Schizophrenia Performa
UHID
OPD No
IPD No
Casualty No
Name

Mobile
Adhaar No
Date
Time

Code
UHID
Name
Age YY
Age MM
Age DD
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Doctor
Address
Status

Notes     
[ Demographic Details/General Details ]
HT[cm]
WT[kg]
Blood Group
Apgar Score
Growth
Waist

Obesity


Do other family know and understand about symptoms of Schizophrenia

What has been done to address the psychotic symptoms? With what results?
Specific To the Caregiver

In what ways has the psychotic symptoms affected your everyday life?

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