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Cummulative Health Record

This document contains a cumulative health record for a student including sections on family health history, personal health history, immunizations, annual medical examinations, laboratory findings, monthly weight records, and a summary of treatment. The record tracks illnesses, allergies, physical disabilities, eye health, menstruation history, immunizations, examination findings over multiple years of study, laboratory tests, monthly weight, and outpatient and inpatient medical treatments received. It provides a comprehensive longitudinal health profile of the student over the course of their education program.

Uploaded by

Annie Priscilla
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
90 views

Cummulative Health Record

This document contains a cumulative health record for a student including sections on family health history, personal health history, immunizations, annual medical examinations, laboratory findings, monthly weight records, and a summary of treatment. The record tracks illnesses, allergies, physical disabilities, eye health, menstruation history, immunizations, examination findings over multiple years of study, laboratory tests, monthly weight, and outpatient and inpatient medical treatments received. It provides a comprehensive longitudinal health profile of the student over the course of their education program.

Uploaded by

Annie Priscilla
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CUMMULATIVE HEALTH RECORD:-

Name . Sex .. Date of Admission ..

Address ..
..

Date of Birth ..Programme of study

A FAMILY HEALTH RECORD:-

Family Member

Father

Age

Disease in the family


(Diabetes, Hypertension,
Heart disease, Mental
Disease, Epilepsy, TB
Leprosy, etc.)

Mother
Brother
sister specify

B PERSONAL HEALTH RECORD:-

Illness during childhood (0-12 yrs) or any defect:

Subsequent illness (After 12 yrs.):

Physical disability
Cause

4 Allergy:
A. Type of reaction :
B. Cause of allergy :
(Drug, food, cosmetics, dust-specify.
Mention seriousness of reaction)

If any one dead

Date,
Cause of death

Use of Spectacles (Specify eye defect and starting age of use of spectacle)

6
A. Age of menarche
B. Duration of periods
C. Any dysmenorrhea

C.
Date
I Dose

IMMUNISATION:Date
II Dose

Date
III Dose

Booster Does
Date
Date

Date

Date

BCG
Hepatitis B
Tetanus Toxoid
Chicken Pox

D. ANNUAL MEDICAL EXAMINATIONS:I Year

II Year

III Year

Height and weight


Nutritional Status
Eye
ENT
Teeth
Thyroid
Lymph Nodes
Cardio Vascular System
Respiratory System
Gastro Intestinal System
Urinary System
Skeletal System
Nervous System
Skin
Pulse rate
Blood pressure
Posture
Others
Remarks
Doctors Signature
E .LABORATORY FINDINGS (Date and Result):-

Internship

Blood
Urine
Stool
X-Ray

F. MONTHLY WEIGHT RECORDS:-

Year

Year

Year

Sept.

Oct.

Nov.

Dec.

May

Jun

Jul.

Aug.

Sept.

Oct.

Nov.

Dec.

May

Jun

Jul.

Aug.

Sept.

Oct.

Nov.

Dec.

Jan.

Feb.

Mar.

Apr.

Jan.

Feb.

Mar.

Apr.

Jan.

Feb.

Mar.

Apr.

Year

May

Jun

Jul.

Aug.

Sept.

Oct.

Nov.

Dec.

May

Jun

Jul.

Aug.

Jan.

Feb.

Mar.

Apr.

G. SUMMARY OF OUTPATIENT AND INPATIENT TREATMENT:-

Date
Ist Year
IInd Year
IIIrd Year
IVth Year

Treatment & Remarks

Date

Treatment & Remarks

including
Internshi
p

Signature :

Date :

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