Sl. No

Physical findings

Result

1

Temperature

2

Pulse

Beats/min

3

Blood pressure

mmHg

4

Respiratory rate

Breath/min

5

Pallor

Yes = 1

No = 2

□

6

Severity of pallor, if present

Mild = 1

Moderate = 2

Severe = 3

□

7

Jaundice

Yes = 1

No = 2

□

8

Edema

Present = 1

Absent = 2

□

9

Rash

Present = 1

Absent = 2

□