tuberculosis R4 R5 Bronchial Asthma others(Infections)

CARDIOVASCULAR SYSTEM CV1 CV2 CV3 NS1 NS2 NS3 NS4 NS5 NS6 NS7 Rheumatic heart disease Congenital heart disease Others-Specify Nervous system Epilepsy Locomotor disability Neural disability Mental disability

Learning disorder Behaviour problem

Physical disability Any other disability, NS8 specify Gastro Intestinal System GS1 Diarrhoea/constipation

GS2 Worm Infestations GS3 Dysentery GS4 Others-Specify Non communicable diseases NCD1 Hypertension NCD2 Diabetis NCD3 Thyroid NCD4 Hernia Any other known NCD5 disaeases Nutritional disorders ND1 Anaemia ND2 Under nutrition ND3 Under Weight(BMI) ND4 Over weight(BMI) ND5 obesity Any other deficiencies, ND6 specify Any other congenital anomalies

CA1 CA2

CA3 PREVENTIVE MEDICATION PM1 DPT (5yrs) PM2 TT(10 Yrs) PM3 TT(15 Yrs) PM4 Deworming 1st dose PM5 Deworming 2nd dose PM6 IFA Consumed PM7 Vit A Children Administered on PM8 the spot Medical attention

Any other Any other Any other

Treatment
T1 T2 T3 Spectacles Distributed Aids and Applainces Distributed Weight measurment Height Measurment

T4
A1 A2 A3 A4 A5 A6 A7 A8 A9 A10 A11

Activities & Status

No. of school having Aarogya Club Formed No.of Referral Students Followed up Toilets with water SH Coordinators No.of SHER Cards updated

No.of schools:

Number referred________

NO.of chinnari Boys______ Doctors_______ No.of surgeries_______ For Girls________________

Girls_____________ No. treated:----------------

For Boys____________ Name of the SHC(H) /Contact No : Boys____________

Common toilets__________

Name of the SHC Edun /Contact No: : Girls________________ Total_________

Whether JBAR Name Painted on wall or Not?

Whether Health Education is conducted during SMC&PTA, School health day/School referral day
Date of Mandal level Health review Meeting attended by HM Date of Medical team last visit. JBAR hand book and JBAR Karadeepika available or not Name ,Designation and Contact N0.of the Nodel Teachers Signature/(HM) & Seal: Signature/(MO)& Seal: