Facility ______________Year -------------- Month__________Date period__21__/__2_/__16__to ___20_/__3_/__16__

Code Male Female

30- >=6 Total
1-4 5-14 15-29 30-64 >=65 1-4 5-14 15-29 64 5
< 1 yr yrs yrs yrs yrs yrs < 1 yr yrs yrs yrs yrs yrs
S/N

Count

Count

Count

Count

Count

Count

Count

Count

Count

Count

Count
Count
National classification of

Case
Disease(NCoD)by Capital Later
1 6A20 MDD - - - 1 1 - - - - 2 3 - 7

2 6A20 Schizophrenia - - - 3 7 - - - - 1 1 - 12

3 6A24 Delusional disorder - - - - - - - - - - 1 - 1

4 MB13.R Suicide attempt - - - 1 - - - - - 1 - - 2

5 6B00 GAD - - - 1 2 - - - - - - - 3

6 8A68.A Epilepsy - - - 1 1 1 - - - 3 - 6

7 F19.951 Substance induced psychotic disorder - - - - 1 - - - - - - - 1

8 6A6Z Bipolar disorder - - - - 2 1 - - - - 1 - 4

9 F41.9 Anxiety disorder not specified - - - - 1 - - - - - - - 1

10 F84.0 Autism - - - - - - - - - 1 - - 1

11 F91.9 Conduct disorder - - - - 1 - - - - - - 1

-
12 F34.1 Dysthemia - - - - 1 - - - - - - - 1

13 6B01 Panic disorder - - - - - - - - - 1 - - 1

 Death Report
Facility ______________Year -------------- Month__________Date period____/___/____to ____/___/____

Male Female
Code

1-4 5-14 15-29 30-64 >=65 1-4 5-14 15-29 30-64 >=65 Total
< 1 yr yrs yrs yrs yrs yrs < 1 yr yrs yrs yrs yrs yrs

Count

Count

Count

Count

Count

Count

Count

Count

Count

Count

Count

Count
National classification of

Case
S/N
Disease(NCoD)by Capital Later
1

10