7/28/2019 NTP Quarterly Report on Hospital TB Referrals Revised

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NTP Quarterly Report on Hospital TB Referrals

For the ______ Quarter, Year__________

Referral outcome of patients referred during the quarter prior to this reporting period:

Name of Hospital Category TDPH TDRH

Location Date submitted

Prepared by ___________________________Name & Signature Designation

Reviewed by ___________________________Name & Signature

Designation

Indicators No. %

1Total no. of referrals (TB symptomatics/ suspects / patients) to

hospital TB team

2 From the wards

3 From OPD

4 Others

5 No. of TB patients admitted at the ward (discharge census)

6 Intrahospital referral rate (ward) [No. 2/No.5 x 100]

7 No. of smear positive detected by laboratory

8Laboratory referral rate (No. 10/No.7 x 100)

9 Internal referrals that were confirmed as TB cases (by TB clinic)

10 New smear positive TB cases

11 TB cases referred to peripheral DOTS facilities (external referral)

12 TB cases registered by TDPH (managed by the TB clinic)

13 No. of TB cases started treatment at the ward

14Total no. of TB cases referred to peripheral DOTS facilities during the

quarter prior to this reporting period

15No. accepted and registered (with TB case number)

at the peripheral DOTS facility

16 External referral acceptance rate (No. 15/No. 14 x 100)%