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Instructions:

Please complete the form below. Required questions are in bold. When all required questions are complete click SAVE or, if available, SAVE NEXT. Based on your responses, additional questions may be required or some answers may need to be corrected.

1. Child visit:

--------- B142-040990408-2-10 2000D.0

2. Report Date:

Date:  Today | 
Time:  Now | 

If reporting today, use today's date/time, otherwise use the date/time this information was reported.

3. How was the infant being fed immediately after delivery? :

• Breastfeed only
• Formula feeding only
• Both breastfeeding and formula feeding
• Medical complications: Infant did not feed

...before discharge from maternity

4. When did you begin breastfeeding your infant?  Today | 

5. Is this date estimated?

• None
• Yes - General estimation
• Yes - Used infant date of birth
• No

6. When did you begin feeding your infant formula?  Today | 

7. Is this date estimated?

• None
• Yes
• No

8. Comment if any additional pertinent information: : Not yet received birth vaccines child was formula fed immediately after delivery at NNU KMK 17/09/2024

Birth Vaccines

	Since delivery, did the child receive any of the following vaccinations	Date Vaccine was given	User created	User modified	Created	Modified	Hostname created	Hostname modified
	--------- Vitamin A BCG Hepatitis B DPT (Diphtheria, Pertussis and Tetanus) Haemophilus Influenza B Vaccine PCV Vaccine (Pneumonia Conjugated Vaccine) Polio Inactivated-Polio Vaccine Rotavirus Measles Pentavalent Vaccine (Contains DPT, Hepatitis B and Haemophilus Influenza B Vaccine) Diphtheria and Tetanus	Today |			Sept. 17, 2024, 8:47 a.m.	Sept. 17, 2024, 8:47 a.m.	flourish
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