View report page

106
Copies of Official (1) Record Forms and (2) Quarterly Reports.
(1) Record Forms (birth cards of visits and revisits).
Infants (under / year of age). Front of Card. Borough of Lambeth.
Births Reg. No.
Address Name Sex
Date of Birth Midwife or otherwise
Full Term or Stillborn Date of notice given by
Date of (a) First Visit (b) Revisits
Condition of Infant—
General State of Heal h
Feeding—(a) Breast (b) Artificial (c) Breast and Artificial
If Artificially Fed—(a) On What? ... (b) Why?
Condition of Mother—
General State of Health Health during Pregnancy
Nature of Work (if any)
Dates of (a) Miscarriages (b) Still Births
Number in Family (a) Alive Ages
(b) Dead . Ages
Condition of House—
No. of Rooms Cleanly or otherwise
Defects found
Centre
Health Visitor of Centre.

Children {aged i to 5years). Borough of Lambeth.
Revisits of Births—continued. Reg. No
Address Name
date.
State of Health
(Good, Fair or Bad).
Illnesses
(if any).
Remarks.
If child is attending another Centre, state date of transfer and District
Date of transfer of child to the Education Authority
If child dies, state :(a) Date of Death (b) Age of Child at Death
(c) Cause of Death
Centre
Health Visitor of Centre.