Pratibandhi Kalyan Kendra Abinash Mukherjee Road, Hooghly Phone (033) 263 2!

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#ur$ey o% &hildren 'ith &hroni& health &onditions (200!)

(ear Parent ) *uardian, +e are ,lanning a sur$ey to a&&urately deter-ine the nu-ber o% &hildren aged 0 to ! years in Hooghly (istri&t 'ho ha$e a &hroni& health &ondition. /urrently due to la&k o% de,endable data on this subje&t, it is di%%i&ult to hel, these &hildren ade0uately and deter-ine the &auses o% their ,roble- reliably. +e are ho,ing that our sur$ey 'ill at least ,ro$ide so-e hel, in resol$ing this di%%i&ulty. 1his sur$ey is i-,ortant be&ause no su&h sur$ey has been done in 2ndia be%ore. 1o &o-,lete this sur$ey satis%a&torily, 'e are being hel,ed by the Ad$an&ed #ur$ey Resear&h /entre (A # R /) o% Kolkata 'ho are a&ting as our ad$isor. Ho'e$er this sur$ey &annot be &o-,leted 'ithout your a&ti$e su,,ort. +e are there%ore asking your &o3o,eration and hel, so that the sur$ey &an be &o-,leted su&&ess%ully. Please let us kno' i% you ha$e any 0uestions about the sur$ey. +e shall stri$e to ans'er your 0uestions as a&&urately as 'e &an. 4ours sin&erely, Mr #ubrata 5annerjee (ire&tor, Pratbandhi Kalyan Kendra, Hooghly Pro%essor Arijit /haudhuri /hair-an, A#R/ 2ndian #tatisti&al 2nstitute (r #uniti /hakrabarti /hild #,e&ialist MR/P, 6R/P/H(7K)

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2 gi$e &onsent to -y son ) daughter (na-e3333333333333333333333333333333333333333333333333333) 1o be in&luded in the sur$ey o% &hildren 'ith &hroni& health &onditions in Hooghly (istri&t. #ignature33333333333333333333333333333333333 (6ather ) Mother ) *uardian) ) (ate33333333333