Questionnaire for Clinic Xey Holder - Page 5

40.

What are the three most frequent types of clinic visits?

Record approximate number of clinic visits per week for each of che following:
4l.

Total visits per week on the average

42.

Infants under one year of age

43.

Children 1 - 5 years of age

44,

Children 6 ~ 15 years of age

45.

Youmg to middle age mex

46.

Young to middle age women

47.

Old men

48.

Old women

49,

Number of children per week wich diarrhea or vomitiag

50.

Number of children per week with fever

31.

Number of children per week for well child care (immmizations,

52.

Number of pragnancy care visits per veek

33.

Number of adults with fever

54.

Number of adultes with gastrointestinal probiems

atc.)

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