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Community Health Volunteer's Training Manual - Population Council

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Box 2.2.3: RECORD OF BIRTHS IN THE COMMUNITY<br />

Place of<br />

Birth<br />

Sex of Child Date of<br />

Birth<br />

Child’s<br />

Name<br />

House<br />

Number<br />

Age of<br />

mother<br />

Mothers<br />

Name<br />

No Fathers<br />

Name<br />

1<br />

2<br />

3<br />

4<br />

5<br />

6<br />

7<br />

8<br />

9<br />

10<br />

<strong>Community</strong> Based Surveillance<br />

11<br />

12<br />

107

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