AYFT TB Screening & Tracking Tool - AYFT Data Management Information System

AYFT TB Screening & Tracking Tool

Important Note: If there is no symptoms, the participant never had TB before or accessed TPT, refer for TPT.

AYFT TB Screening & Referral Tracking Tool

Date of Screening

First Name

Last Name

Date of Birth

Gender

District

Harare South Western District

Harare West South West District

Harare Western District

Health Facility

Budiriro Polyclinic

Budiriro Satellite Clinic

Glen Norah Satellite Clinic

Glen View Satellite Clinic

Glen View Polyclinic

Rutsanana Polyclinic

Highfields Polyclinic

Mufakose Polyclinic

Warren Park Polyclinic

Kuwadzana Polyclinic

Kuwadzana Satellite Clinic

Western Triangle Satellite Clinic

Sally Mugabe Hospital

Kambuzuma Polyclinic

TB Symptoms

Current Cough

Night Sweats

Weight Loss

Fever

No Symptoms

TPT History

Been on TPT for the past 3 years

Recently Completed TPT

Currently on TPT

Never Been on TPT

TB History

Been on TB Treatment

Never Been on TB Treatment

TB Treatment Defaulter (If so, refer to CATS for TB reinstation)

Post TB Screening Action Taken

Referred for TPT by CATS

Referred for further TB Investigations by CATS

No Action Required (for those who are on TPT/TB Treatment or completed recently without present symptoms)

Name of the CATS

Form Captured By

Officer's Designation

AYFT Data Management Information System

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