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PROTOCOLE NATIONAL DE PRISE EN CHARGE DE LA MALNUTRITION AIGUE

protocole national de prise en charge de la malnutrition aigue

protocole national de prise en charge de la malnutrition aigue

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ANNEXE 7 : Fiche de suivi CNAFiche de suivi CNAN de MAS UNIQUEZS……………………Commune…………………….CS……..…………Date N d’ordre :PT : Z PB : Poids Cible :Nom patient……………………………………………………………………………………….Nom des parents ………………………………………………………………………………….Age……………Sexe……… Allaitement O Oui / O Non Alimentation de complément O Oui / O NonAdresse………………………………………………………………………………………………………....………………………………………………………………………………………………………………….I<strong>DE</strong>NTIFICATION <strong>DE</strong> <strong>LA</strong> PROV<strong>EN</strong>ANCE DU MA<strong>LA</strong><strong>DE</strong>Spontané / Communauté / Autre ………..Transfert de : CNT / CNA / PédiatrieNom centre………………..<strong>DE</strong>……………..DS…………….. Nouvelle admission Transfert de Rechute<strong>DE</strong>= date d’entréeDS=date de sortie Réadmission après abandonANTECE<strong>DE</strong>NT/EXAM<strong>EN</strong> CLINIQUEEDUCATION DONNEEDateSignature163

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