30 MANUAL OF VACCINATION FOR THE.
VACCINATION FORM No. 2.
Weekly abstract of totals of the Vaccination Register for the month of—190 , for Tahsíl—, District—
Week. |
Dates of week. |
Primary vaccination. |
Re-vaccination. |
||||||||||||||||||
Sex. |
Caste. |
Result. |
Age of successful case. |
Sex. |
Success- |
||||||||||||||||
Male. |
Female. |
Total. |
Christians. |
Muhammadans. |
Hindus. |
Other classes. |
Total. |
Successful. |
Unsuccessful. |
Absent. |
Total. |
Under one |
One and under |
Six years and |
Total. |
Male. |
Female. |
Total. |
|||
First ... |
From 1st to 7th ... |
||||||||||||||||||||
Second ... |
From 8th to 14th ... |
||||||||||||||||||||
Third ... |
From 15th to 21st ... |
||||||||||||||||||||
Fourth* ... |
From 22nd to end of |
||||||||||||||||||||
Total ... |
|||||||||||||||||||||
Total for the corresponding month of |
* The remaining days of the month should be included in the fourth week.
NOTE.—This statement should be submitted to the Assistant Superintendent of Vaccination within five days after the expiry of the month.
Date— Signature of Vaccinator—