FAMILY HEALTH REGISTER Form 1 House No . Area/ Village(Locality) Name of PHC ___________ District _______________ State _______ SI.NO Name Of the Family Member Name of the Head Of the Family Whether Usual Resident (Yes/No) Age With Sex( Date Of Birth if possible) Marital Status Education Occu-Pation In-Come Number Of Living Children M/F 1 2 3 4 5 6 7 8 9 10 Instructions for filling up of family Health Register Col 1 : This should be running number starting from (1) for each family separately. Col 2 : Name of all the members of the family should be given in this column. Casual; Members may also be shown in this column,if they start for long. Col 3: Head of the family shall be the same for casual members also. Relationship of the members shpuld also be mentioned here likewise. Col 4: Nature of stay of member may be shown here. Col 5: The age of each member should be entered in complete years against his/her name.
