[Report 1963] / School Medical Officer of Health, West Suffolk County Council.

  • West Suffolk (England). County Council.
Date:
1963
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1963] / School Medical Officer of Health, West Suffolk County Council. Source: Wellcome Collection.

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    FORM H,MS;Y2 HEALTH VISiTiNG (0-5 years) NAME.M/F. Date of Birth (Surname first) ADDRESSES Family Doctor. (1) (2) (3) If “AT RISK’* state why OTHER PHYSICAL and MENTAL DEFECTS SUMMARY 0-5 years VACCINATIONS Date PROGRESS Age (months) Smallpox. Diphtheria. Tetanus. Whooping Cough. Poliomyelitis. 1st tooth. 16 teeth. Sat up. Talked . Walked. Clean Habits PHENYLKETONURIA ILLNESS Date Date of Test. RESULT. Living Rooms. People over 12 Water. Ventilation. Remarks. HOUSE at address (I).(date) .Bed Rooms. People under 12 M F Sanitation. . Cleanliness for notes re address (2) see overleaf (date) FAMILY on.(date) FATHER. Age. Occupation General Health. MOTHER. Age. Occupation General Health. f M. Ages of Children. Alive ^ Died /age&\ I F. Vcause/ Stillbirths, misc., etc.. OTHER RELATIVES (relevant illnesses or defects)