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Appendix C HEALTH DATA CARD

Household No. 1 Family P

Q1 Q2 Q3 Q4 PI N T W F G S A

66

LEGEND: Q1 January Safe Q2 April Warning Q3 July Danger Q4 - October Not Applicable

P Pregnancy I Immunization N Nutritional Status T Toilet Facilities W Water Supply F Family Planning G Garbage S Smoking A - Alcoholism

67

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