Annexures 5 - SA HealthInfo

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Annexure 10 DOTS-PLUS FOR MULTIDRUG-RESISTANT TUBERCULOSIS PATIENTS IN SOUTH AFRICA PATIENT POST-TREATMENT FOLLOW-UP DOTS-Plus Number / Registration Date / / (ddmmyy) First Name Surname FOLLOW-UP FLOW DIAGRAM Follow-Up Appointment (Every 6 Months) Update Patient Weight Update Patient Personal Details Screen for TB Signs & Symptoms Symptoms Absent Symptoms present Appointment Dates (ddmmyy) / / / / / / / / / / / / / / / / / / / / Results Negative Results Positive: MDR confirmed Refer to MDR Centre Collect Sputum for Microscopy Culture DST (H,R,E) Results Positive: MDR not confirmed Start Appropriate TB Treatment
FOLLOW-UP DETAILS Vital Status Weight (kg) TB Signs & Symptoms Bacteriology Date Sputum collected _______________ Other Illnesses (List) Date (ddmmyy) ___________ Alive: Yes No No Yes Smear Pos Culture Pos Neg Neg Unknown If yes, list Unknown Unknown MDR-TB confirmed Yes No Vital Status Weight (kg) TB Signs & Symptoms Bacteriology Date Sputum collected ________________ Other Illnesses (List) Date (ddmmyy) ___________ Alive: Yes No No Yes Smear Pos Culture Pos Neg Neg Unknown If yes, list Unknown Unknown MDR-TB confirmed Yes No Vital Status Weight (kg) TB Signs & Symptoms Bacteriology Date Sputum collected ________________ Other Illnesses (List) Date (ddmmyy) ___________ Alive: Yes No No Yes Smear Pos Culture Pos Neg Neg Unknown If yes, list Unknown Unknown MDR-TB confirmed Yes No Vital Status Weight (kg) TB Signs & Symptoms Bacteriology Date Sputum collected ________________ Other Illnesses (List) Date (ddmmyy) ___________ Alive: Yes No No Yes Smear Pos Culture Pos Neg Neg Unknown If yes, list Unknown Unknown MDR-TB confirmed Yes No
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Page 3 and 4: ADHERENCE RECORD Use one of the fol
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Page 7 and 8: ADHERENCE RECORD Use one of the fol
Page 9 and 10: Annexure 6 Page 1 DOTS-PLUS FOR MUL
Page 11 and 12: Page 3 DOTS-PLUS FOR MULTIDRUG-RESI
Page 13 and 14: Page 2 DOTS-PLUS FOR MULTIDRUG-RESI
Page 15: Annexure 9 DOTS-PLUS FOR MULTIDRUG-
Page 19 and 20: Annexure 11 Management algorithm fo
Page 25 and 26: Management algorithm for fever: Par
Page 31 and 32: Annexure 22a Management algorithm f

Annexures 5 - SA HealthInfo

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