Daily monitoring report for Foreign returnee COVID-

Name of the PHC PHC - KALLUMARRI

Date 3/7/2020
No of foreign returnees AS 1
ON DATE

Name of the Foreign country Date of arrival Health status Name of

foreign returnee from which the symptomatic/ ANM with
individual has asymptomatic Phone
arrived number

U.NAGABHUSHANA NEPAL 3/7/2020 ASYMPTOMATIC G.VIJAYA

MPHA (F)
7780525447
reign returnee COVID-19

Name of ASHA Name of whether Whether

with Phone VOLUNTEER ASHA / ANM Medical
number with Phone contacted officer
number twice a day contacted
YES/NO daily

SUNITHA ASHA, LAKSMINARAYA YES YES

9949881724 NA,
7093932349

Signature of the Medical officer