| Laboratory form | ||||||||
| 20-Jan-08 | ||||||||
| CHSUNO | Child survey number | CHSUNO | ||||||
| Chsno | Child serial number (if mother, add 10,000 to her child's chsno) | Chsno | ||||||
| BF4_1 | Date | BF4_1 | ||||||
| BF4_2 | Time of last meal (khana) (If not today enter 8888) | BF4_2 | ||||||
| BF4_3 | Time of last snack (kaja) (If not today enter 8888) | BF4_3 | ||||||
| BF4_4 | Time of last tea (If not today enter 8888) | BF4_4 | ||||||
| BF4_5 | Time of last breast feed (If not today or mother enter 8888) | BF4_5 | ||||||
| BF4_6 | Time of breast milk collection | BF4_6 | ||||||
| BF4_7 | Amount of blood (ml) | BF4_7 | . | |||||
| BF4_8 | Remarks | |||||||
| SUPERVISOR'S SIGNATURE | ||||||||
| DATA ENTRY 1 | ||||||||
| DATA ENTRY 2 | ||||||||