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60-Day Follow-up Examination for Acute Flaccid Paralysis (AFP) Case Date of onset of weekness/paralysis ( Day/Monthyear )] OB /O6 iQ F EPID Wo. PARSD/ 3) UG Co) Foe ptr ascatonstafparsisiMontny Mwowhs | (m) TUR, pads: UF Ye Se Tou Tilpw, U-l- Deutatjon, Upton ir tay low up ceamination condi? 7 ‘TCe) Ts of canon (a owe (oaibteivan | SF 710 7231 fiver wane wating [ve [wor [ve No | Gat Ghange | ye | No [Wher moving ibs Ray edSGay [Able to sit, crawl of stand with or without support = 5 [Bearing weight on Jegs (mention whether on one or both legs) = S cease Upper tng Tower tin amination Area) [Fac Oana | tgneormay | —Lonorcp = a Fee Bi IN Ge (Att Fees =| | ae is | Is is | os 7 js eee Dene maperae, teeecranes ba | Biceps Biceps S S a pa [i [rowel scores, Mheranad reso ted ve Nee aly aS semen OM [Gaba Wop [carp Dake Wikece (Siea| Dia Plantats emnarapome |Ascending/ descending pattern of paralysis (as compared to inuar investigation) — = AN Residual Weakness/paralysis im Diagnosis, if case does not look like a polio case: — fate Chane Hs - er SLBA aR [Bret clinical notes in support of your final diagnosissit discarded as non-poti, Ces ET DiwosF Ker—agetig— fs ; x Ove RSENS No i Wf Pures yoreus {Same oftovesignt Dn a of vesigaor front apis teath OF eqn on™ ‘Scanned with CamScanner

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