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    TBMAC DSTB Template

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    Mica Disquitado
    This document contains medical information for a patient diagnosed with bacteriologically confirmed rifampicin-resistant tuberculosis (RR TB), including their age, address, diagnostic test results, treatment history, current treatment regimen, and physician notes. It lists the patient's municipality, initials, diagnostic test dates and results, treatment regimen of HRZE for 56 days followed by HR for 112 days, and classification as Category I RR TB.

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    TBMAC DSTB Template

    Uploaded by

    Mica Disquitado
    4 views1 page
    This document contains medical information for a patient diagnosed with bacteriologically confirmed rifampicin-resistant tuberculosis (RR TB), including their age, address, diagnostic test results, treatment history, current treatment regimen, and physician notes. It lists the patient's municipality, initials, diagnostic test dates and results, treatment regimen of HRZE for 56 days followed by HR for 112 days, and classification as Category I RR TB.

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    This document contains medical information for a patient diagnosed with bacteriologically confirmed rifampicin-resistant tuberculosis (RR TB), including their age, address, diagnostic test results, treatment history, current treatment regimen, and physician notes. It lists the patient's municipality, initials, diagnostic test dates and results, treatment regimen of HRZE for 56 days followed by HR for 112 days, and classification as Category I RR TB.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    4 views1 page

    TBMAC DSTB Template

    Uploaded by

    Mica Disquitado
    This document contains medical information for a patient diagnosed with bacteriologically confirmed rifampicin-resistant tuberculosis (RR TB), including their age, address, diagnostic test results, treatment history, current treatment regimen, and physician notes. It lists the patient's municipality, initials, diagnostic test dates and results, treatment regimen of HRZE for 56 days followed by HR for 112 days, and classification as Category I RR TB.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    MUNICIPALITY

    Province
    Patient Initials (Surname, First
    Name Middle Name)

    Age, Sex & Address

    Date/Year/Duration Regimen Health Facility Outcome


    Treatment History

    Registration Group

    Risk Factor
    Test Date Result

    DSSM

    Xpert MTB/Rif
    Diagnostic Tests

    CXR

    Latest Comparative
    CXR
    Bacteriologic Status Month Date Done DSSM
    2nd Month Follow-Up
    5th Month Follow-Up
    6th Month Follow-Up
    TB Disease
    BACTERIOLOGICALLY CONFIRMED RR TB
    Classification
    Current Weight
    CAT I
    Suggested Regimen HRZE 2 tabs x 56 days
    HR 2 tabs x 112 days
    Other Pertinent
    Details

    Noted by:

    Physician

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