CUMULATIVE RECORD OF Auxiliary Nursing & Midwifery Affix

Name (In Block letters as entered in XII- Mark list): --------------------------------------------------------------------------- Passport

Sex: M / F Date of Birth: --------------------------- Nationality: --------------------------Religion: -------------------- Size

Community: FC / BC / SC / ST / Blood Group: ------------------------ Photograph

Name of Parent / Guardian : -------------------------

Address: : Permanent Temporary

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-----------------------------------------

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Identification Marks: 1. ------------------------------------ 2. ----------------------------------------------

Academic Qualification:

Higher Secondary Examination: Certificate No: -------------------- Date: ------------------Total Marks: ------------- No of attempt: ---------

Date of Admission: ---------------------------------- Admn. / Regn. No / Year: -----------------------------

Scholarship availed: Source: ---------------------- Amount: -------------------- Duration: ----------------------

Bank Loan availed: Source: ---------------------- Amount: -------------------- Duration: ----------------------

SUBJECTS WITH HOURS OF PLANNED INSTRUCTIONS GIVEN IN ANM NURSING

S.NO Subjects No. Of No. of Subjects No. Of No. of

Hrs. as Theory Hrs. as per Theory
per INC S.NO INC
Hrs Given Hrs Given

I-Year II-Year

1. Community Health Nursing 180 1. Midwifery 360

2. Health Promotion 2. Health Care Management 75

A. Nutrition 65
B. Human body and
Hygiene 55
C. Environmental
Sanitation 35 TOTAL 435
D. Mental Health 40
Primary Health Care Nursing I
45
A. Infection and
Immunization 75
B. Communicable Disease
C. Community Health 85
3.
Problems
40
D. Primary Medical Care
E. First Aid and Referral 60

4 Child Health Nursing

180

TOTAL
860

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

CLINICAL AND FIELD EXPERIENCE HOURS Duration of the course: 1 1/2 Years

Wks Given

Night duty
S.N

S.N
Hrs Given

Weeks
Year Area clinical /field

Hrs allotted

allotted by INC
by INC

1 Community Health Nursing 130

2 Health Promotion 220

3 Primary Health Care Nursing I 440

4 Child Health Nursing 200

TOTAL 990

II

1 Midwifery 560

2 Health Care Management 60

TOTAL 620

Sign of I year Co-coordinator : ----------------------- Date: -------------------- Signature of the principal-------------- Date: -----------------

Sign of II year Co-coordinator : ----------------------- Date: -------------------- Signature of the principal-------------- Date: -----------------

CLINIICAL POSTINGS (HOSPITAL @ COMMUNITY)

S.NO Year Clinical setting Bed Duration S.NO Year Clinical setting Bed Duration
strength strength
 VACATION AND HOLIDAYS VACCINATION

Type of leave I Year II S.No Name of the vaccination Date

Days Year

Days

Annual Vacation

Sick Leave

Preparatory Leave

Extraordinary Leave

Leave without stipend

WORK ASSESSMENT

Assessment I Year II Year

Work

Grade: A- Excellent, B- V.Good, C- Good, D- Average, E- Poor A : >85%, B-75% to 84%, C- 65% to 74%, D- 50% to 64%, E- <50%

SIGNATURE OF PRINCIPAL

UNIVERSITY EXAMINATION MARKS I YEAR

Board Examination Theory Practical

Regular Supplementary-I Supplementary-I Regular Supplementary-I Supplementary-II

Pape Subjects Month/Year Month/Year Month/Year Month/Year Month/Year Month/Year

r
Internal- 25

External 75

Internal 100

External 100

200

Internal 100

200

Internal 100 100

External 100

200

Internal 100

External 100

200

Internal 100

External 100

200
100

External 100

Subjects
Total

Total
Total

Total

Total
Total

I Community Practical-1
Healt
Nursing Community
Health Nursing
and Health
Promotion

II Health
Promotion

III Primary
Health Care
Nursing I
 IV Child Health Practical-
Nursing 2Child Health
Nursing

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

UNIVERSITY EXAMINATION MARKS II YEAR

Board Examination Theory Practical

Regular Supplementary-I Supplementary-I Regular Supplementary- Supplementary-

I II

Paper Subjects Month/Year Month/Year Month/Year Month/Year Month/Year Month/Year

Total 200
Internal- 100

External 100

Internal 100

External 100

Internal 100

200

Internal 100

External 100

200

Internal 100

External 100

200

Internal 100

External 100

200
200

External 100

Total

Total
Total

Total

Total
Subjects

I Midwifery Practical-I

Midwifery

II Health Primary
Centre Health Care
Manageme and Health
nt centre
Management

SIGNATURE OF THE CLASS CO-ORDINATOR SIGNATURE OF THE PRINCIPAL

Note: certificate will be issued by Kumouan University after successful completion of course.

Certificate Number: ------------------ RN: ---------------------- RM: ---------------------- Date of registration: --------------------
Special Notation: ------------------------------------------
Aggregate Marks: -------------------------- Division: --------------------- School Rank: ------------------ State Rank: -----------------
Distinction: 80% and above, First Division: 70% to 79%, Second Division: 60% to 69% Pass: 50% to 59%

Signature of the class co-coordinator Signature of the principal