National Tuberculosis Center

Recording and Reporting System

  A) Recording/Reporting Forms and Formats for DOTS

• Tuberculosis (TB) Treatment Card
• Patient Retained Card
• Sputum Test Request Form
• Smear Results Sheet for Quality Control-QC-1
• Quality Control for Sputum Smear Examination-QC-2
• Quality Check Report on Sputum Smear Examination-QC-3
• Trimester Report on Treatment Outcome
• Trimester Programme Management Report
• Trimester Report on Sputum Conversion
• Trimester Report on Case Finding
• Trimester Drug Order Form
  
  
  B) Recording/Reporting Forms and Formats for DOTS Plus

• Medical  History And Laboratory Form-Annxture-1
• Dots Plus Patient Treatment Card -Annxture-3
• DOTS-plus Register-Annex-2
• Dots Plus Treatment Centre Card -Annxture-4
• The Commitment Form -Annxture-5
• Protocol For Collection And Transport Of Sputum -Annxture-6
• Drugs For Side Effects In Dots Plus (Sub) Centres -Annxture-7
• Sputum + Side Effect Follow Up Form -Annxture-8
• Drug Box Ordering Form For Dots Plus Sub Centre-Annxture-9
• Drug Box Ordering Form For Dots Plus Centre -Annxture-10
• Dots Plus Quarterly Cohort Analysis Form -Annxture-11
• Construction Of Other Weight Category Boxes-Annxture-12 
• Central DOTS plus Lab Register-Annex-13
• Results Of Blood Test Forms-Annxture-14
• District Dots Plus Centre/Subcentre Box A,B,K Store Card-Annxture-15 
• Side Effect Drug Box Use Monitoring Sheet -Annxture-16

 

• Case finding and Outcome Reporting Tools
  • Trimester Case Finding Reporting Form
  • Sputum Conversion Form
  • Treatment Outcome Form
• Drugs and Laboratory Materials Supply Form
• Programme Management Form
• Laboratory Related Form
  • Sputum Test Requirement Form
  • Quality Control-1
  • Quality Control-2
  • Quality Control-3

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