| 1 | Prescreening Number |
| 2 | Initial of the child |
| 3 | Date (according to English calendar- DDMMYY) |
| 4 | Researcher code |
| 5 | Date of birth (if known), (English calendar-DDMMYY) |
| 6 | Age of child (in months) |
| 7 | Sex of child (1=Male, 2=Female) |
| 8 | Are there any plans to migrate within one year? |
| 9 | Does the child have any acute illness? |
| 10 | Does the child have any chronic illness? |
| 11 | Does the child taking any multivitamins that include vitamin B12 in the last one month? |
| 12 | Length (in cm) |
| 13 | Length for age <-1 z score |
| 14 | Is the child eligible to enroll in the study? |
| 15 | If the child enrolled in the study, write CHENO |
| 15_txt | If the child is not enrolled, Specify….. |