New Registration
  Child Details
First Name* Middle Name Last Name*
Date Of Birth* Sex*  
  Parent's Details
Father's Name Father's Occupation Email ID.
Mother's Name Mother's Occupation    
Address Line1 Line2 Line3
Pin Code          
Residence Phone  Office Phone Mobile*
  Birth Time Details
Born At Mode Of Delivery Birth Wt.  Grams
  Any complication during pregnancy?   Any complication during delivery?
  Did child cry immediately after birth? Was the child admitted in hospital?
  Was there any injury to the child?      Any previous surgery of the child?
  Child History
  Any allergy problem to the child?   Any other information you want to provide.
  Family History
  Diabetes                                          Hypertension                              
  Asthama                                          Tuberculosis                              
  Cardiac/Heart                                   Other                                        
  Feeding and Dietary History
  Breast feeding upto months?                  Solid introduced at months?       

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