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Annexures 5 - SA HealthInfo

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APPOINTMENTS<br />

Date<br />

(ddmmyy)<br />

Where<br />

Seen by<br />

Name Date<br />

Comments<br />

TREATMENT OUTCOME<br />

Cured<br />

Treatment Completed<br />

Treatment Failure<br />

Defaulted<br />

Died<br />

Transferred<br />

Lost to Follow-up<br />

Completed by<br />

Signature<br />

Date / / (ddmmyy)

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