Alkem

Date of Assessment *

Subject Initials *

Age (Completed years) *

Gender *

Male Female

Height (cm) *

Weight (kg) *

Geographic location / site code *

Area of residence *

Urban Rural Semi-urban

Occupation type *

Indoor (e.g., office, factory) Outdoor (e.g., agriculture, construction) Mixed Unemployed Not recorded

Dietary habits (as noted or reported) *

Vegetarian non-vegetarian Mixed Not recorded

Daily sunlight exposure *

<15 minutes 15-30 minutes >30 minutes Not recorded

Season at time of 25(OH)D testing *

Summer Monsoon Winter Spring Not recorded

Family history of vitamin D deficiency or bone disorders *

Yes No Unknown

Diagnosis of Vitamin D Deficiency confirmed? *

Urban Rural Semi-urban

Date of diagnosis *

Level of Serum 25(OH)D (If available)

Duration *

Presenting Symptoms *

Fatigue Muscle Weakness Bone Pain Fracture History Others

vitamin D therapy prescribed? *

Yes No

Reason of prescribe *

Dose per administration *

60,000 IU Others

Dosing Frequency *

Total Duration of Therapy (weeks) *

Any transition to maintenance dosing? *

Yes No

Clinical Symptom Improvement *

Improved No Change Worsened

Adverse event recorded during therapy *

Yes No

ASSESSMENT 1 - THERAPY EVALUATION