Medical Patient Observation- Pre and Post Kikombe cha Babu
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1
. What department where the patient been attended?
What department where the patient been attended?
Emergence Department
OPD Clinic {Not specified}
In Patient in the wards
HIV clinic
Diabetes Clinic
Radiology Departme
Other (please specify)
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2
. List your Job Title
List your Job Title
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3
. Region of the Working Station?
Region of the Working Station?
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4
. What is the Diagnosis of the patient?
What is the Diagnosis of the patient?
I
II
III
IV
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5
. Was the Diagnosis confirmed previously?
Was the Diagnosis confirmed previously?
Yes
No
Not sure
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6
. When did the patient took the Babu portion?( how many days/weeks/months have passed)
When did the patient took the Babu portion?( how many days/weeks/months have passed)
7
. What was the reason for Reviewing the patient?
What was the reason for Reviewing the patient?
New patient coming to test
Known patient coming to re-test
Follow up clinic
Brought in sick
Admitted in the ward
Others {please specify}
Other (please specify)
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8
. What was the test result post Babu portion?
What was the test result post Babu portion?
Positive
Negative
Refuse to test
Not tested
9
. What complication(s) did the patient presented with if any?
What complication(s) did the patient presented with if any?
I
II
III
IV
10
. Please use the space below to add any comments you may have.
Please use the space below to add any comments you may have.
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