INCIDENCE OF SNAKE BITES AND DEATH BY SEX AND AGE GROUP
1. Name of the State/UT _____________________________________
2. Month/Years ________________________________
3. Total No of the existing institutions in the state /UT ___________________________________
4. Total No. of Reporting for the month in the state /UT ___________________________________
5. Total No of defaulting for the month in the State/UT ____________________________________
(Unit in numbers)
S. No Age Group Outdoor Patient Indoor patient Indoor deaths
Male Female Total Male Female Total Male Female Total
1 0-4
2 5-9
3 10-14
4 15-19
5 20-29
6 30-39
7 40-49
8 50-59
9 60 & above
Total
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