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

Schooling status *

Attending school (in-person) Attending school (online/home-based) Not attending school Preschool/Daycare Not recorded

Outdoor activity (average per day) *

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

Dietary habits (as noted or reported by caregiver) *

Vegetarian non-vegetarian Mixed

Calcium/milk intake (as noted or estimated) *

Regular (≥1 serving/day) Occasional (<1 serving/day) Rare/None

Season at time of 25(OH)D testing *

Summer Monsoon Winter Spring

Family history of vitamin D deficiency or bone disorders: *

Yes No Unknown

Diagnosis of Vitamin D Deficiency confirmed? *

Yes No

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 (IU) *

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