Screening Health Status of Adolescent Boys
BPBD International Academy
Dankaur, Greater Noida (UP- 203201)
Name 7
Father's Name_ Gedo,” Vagos
Aduess gila bygtort Se
eos a
Contacto: _828972£ 700
Date of Sereening_ A9/ZO/2Y
Measurable Variables of Individuals
Age(years) —-Z8..
Height (inom) 2235.
Hemoglobin(g/dL)
5B.
Weight (i ko) 3
Blood Pressure (ap) BIL OD
Ib.
 
 
   
 
 
 
Blood Glucose (mg/ dL.)
Pulse Rete(bpm)
Oxygen Level (%) —-——
 
 
 
Family detai
1. Family Structure-
4. Nuclear Family
stint Family
2. Total Family Members? __.7
8. Number of Siblings
4. Members eaming in the family __2.
5. Income of the familyiyear
4.