Medicalproforma
2
Medical Facilities Evaluation Proforma Name of School Session & Classes Doctor Name Date of appointment Visiting Hours Nurse Name Date of appointment Visiting Hours Medical Room equipment- Item No. Item No. Item No. Item No. Table Washbasin Wheel Chair Water bottle Chair First aid Box Stretche r Disposable Glasses/sp oons Bed Refrigera tor BP Instrume nt Hand Towel Weighi ng Scale Examinati on Table Fire Extingui sher Match Box Height Scale Thermomet er Umbrella Thread/ Needle Medical Record Medica l cards Regist er Studen t Diary Repor t card Medical Check up done for classes- First Round Second Round No. of Students referred to specialist- First Aid Diet Epilepsy Eye Dengue Orthopedi c Ear Polio Cardiac Dental Diabetic Children
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Transcript of Medicalproforma
Medical Facilities Evaluation Proforma
Name of School
Session & Classes
Doctor Name
Date of appointment
Visiting Hours
Nurse Name
Date ofappointment
Visiting Hours
Medical Room equipment-Item No. Item No. Item No. Item No.Table Washbasin Wheel Chair Water bottleChair First aid Box Stretcher Disposable
Glasses/spoonsBed Refrigerator BP
InstrumentHand Towel
WeighingScale
Examination Table
Fire Extinguisher
Match Box
Height Scale
Thermometer Umbrella Thread/Needle
Medical Record Medical cards
Register Student Diary
Report card
Medical Check up done for classes-First Round Second Round
No. of Students referred to specialist-First Aid Diet EpilepsyEye Dengue OrthopedicEar Polio CardiacDental Diabetic Children with
special needPhysician Asthma Other
Tie up with nearest Hospital12
Follow up of students referred to specialist-
Any other info
