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