List of Schools Under School Health Programm
Sun Rise Public School  Loni Ghaziabad U.P.
Gread Delhi Public School Khajoori Khas Delhi
Brite Way School   Loni
Josoph & Marry School Loni
St. Jhons School  Loni
Shaeed Bhagat Singh School Loni
D.K. International School  Loni
D.K. Moderl School Loni
Saraswati Girls School Loni
Little Star Public School Loni
Jyoti Vidhya Mandir  Loni
Ring Bell Public School Loni
Prakash Memorial  Public School Loni
Sakshi  Public School Loni
V.D.H.L. Public School Loni
Prahlad Model Public School   Loni
Priya Darshni Public  School Loni
David Maden Secandary School Loni
Pushpanjali  Modern Public School Loni
Akhtar Memorial Public  School Loni
Lav Prakash Public School Loni
Sunbean Public School                                   Delhi
Lakhpet Memorial Public School                     Delhi
R.P. Model Public School                             Delhi
Vivek Bharth Public School                                Delhi
B.A.V Public School                                             Delhi
Shubham Modern Public School                      Delhi
Sandhaya Public School                                     Delhi
New Orital ModenPublic School                      Delhi
Inderpertha Public School                                Delhi
Sunder Public School                                          Delhi
Shiealik Public School                                        Delhi
Gyandeep Vidhya Bhawan Sec. School          Delhi
Nav jeevan Adaresh Public School                 Delhi
Happy Time Public School                                Delhi
Vidhaya deep Public School                             Delhi
R.S. Public School Delhi
S.D.Public School                             Delhi
Holy Home Public School                            Delhi
R.D. Morden Public School                             Delhi
Kapil Vidhya Mandir          Delhi

As Per Planning of:
School Health Scheme :
School Health Scheme : Directorate of Health Services
Govt. of National Capital Territory of Delhi

Medicare Educare & Social Welfare Services Society
(Regd. Under Society Act XXI 1860)

PANNEL

 
 

CUMULATIVE HEALTH RECORD
Name of Child ..................................................... Sex ......................................................... Age .........................................................
Name of the Parent ..................................................... Income .....................................................
Residential Address ............................................................................................................ Telephone .........................................................
Name & Address of the School ........................................................................................................................................................................


URI            
RES            
PHY            
ORT            
NUT            
NUE            
HEP            
HEM            
GIT            
GEN            
EYE            
ENT            
DER            
DEN            
CVS            
CLASS ROLL NO.            
YEAR CARD NO.            
 

Immunization
1. B.C.G. Veccination ..................................................... Triple Immunization .........................................................
  Polio ...........................................................Measles ............................................................................................
2. Family History
3. Past history of illness of the child :
  Tonsillitis ................................................................. Typhoid Fever ....................................................................
  Whooping cough ..................................................... Malaria ...............................................................................
  Diphtheria ............................................................... Tuberculosis........................................................................
  Mumps .................................................................... Jaundice .............................................................................
  Measles ................................................................... Scabies ...............................................................................
  Chicken Pox ........................................................... Convulsions .........................................................................
 
 
TEACHER’S OBSERVATIONS (To be recorded at least once)-See Code
Standard/Class        
Date of Examination        
General-
Personal cleanliness ..........................................        
Very Pale .........................................................        
Tires easily ....................................................        
In attention to class : Frequent headaches        
Pediculosis (lice) of Hair/Body .........................        
Ropk Skin -
Eruptions (Boils and Sores) ..............................................        
Dry Rough Skin  ..............................................        
Eyes –
Reads with book too close ................................        
Reads with book too far.....................................        
Redness/Yellowness of eyes ............................        
Squint ..............................................................        
Ears-
Frequent earache ...........................................        
Does not hear properly ...................................        
Nose & Throat-
Frequent colds ...........................................        
Frequent sote throat  ..................................        
Frequent cough ..........................................        
Mouth-
Breathes through mouth ..............................        
Cracks at corners of mouth ..........................        
Gums Red and bleeding ................................        
Teeth decayed ..............................................        
Population Education -        
Knowledge-Poor-Adequate        
Psychosomatic Behaviors & Mental adjustment        
 
Shy ..............................................        
Day dreaming  .................................        

Resentful ........................................

        
Mannerism ... ...................................        
Self reliant ........................................        
Bites nails ........................................        
Orderly ............................................        
Little Group participation ..................................        
Perfers to be toiled .............................................        
Excessive use of toilet ........................................        
Early Excitable .................................................        
Sitting posture ..................................................        
Standing posture .............................................        
Marked aggressiveness .................................        
Is a leader ......................................................        
Initials of Class Teacher  ...................................
 

MEDICAL EXAMINATION (To be filled by the Doctor) - See Code
Standard/Class            

Tongue ......................................

            
Nose .......................................            

Adenoids .................................

            

Tonsils...... ...............................

            
Lympt Nodes ............................            

Thyroid ..... ...............................

            

Othopaedic diseases ...............

            

Disability...................................

            
Ear Diseases Otisis Media/External...... ..            

Wax........... ...............................

            
Hearing Power    R ...........................            
 

L............................
Speech defects ..........................            
Eye Disseses-Trachoma.............            

Strabismus. ...............................

            

Hearing        R ...........................

            

Heart-Organic diseases ..................

            

Functional Murmur .........................

            
Lungs .............................................            
Liver................. ...............................            

Spleen ............ ...............................

            

Hernia ...........................................

            

Nervous system disorders .............

            

Mental development.......................

            

For boys only
(Hydrocele)..................................                 

Phimosis......................................

            

(Undescended Testis) ...................

            

For girls only

Menarche......................................

            

Dysmenorrhoea ...........................

            
Initials of Medical Officer...............            
Code: N = Normal    D = Defective C = Corrected A = Absent
 

MEDICAL HISTORY AND EXAMINATION OF THE CHILD AT THE SCHOOL BY THE DOCTOR
Date Condition of the child and advice given Action taken Initials

 

      
 

LIST OF SCHOOLS

S.NO. NAME OF SCHOOLS
1.  
2.  
3.  
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