GROW WELL -Case Study Form - Step
Case Study Form
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Parent Details*
Address*
Observation while treatment
Past History of Any Disease:*
Measles
Mumps
Chickenpox
Chicken Gunia
Maleria
Jaundice
Typhoid
Renal Stone
Gall Stone
Heart-Attack
Piles
Upload Reports
Concentration Level Improves*
YES
NO
Immunity Improves*
YES
NO
Obstetric and Gynecological History
For Femals
Menses
Regular
Irregular
Profuse with Clots
Absent
Leucorrhoea
YES
NO
White
Yellowish
Greenish
Offensive Smell
Generalities
Water Thirst*
Normal
Absent
At a Time Small quantity at a small interval
At a Time Large quantity Large Interval.
Appetite*
Normal
Increase
Absent
Bowel Habit
Stool
Regular
Insufficient
Constipation
Stool with Bleeding
Urine
Normal
Increase
Absent
Involuntary Urination
Sleep*
Sound
Increase
Insomnia
Disturbed
Perspiration*
Normal
Increase
Offensive
Relation with Heat and Cold*
Tolerate Cold
Tolerate Heat
Can Tolerate Both
Can not Tolerate Both
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