WCI Screening
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John Mark
Demographics
Child's Name
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Parent / Guardian Name
Guardian Phone Number
Age (years)
Age (months)
Sex
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Male
Female
NHIS Status
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Active
Inactive
None
NHIS Number
Vitals
Weight (kg)
Height (cm)
BMI (auto)
14.9
Normal
z -0.43
Pulse (bpm)
Temperature (°C)
Hb (g/dL)
Clinical
Complaint
Complaint Duration
Examination Findings
Treatment Plan
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