Logo
Ministry of Health, Community Development, Gender,Elderly and Children
National TB and Leprosy Programme


TUBERCULOSIS TREATMENT CARD


{{-- @dd($patientData) --}}

Name: {{ $patientData['Fname'].' '.$patientData['Mname'].' '.$patientData['Lname'] }}

Physical Address(Ward): {{ $patientData['ward'] }}

Physical Address(Village/Street): {{ $patientData['village_or_street'] }}
Contact telephone: {{ '0'.$patientData['phone'] }}
Place of work:____________

Area Leader/Neighbour: @if($supporter) {{ $supporter['fullName'] }} @else ____________ @endif
NIDA: {{ $patientData['nida'] }}
Mining's Key Populations:____________

Referred by:__________________
List of household contacts of confirmed TB cases
SN Name Age Sex Screene Outcome Started
YES
NO
TB No TB TB Bx IPT
1
2
3
4
5
6
7
8
9
10

District registration No. {{ $patientData['d_code'] }}

Name of Health facility: {{ $patientData['c_name'] }}

DOT option: 1:Health Facility DOT

2:Home-based DOT _____________

Classification by site: {{ $disease_site['name'] }}

Patient type: {{ $patient_type['p_name'] }}

Date of Start of Treatmennt: {{ \Carbon\Carbon::parse($medicineInfo['start'])->format('d/m/Y') }}

VVU: @if($hiv_res['hiv_result'] == 1)Pos @elseif($hiv_res['hiv_result'] == 0) Neg @elseif($hiv_res['hiv_result'] == 2) Not Tested @endif

@if($hiv_res['hiv_result'] == 1) @php $patient = getHivPatientNumber($patientData['patient_id']); @endphp

HIV Reg. No: {{ $patient->hiv_number }}

@endif

CPT:___ Start Date___/___/__

Treatment Supporter details
Name of treatment supporter: @if($supporter) {{ $supporter['fullName'] }} @else ____________ @endif
Relationship with patient: @if($supporter['relation']) {{ $supporter['relation'] }} @else __________________ @endif
Physical address: @if($supporter['address']) {{ $supporter['address'] }} @else __________________ @endif
Telephone/Mobile number: @if($supporter['phone_number']) {{ '0'.$supporter['phone_number'] }} @else __________________ @endif

ART drugs:____ Start Date___/___/__

INTENSIVE PHASE
New Case
________
RHZE

Retreatment
_________
RHZE

Children
__________
RHZE

For patients on health-facility DOT, write the number of dose on the date of DOT.
Month Year 1 2 3 4 6 7 8 9 10 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

CONTINUATION PHASE: For patients on health-facility DOT, write the number of dose on the date of DOT.
Month Year 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Other causes for not completing treatment

  1. Started MDR/RR-TB treatment
  2. Died before start of treatment
  3. Did not start treatment

Remarks:_______________________________________

Treatment outcome date:___________

  1. Cured: _________
  2. Treatment completed: _________
  3. Treatment failure: _________ Died: _________ Lost to follow-up_______