CUMULATIVE RECORD OF Auxiliary Nursing & Midwifery Name (In Block letters as entered in XII- Mark list): --------------------------------------------------------------------------Sex: M / F Date of Birth: --------------------------- Nationality: --------------------------Religion: --------------------
Affix Passport Size Photograph
Community: FC / BC / SC / ST / Blood Group: -----------------------Name of Parent / Guardian Address: : ------------------------: Permanent Temporary
Higher Secondary Examination: Certificate No: -------------------- Date: ------------------Total Marks: ------------- No of attempt: --------Date of Admission: ---------------------------------- Admn. / Regn. No / Year: ----------------------------Scholarship availed: Source: ---------------------- Amount: -------------------- Duration: ---------------------Bank Loan availed: Source: ---------------------- Amount: -------------------- Duration: ---------------------SUBJECTS WITH HOURS OF PLANNED INSTRUCTIONS GIVEN IN ANM NURSING S.NO Subjects No. Of No. of Hrs. as Theory S.NO per INC Hrs Given Subjects No. Of No. of Hrs. as per Theory INC Hrs Given
I-Year 1. 2. Community Health Nursing Health Promotion A. Nutrition B. Human body and Hygiene C. Environmental Sanitation D. Mental Health Primary Health Care Nursing I A. Infection and Immunization B. Communicable Disease C. Community Health Problems D. Primary Medical Care E. First Aid and Referral Child Health Nursing 65 55 35 40 45 75 85 40 60 180 1. 2.
II-Year Midwifery Health Care Management 360 75
TOTAL
435
3.
4
180
TOTAL
860
.
SIGNATURE OF THE CLASS CO-ORDINATOR
SIGNATURE OF THE PRINCIPAL
CLINICAL AND FIELD EXPERIENCE HOURS
Duration of the course: 1 1/2 Years
Wks Given
Hrs allotted by INC
Night duty
S.N
Hrs Given
Year
Area clinical /field
I 1 Community Health Nursing 2 Health Promotion 3 4 Primary Health Care Nursing I Child Health Nursing TOTAL II 1 2 Midwifery Health Care Management TOTAL 560 60 620 130 220 440 200 990
Sign of I year Co-coordinator
: ----------------------- Date: -------------------- Signature of the principal-------------- Date: -----------------
Sign of II year Co-coordinator
: ----------------------- Date: -------------------- Signature of the principal-------------- Date: -----------------
CLINIICAL POSTINGS (HOSPITAL @ COMMUNITY)
S.NO Year
Clinical setting
Bed strength
Duration
allotted by INC
Weeks
S.NO Year
Clinical setting
Bed strength
S.N
Duration
VACATION AND HOLIDAYS Type of leave I Year Days II Year Days Annual Vacation Sick Leave Preparatory Leave Extraordinary Leave Leave without stipend S.No Name of the vaccination Date
VACCINATION
WORK ASSESSMENT Assessment Work Grade: A- Excellent, B- V.Good, C- Good, D- Average, E- Poor A : >85%, B-75% to 84%, C- 65% to 74%, D- 50% to 64%, E- <50% I Year II Year
SIGNATURE OF PRINCIPAL UNIVERSITY EXAMINATION MARKS I YEAR Board Examination Regular Pape r Internal- 25 External 75 Internal 100 External 100 200 Internal 100 200 Internal 100 100 External 100 200 Internal 100 External 100 200 Internal 100 External 100 100 External 100 200 Total Subjects Month/Year Theory Supplementary-I Month/Year Supplementary-I Month/Year Regular Month/Year Practical Supplementary-I Supplementary-II Month/Year Month/Year
Total
Total
Total
I
Community Healt Nursing
Total
Practical-1 Community Health Nursing and Health Promotion
II
Health Promotion
III
Primary Health Care Nursing I Child Health Nursing Practical2Child Health Nursing
IV
Total
Subjects
SIGNATURE OF THE CLASS CO-ORDINATOR
SIGNATURE OF THE PRINCIPAL
UNIVERSITY EXAMINATION MARKS II YEAR Board Examination Regular Theory Supplementary-I Supplementary-I Regular Practical Supplementary- SupplementaryI Paper Subjects Month/Year
Internal- 100 External 100 200
II Month/Year
200 Internal 100 External 100 200 Total
Month/Year
Internal 100
External 100
Month/Year Total 200
Internal 100 200 External 100
Month/Year
Internal 100 External 100 200
Month/Year
Internal 100 External 100
Total
Total
Total
Subjects
I
Midwifery
Practical-I Midwifery
II
Health Centre Manageme nt
Primary Health Care and Health centre Management
SIGNATURE OF THE CLASS CO-ORDINATOR
SIGNATURE OF THE PRINCIPAL
Note: certificate will be issued by Kumouan University after successful completion of course.
Certificate Number: ------------------ RN: ---------------------- RM: ---------------------- Date of registration: -------------------Special Notation: -----------------------------------------Aggregate Marks: -------------------------- Division: --------------------- School Rank: ------------------ State Rank: ----------------Distinction: 80% and above, First Division: 70% to 79%, Second Division: 60% to 69% Pass: 50% to 59%