Questionaire for Clinic Xey Holder - Page §

4Q.

What are the chree most frequent cypes of clinic visits?

Record approximate number of clinic visits per week for each of chk following:
41.

Total visits per week on the average

42.

Infants under one year of age

43.

Children 1 - 5 years of age
Children 6 - 15 years of age

45.

46.

Young ta middle age nea
Young to aiddle age women
Old nen

Old women

Number

f children per week with diarrhea or vomitih

Number of children per week with fever
Number of children per week for well child care (inmmizaticons,

etc.)

32.
33.

of pragnancy care visits per week
Number of adules with fever

Number

adults with gastroincestinal probiems

Select target paragraph3