03.03.2015 Views

Evaluation et prise en charge de la filariose lymphatique

Evaluation et prise en charge de la filariose lymphatique

Evaluation et prise en charge de la filariose lymphatique

SHOW MORE
SHOW LESS

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Formu<strong>la</strong>ire d’<strong>en</strong>registrem<strong>en</strong>t individuel<br />

Nom <strong>de</strong> l’ag<strong>en</strong>t <strong>de</strong> santé<br />

Date ............................................. Vil<strong>la</strong>ge ......................................................................................... Rue .....................................................................................................<br />

Nom du ma<strong>la</strong><strong>de</strong> ................................................................................................................................. Sexe ....................................... Age ........................................<br />

LYMPHOEDEME<br />

ACCES AIGU<br />

HYDROCELE<br />

Jambe Bras<br />

Sein<br />

OUI<br />

NON OUI NON<br />

OUI<br />

NON<br />

Blessures<br />

Pati<strong>en</strong>t transféré dans une USSP<br />

29<br />

5MODULE

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!