Administrative | Health Services |
---|---|
-Clinic identification number | -Patient identification number |
-Patient identification number | -Date of visit |
-Date of enrollment at HIV clinic | -Type of provider seen |
-Pregnancy status at time of enrollment | -Pregnant at time of visit |
-Number of months pregnant at enrollment | -Temperature |
-Age | -Weight |
-Gender | -Height |
-Site of HIV testing | -CD4 count |
-Date of HIV testing | -CD4 percentage |
-Results of HIV testing | -Date of CD4 count |
-City of residence | -Viral load |
-Neighborhood of residence | -Date of viral load |
-Marital status | -Clinical diagnoses* |
-Type of employment | -WHO stage |
-Years of education | -CTX prophylaxis |
-Type of higher education | -TB prophylaxis |
-Patient active at HIV clinic (yes/no) | -Patient receiving ART |
-Reason patient left HIV clinic | -Type of ART regimen |
-Date patient left HIV clinic | -Type of ART refill visit |
-Date the HIV clinic found out patient left | -# of pills dispensed |
-Exit comments | -Next refill date |
-ART committee date | -Receiving TB treatment |
-Patient receiving ART (yes/no) | -Comments |
-ART start date | Â |
-Type of ART initiation (new patient or transferred from another facility) | Â |
-Comments about treatment | Â |
-Pregnancy status at time of treatment initiation | Â |
-Prophylaxis for PMTCT | Â |
-Prophylaxis type | Â |
-Prophylaxis date | Â |