Annexure-1 - Micro Action Plan Fro Anganwadi Children Screening

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Annexure-1 -Micro Action Plan fro Angan

Name of the Medical Officer- Contact Number of the MO

Name of the Habitation Name and Number of the


S.No PHC /UPHC Name Anganwadi centre Name Institution Code
/Village Secretariat

1
Plan fro Anganwadi children screening

Total AWW Name and ANM Name and ASHA Name and
Boys Girls Date of screening by M.O
Children contact number Mobile number Mobile number
Annexure-2 -Referral childr

Name of the Medical Officer- Contact Number of the MO

Name of the Name and Number Anganwadi centre


S.No PHC /UPHC Name Institution Code Name of the child Gender Age
Habitation /Village of the Secretariat Name
ral children particulars

In case child referral,


Date of screening by Whether treated at Referred to centre name- Contact Number of the
30D identified Follow up Remarks
M.O PHC/UPHC CHC/DH/AH/SNCU/ child/Parent
NRC/DEIC
Annexure-3 -Weekly AWC Screening Reporting Format
Name of the Medical Officer- Contact Number of the MO

Name of the PHC/UPHC

Anganwadi Centres Children Strength Screened Treated Referred


Sl.No
Total no of AWCs Screened Balance Boys Girls Total Boys Girls Total Boys Girls Total Boys Girls Total

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