PSCC_Mission
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Mission Name
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???? ?????
Mission Location
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High School
STC
City
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Badayea
Buridah
Rass
Unizah
Target Group
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Employee
Other
Student
Visitor
Worker
Mission Date
Applicant Name
Gender
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Male
Female
Age
Age Group
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0-15
15-25
Nationality
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Indian
Saudi
Contact Number
Entered By
Smoking
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Yes
No
Not Sure
Diabetes (DM)
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Yes
No
Not Sure
Hypertension
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Yes
No
Not Sure
Coronary Artery Disease (CAD)
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Yes
No
Not Sure
Dyslipidemia
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Yes
No
Not Sure
Other Disease
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CHD
PHTN
Physical Activity
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1-2 Times/week
3-5 Times/week
Daily
Less than once/Week
No
Oily Food
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Frequently (4-6 /Week)
Never or rarely
Occasionaliy (2-3/Week)
Fruits & Vegetables
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1-2 serving
3-4 serving
5 or more serving
Less than 1 serving
Sugar
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Daily (7 or more times/Week)
Frequently (4-6 /Week)
Never or rarely
Occasionally (2-3 /Week)
Family History - DM
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Yes
No
Not Sure
Family History - HTN
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Yes
No
Not Sure
Height
Weight
Systolic Blood Pressure (SBP)
Diastolic Blood Pressure (DBP)
Random Blood Sugar (RBS)
Score
Doctor
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Dr. Badi
Dr. Shaik
Recommendation
Time of Survey
Urgent Contact
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Yes
No
Not Sure
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