UNITED PROVINCES OF AGRA AND OUDH 31
VACCINATION FORM No. 3.
Statement showing vaccinations performed in the district during the month of—190
Number. |
Name of |
Name of |
Primary vaccination. |
Re-vaccination. |
Increase or decrease in com- |
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Sex. |
Caste. |
Result. |
Age of successful |
Sex. |
Successful. |
Total of successful |
Total of successful |
Increase. |
Decrease. |
|||||||||||||||||
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. |
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Total ... |
NOTE.—This statement should be submitted to the District Superintendent of Vaccination within seven days after the expiry of the month.
Date— Signature of Assistant Superintendent of Vaccination.