Form Approved
OMB No.0920-XXXX
Exp. Date xx/xx/20xx
Growth |
|
Participant ID |
_______________________ |
Name of Assessor |
__________________(free type) |
Name of Data Clerk |
__________________(free type) |
Date of assessment |
______ (day – 2 digits) ______ (month – 2 digits) __________ (year – 4 digits) |
|
|
Child’s length (centimeters) |
________________ cm (3 digits) Percentile: ___________ (2 digits)
________________ kg (3 digits) Percentile: ___________ (2 digits)
________________ cm (3 digits) Percentile: ___________ (2 digits) |
Child’s weight (kilograms) |
|
Child’s head circumference (to the nearest 0.1 cm) |
|
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Kotzky, Kim (CDC/ONDIEH/NCBDDD) (CTR) |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |