SOP FOR DTCs

Objective

To inform the rehabilitation of existing DTCs and the establishment of additional DTCs in Yemen
according to national and WHO standards.

When to Open a DTC

During an outbreak of acute watery diarrhea, most patients can be treated in existing health facilities.
However, during outbreaks, particularly cholera, health officials may decide to set up a temporary
Diarrhea Treatment Center (DTC), either in part of the existing facility or as a separate site. The purpose
of a DTC is to provide rapid and efficient treatment for patients who meet the admission criteria for
stationary treatment of cholera (see page 4 for admission criteria).

Establishing a DTC requires identification of suitable sites, organization of patient flow, infection control
and pre-position of supplies, stocks of drugs and other material.

How to choose a site for a DTC

A DTC should be in a place where patients can be adequately treated, and that patients can reach easily.
The nearer the patients, the lower the case fatality rate (CFR) can be. The specific objective of operating
a DTC is to bring emergency health care services as close as possible to patients who otherwise would be
at risk of death during cholera epidemics. The DTC may be in an existing health facility, or other existing
building, such as a closed school or community hall. If there is no suitable building, the DTC could be set
up in a tent in a field. Health authorities and communities should be involved in the selection of sites
and their preparation. The DTC should not be close to a water source or any other functioning public
structures (e.g., schools, dispensaries, markets).

When planning, consider the following characteristics:

• Good drainage away from the site (Do not select low ground or depressions.)
• Good access for patients and supplies (Consider the distance and availability of transport.)
o To market = 100 m
o To water source = 40 m on sandy soil, 15 m, if clay
o To other buildings and dwellings = 100m
• Easy to clean
• Ventilation
• Light (ideally electricity), especially in hospital wards
• Provisions for disposal of excreta, vomit, or medical and other waste
• Convenient hand-washing and toilet facilities
• Concrete floor, or, if temporary structure, a plastic sheeting cover
• Separated from other patient wards, if located within an existing healthcare facility
• Adequate space of Ward capacity = 2.5m2 per patient + 1 attendant
o A 29m2 tent can accommodate 10 patients + attendants

1
 o A 82m2 tent can accommodate 30 patients + attendants

DTCs can be opened and closed very quickly, based on epidemiological findings. Do not hesitate to move
a DTC from one place to another, if necessary. Flexibility must be maintained throughout the course of
the epidemic.

Organization of patient flow

The layout of a building probably cannot be changed, but plans can be made for making the best use of
the space available (see Figure 1). The DTC is organized into separate areas, following two key principles:

1. Isolation of the entire facility from other public structures (dispensary, school, market)
2. Separation of patients (contaminated area) from the “neutral area” (not contaminated)
See detailed floor plan in Annex 1

Patient and staff flow should accommodate the following:

Patient care

o An entry/observation ward o Prevention and hygiene

o Provision for administering ORS o Washing and cleaning areas,
o A ward for patients who are laundry area
very ill and require intensive o Convenient hand-washing
care stations
o A ward for patients who are o Water treatment, preparation
recovering of chlorine solution
o Storeroom(s), staff room o Kitchen (where feasible)

2
 Environment and waste

o Toilets (latrines) o Watchman for information and

o Safe waste disposal patient flow control
(incinerator, dustbins) o Fences
o Morgue o Protection of stocks (food,
o Security drugs, supplies)

Functions to be ensured in the DTC

Five areas have to be well defined and restricted for their intended use to respect the clean flow of air and limit the
spread of infection:

1. Admission and screening area where all the new arrivals have to go through for triage and registration

2. Observation area where patients with moderate dehydration receive oral rehydration therapy

3. Hospitalization area where patients with severe dehydration or vomiting are treated with IV and oral
rehydration

4. Neutral area for the kitchen, stocks, changing room, and rest room for the personnel

5. Recovery area where hospitalized patients proceed from the hospitalization area for continued oral
rehydration after being upgraded from severe dehydration to mild or moderate dehydration

Triage/Patient flow

If no dehydration

Refer patient to the onsite oral rehydration corner

If some dehydration = “Moderate Case”

1. Register patient

2. Admit patient to Oral Rehydration Corner/Observation Area

3. Treat patient with Oral Rehydration Salt (ORS) solution

4. Move to Hospitalization Area if patient worsens, discharge when patient recovers

If severe dehydration and/or uncontrollable vomiting = “Severe Case”

1. Initiate IV therapy immediately in patients arriving in shock (lethargic, unconscious…)

2. Register patient
3. Admit patient to Hospitalization Area
4. Treat patient according to treatment guidelines

3
 5. Move to the Recovery Area when no longer dehydrated/significantly reduced loose stools with no vomiting
6. In Recovery Area, continue ORS until asymptomatic

See Annex 2 for detailed Treatment Flowchart for Cholera Cases

See Annex 3 for Assessment and Treatment of a Severely Malnourished Child 6–59 Months Old with Watery Diarrhea

Admission and Discharge Criteria in a DTC

Screening, admission and observation

Patients are examined by a medical person in the ORC for screening. If suspected cholera, admit; otherwise send to
normal dispensary. Patients are admitted with 1 attendant (caregiver). Patients who are admitted are registered
(cholera register).

Moderate or mild cases receive oral rehydration therapy in observation where they stay under medical observation for
4- 6 hours. Patients stay under tents or shelters, on mats or benches and will be discharged directly from there. Severely
dehydrated persons or those with uncontrollable vomiting should be admitted into the DTC directly.

Discharge

If hospitalized, first transfer to recovery area and keep under observation and ORS for 6 hours. From recovery area,
discharge when there are no more signs of dehydration and less than 3 liquid stools during the past 6 hours. Advice the
patient or caregiver to come back to the treatment center immediately if:

o vomiting restarts,
o diarrhoea worsens,
o patient is drinking or eating poorly

Discharge with enough ORS bags for 2 days (age dependent) at home and instruct the patient to prepare the ORS
solution with clean water.

Infection Control

At the Entry/Exit Point

The most important time for spraying of feet is upon entrance to and exit from the center to avoid contamination in and
out of the center. It also makes staff and visitors aware of the contamination they are potentially bringing into the
different areas.

Footbaths are inefficient as disinfectants, as they become dirty very quickly. Therefore, spraying is preferred. If
footbaths are installed, they should be trays with cloth or sponge soaked in 0.5 % chlorine solution and changed twice
per day or when the cloth appears dirty. Spraying and footbaths also can be important barriers between the outside and
the center.

4
It is important to note that after chlorine solution preparation, the calcium deposits at the bottom of the container
should not be used, particularly in the sprayers, as this will cause blockages. Sprayers adapted to resist strong
concentrations of chlorine should be used.

At Admission

o Patients and caregivers should enter through the patient entrance area where their feet and shoes will
be disinfected with a 0.5 % chlorine solution by a sprayer preferably, or footbath.
o They will then be asked to wash their hands upon entry using the container provided.
o Disinfect the mean of transport of the patient with the 0.05% solution for stretchers and beds or 0.5%
for moving vehicles.
o Dip the clothes of the patient into a 0.05% solution for 30 minutes, then rinse with clean water and dry
under the sun.
o Restrict and control movements into and within the wards as much as possible.
o Establish hand‐washing stations with chlorine-treated water and soap.
o Restrict admission and care to one caretaker per patient.

During Hospitalization

o Wash hands with soap or chlorine solution (0.05%) before and after examining each patient.
o Gloves should also be made available for those manipulating blood, chlorine, and the chlorinated
solutions.
o Disinfect the shelters, beds, and floor at least twice daily with the 0.5% solution.
o Disinfect the showers, latrines, and washing areas with the 0.5% solution.
o Dispose of stools of patients in a specific, regularly disinfected (2%) latrine.
o Wash and disinfect (0.05%) the clothes and bed linens of cholera patients frequently and separately.

Those caring for patients should not be allowed to prepare or serve food.

At Discharge

o Sponge or wash the person with a cloth, his hands, and his clothes with the 0.05% solution.
o In case of death, wash the body of the deceased with a 2% solution in a reserved area, close the orifices
of the body with chlorinated cotton wool (2%), and wrap the body in a sheet or place in a body bag, if
available.
o The burial must be done immediately

Visitors

If a family member will stay with the patient to provide general nursing care and feed the patient, fewer staff may be
needed. Clinical staff should concentrate on the treatment of patients, and look for others who can temporarily take
over routine or clerical work. However, professional staff and community health workers must teach and closely
supervise nonprofessional caretakers.

5
Water, Hygiene, and Sanitation

Water supply

• Patients: Approximately 60 liters of treated water per patient per day is needed for drinking, cleaning, bathing,
and washing clothes.
• Caregivers: At least 15 liters of treated water per caregiver per day is needed.

Water quality

• All drinking-water is treated (levels of chlorine are tested regularly—see Appendix VI for chlorine solutions)
• Water for consumption in a DTC should be chlorinated to give a residual of either/or:
o 0.2–0.5 mg/l where pH <8
o 0.4–1 mg/l where pH is ≥8

• Water can only be effectively chlorinated if turbidity (cloudiness of fluid) is <5 Nephelometric Turbidity Units
(NTU) and up to 20 NTU for minimum periods in times of emergency (NTUs are measured by a calibrated
nephelometer).
• Quantity of chlorine per patient per day for all needs (including storage/preparedness) is approximately 100 g of
HTH/patient/day.

Drinking water storage

• Drinking water is stored separately from water for other uses.

• If drinking water is stored in containers, only safe containers should be used. The following characteristics of a
water storage container will provide physical barriers to recontamination and render the container safe to store
water:
o Contains a small opening with a lid or cover that discourages users from placing potentially
contaminated items such as hands, cups, or ladles into the stored water.
o Has a spigot or small opening to allow easy and safe access to the water without requiring the insertion
of hands or objects into the container.
o Is a size appropriate for the water treatment method, with permanently attached instructions for using
the treatment method and for cleaning the container
o If containers with these characteristics are not available, efforts should be made to educate health care
workers to access the water by pouring from the containers rather than dipping into it with a possibly
contaminated object

Chlorine solution storage

• Only one person should be in charge of preparing the different chlorine solutions per shift.
• Often 125 liter containers with taps are used in the centers. These should be clearly marked with the solution
that it is used for, to avoid accidents.
• Different colored containers can also be used to call attention to the different concentrations.
• Additional quantities of all the solutions are stored in a neutral area.

Please see Annex 4 for a summary on water, hygiene and sanitation needs of a DTC.

6
Supplies and Resources

The key principle is to avoid any shortage. Determine a detailed list of supplies per patient load to obtain estimates for
your facility. Expected number of cases and delays in supply accessibility should be considered in this estimate. A supply
of excess essential supplies or contingency supplies, also known as buffer stock, (for 3-14 days) in case of surges of cases
or re-supply issues should be on-site at all times. Supplies include medical material for rehydration and other
treatments, water facilities, chlorine for disinfection, and all logistic material needed to equip a DTC (see Appendix V). In
addition, stationery, registers, and other supplies are needed, as well as bags and linen for the bodies of deceased
patients.

Initial Supply

The central cholera kit contains the necessary equipment and supplies for the initial response to a cholera outbreak, at
central level within an existing health structure such as a referral hospital or an already established cholera treatment
center. One complete central cholera kit provides treatment for 100 patients (80 severe cases, requiring IV rehydration,
and 20 mild/moderate cases who should be given oral dehydration solutions only).

The central cholera kit contains separate modules including the drugs module, the renewal supplies module, the medical
equipment module, the logistics module and the document and stationary module. For preparedness, a full kit should be
ordered, although each module can also be ordered separately, depending on the local availability of the different
components. Please find a list of the cholera kit content in online http://www.who.int/cholera/kit/cholera-kit-
information-note.pdf?ua=1. In additional to the central kit, there is a community kit which contains the necessary
equipment and supplies for the initial response to a cholera outbreak at community level. The community kit is designed
to support a small treatment facility for an average of 40 patients’ maximum per day. The community kit is designed for
the oral dehydration of 100 mild/moderate cases.

Maintaining supplies beyond the initial kit

To avoid supply shortages, there are several key principles:

1. Assessing storage capacity: The physical space that is available for storage determines the DTC storage
capacity. When building/designing a DTC/CTU, keep in mind the amount of space needed to store supplies
(including the initial stock, re-supply, and a buffer stock for 3-14 days). Storage areas must be kept secure from
crime and weather.

2. Monitoring inventory (i.e. counting supplies periodically): Personnel to regularly perform an inventory of
supplies, especially critical supplies, are necessary. Tracking sheets of critical supplies in storage and dates the
supplies were used will help the DTCmaintain adequate supplies.

3. Rate of consumption: The rate of consumption (i.e. the number of key supplies used per day) should be
determined on a regular basis. Important information to monitor includes:

a. Number of inpatients seen per day

b. Number of outpatients seen per day
c. Number of ORS packets used per day
d. Number of lactate ringer bags used per day
e. Number of antibiotic doses used per day

7
 4. Time needed to re-supply: The time required for a supply order to arrive at the DTCafter an order is requested
is referred to as the ‘time needed to resupply’. This time varies by supplier and/or the type of supply needed
and also may vary during times of political unrest, bad weather conditions, or nation-wide stock-outs. Supply
ordering and communication protocols with suppliers should be understood by the logistician/person in charge
of supply.

5. Surge capacity: DTCs/CTUs should anticipate that they may have sudden increases (surges) in the number of
patients seeking care. Monitoring trends over time of the number of patients seen daily and the rate of
consumption of critical supplies may help the DTC identify patient surges. If the trends suggest that the DTC is
treating more patients, then supply ordering can be adjusted.

6. Critical Supplies: Critical supplies - without which the medical care of patients will be significantly impaired -
should be monitored closely. Ideally, a DTC should not run out of critical supply items. All critical supplies can be
stored at room temperature for 2 years. Critical supply items include:

a. Ringer’s lactate i. HTH

b. IV infusion sets j. Disinfectant (i.e. iodine)
c. IV cannulae k. Soap
d. Oral Rehydration Solution l. Latex/Nitrile gloves
e. Doxycycline m. Naso-gastric (NG) tubes
f. Azithromycin n. Tape
g. Zinc o. Body bags
h. Aquatabs p. Cotton balls

7. Buffer stock: Buffer stock is an excess of essential supplies or contingency supplies stored at the DTC/CTU. The
buffer stock assures that the DTC can provide adequate care for patients in the event of a sudden patient surge
or a problem with delivery or acquisition of critical supplies. The amount of buffer stock necessary ranges from
supplies for 3-14 days, depending on the frequency of re-supply, time needed to re-supply, and storage capacity.

8. Dependent units (e.g. ORCs): A DTC must account for the supply needs of ORCs or other facilities nearby that
will depend on that DTC for supplies. Logisticians/stock-keepers should receive inventory and rate of
consumption data from ORCs frequently. A buffer stock and stock in case of patient surge should be maintained
for these facilities at the DTC.

8
Human Resource Requirements

The DTC should be staffed by health workers (physicians, nurses, and other support staff) who have been trained in the
case management of diarrhea. In addition to clinical staff, the DTC will need non-clinical staff such as clerks, cleaners,
crowd controller/sprayers, health educators, and stock-keeper etc. In order to provide 24/7 services the staffing plan
needs to have enough staff to cover at least three shifts per day with weekly rest days.

Required staffing for standard DTCs - ORC

Staff Number of Number of staff needed per 8 hour shift

Beds
Morning Afternoon Night Total
DTC/ 12-72 1 - - 1
ORC team leader
Triage nurses * 18 1 1 1 3
Patient registrars 12-72 1 1 1 3
ORC nurses 50 – 100 2 2 2 6
patients
Hygiene promotion officers 50 – 100 1 1 - 2
patients
Physicians 18 1 1 1 3
Infection control nurses 12-36 1 1 1 3
Ward nurses 18 2 2 2 6

Pharmacist / stock keeper 12-72 1 1 - 2

Attendants* 12-36 3 3 3 9
Guards / crowd controllers 12-36 1 1 1 3

Cleaners / disinfectors ** 12-36 3 3 2 8

Total 18 17 14 49

*Family members assisting in the care taking of the patient - not on the payroll
** Community members assisting in running the services

9
Recording and Reporting

Each DTC will record information using the following documents

• The cholera line list (shared separately)

• Patient records (annexed)
• DTC activity report – daily – documenting overall numbers by sex and >5 <5, screened/treated/educated and
most importantly stock monitoring to monitor consumption and allow for informed re-stocking (draft to be
shared asap)
• Referrals received from ORCs (annexed)

Each DTC will report information using the following documents

• Line list submitted daily to governorate surveillance officer before 5 pm every evening
• Weekly report (draft to be shared with partners asap)

10
Annex 1 detailed DTC floor plan

11
Annex 2

12
13
Annex 4

14
Annex 5

‫سجل التبليغ عن حاالت اإلسهاالت المائية الحادة‬ : Reporting Health facility

...………………………………………………
/ ‫الصح‬
‫ي‬ ‫المرفق‬
Treatment
Received:
culture other symptoms Status of
Outcome ‫العالج‬
testing ‫أعراض أخرى‬ dehydration ‫حالة‬
‫حالة المريض‬
results 1.ORS: ‫الجفاف‬
‫عند الخروج‬ Rapid
‫نتيجة الفحص‬ ‫تاري خ اخذ‬ ‫محلول إرواء‬ 0. No other signs
If reffered, Diagnosis Test Acute rice watery
‫اع‬
‫الزر ي‬ ‫العينة‬ ‫التوجد اع راض‬ 0: Non dehydration
specify HF in case of 1. Referred (RDT) results diarrhoea Sex
Date of 2. IV fluids: 1. Abdominal ‫ال يوجد جفاف‬

Age in years
‫اذا‬ death ‫احالة‬ ‫نتيجة الفحص‬ ‫إسهال‬ Date of Date of ‫الجنس‬ Status

‫العمر بالسنه‬
1. Yes ‫نعم‬
vomiting
0. Note Sample ‫سوائل وريدية‬ cramps ‫الم البطن‬

0. No ‫ال‬
‫تمت‬ ‫ يف حالة الوفاة‬2. Death ‫وفاه‬ ‫الرسي ع‬ ‫مائ حاد شبيه الرز‬
‫ي‬ admission Date of visit onset village Sub district District Governorate 1. M Name ‫الحالة‬
done ‫لم يعمل‬ Collected 2.Cramps in legs 1: some Id

‫يفء‬
‫االحاله‬ 3.Discharge/ ‫تاري خ الرقود يف‬ ‫تاري خ زيارة‬ ‫تاري خ بداية‬ ‫ ي‬/ ‫القرية‬
‫الح‬ ‫العزلة‬ ‫المديرية‬ ‫المحافظة‬ ‫ذكر‬ ‫أسم المريض‬ New ‫جديد‬
1. Positive Rectal Swab 3. Antibiotic: and arms dehydration
‫حدد المرفق‬ Death date improved 0: Not done ‫مضادات حيوية‬ 0.No ‫ال‬ ‫الصح‬
‫ي‬ ‫المرفق‬ ‫الصح‬
‫ي‬ ‫المرفق‬ ‫اض‬ ‫االع ر‬ 2. F follow up ‫متابعة‬
‫ايجائ‬
‫ي‬ or Stool ‫الم االرجل‬ ‫بعض جفاف‬ ‫ى‬
‫الصح‬
‫ي‬ ‫تاري خ الوفاة‬ ‫شفاء‬ ‫لم يعمل‬ 1.Yes ‫نعم‬ ‫أنث‬
2.negative Sample ‫والذراع‬
4. health 1: Positive ‫ايجائ‬
‫ي‬ 4. health
‫سلث‬‫ي‬ Collected 3: General body 2 : Severe
promotion 2: Negative ‫سلث‬ ‫ي‬ promotion ‫تثقيف‬
3. Pending weak dehydration
‫صح‬
‫ي‬ ‫تثقيف‬ ‫صح‬
‫ي‬
‫بانتظار النتائج‬ ‫الم عام يف الجسم‬ ‫جفاف حاد‬
‫ى‬ 4:Headache
(‫يمكن تسجيل أكث‬
‫صداع‬
‫)من خيار‬

15
‫‪Annex 6 Patient record‬‬

‫الوقت‪.........................:‬‬ ‫تاريخ الدخول‪........../........./.....:‬‬ ‫أسم المريض‪.........................................:‬‬

‫األسم‪ .......................................................:‬اللقب‪............................................:‬‬
‫المديرية‪...........................:‬‬ ‫القرية‪.....................................:‬‬ ‫المنطقة‪............................:‬‬
‫الوزن التقريبي‪......................:‬‬ ‫العمر‪................:‬‬ ‫تاريخ بداية األعراض‪........../......./....:‬‬

‫‪-1‬التقييم األولي‪:‬‬
‫غير موجود ( )‬ ‫ضعيف ( )‬ ‫موجود ( )‬ ‫النبض‬
‫خمول ‪ /‬فقد الوعي ( )‬ ‫ارق ‪ /‬منفعل ( )‬ ‫جيد ‪ /‬حذر ( )‬ ‫الحالة‬
‫نعم ( )‬ ‫نعم ( )‬ ‫ال ( )‬ ‫العين (غائر)‬
‫غير قادر على الشرب ( )‬ ‫الشرب بنهم ( )‬ ‫الشرب طبيعي ( )‬ ‫العطش‬
‫تتراجع ببطئ شديد ( )‬ ‫تتراجع ببطئ ( )‬ ‫تتراجع بسرعة ( )‬ ‫قرصة الجلد‬
‫حاد ( )‬ ‫متوسط الوجود ( )‬ ‫اليوجد ( )‬ ‫الجفاف‬

‫‪ -2‬المخرجات ‪:‬‬
‫اليوم الرابع‬ ‫اليوم الثالث‬ ‫اليوم الثاني‬ ‫اليوم االول‬
‫التاريخ ‪......./...../....‬‬ ‫التاريخ ‪......./...../....‬‬ ‫التاريخ ‪......./...../....‬‬ ‫التاريخ ‪......./....../.....‬‬
‫الليل‬ ‫مساء‬ ‫صباح‬ ‫الليل‬ ‫مساء‬ ‫صباح‬ ‫الل‬ ‫منتصف‬ ‫المساء‬ ‫الصباح‬
‫يل‬ ‫النهار‬ ‫‪3‬‬ ‫ساعة‬ ‫‪30‬‬ ‫‪15‬‬
‫ساعات‬
‫‪min‬‬ ‫‪min‬‬ ‫الوقت‬

‫محلول اإلروا‬
‫( فموي)‬

‫المحلول‬
‫الوريدي‬

‫اإلسهال‬

‫القيئ‬

‫الجفاف‬

‫تاريخ الخروج ‪ * ...../..../....‬متشافي *متهرب *انتقل او تم إحالته * توفى‬

‫اذا المريض توفى‪ ،‬ماهو سبب الوفاة والوقت‪............................................‬‬
‫‪16‬‬
Annex 7 Daily reporting (TO BE SHARED ASAP)

17
Annex 8 Weekly reporting (TO BE SHARED ASAP)

18
‫‪Annex 9 ORC Referral form‬‬

‫ا‬
‫مذكرة إحالة لمركز معالجة اإلسهاالت المائية الحادة‬
‫رقم المريض (اإلحالة)‪......... :‬‬
‫التاريخ‪2017/...../... :‬م‪ ،‬الوقت‪........ :‬‬

‫الجنس‪......... :‬‬ ‫العمر‪.............. :‬‬ ‫اسم المريض‪.............................. :‬‬

‫عنوان المريض‪ :‬القرية‪....................... :‬العزلة‪ .................... :‬المديرية‪............... :‬‬

‫إسم زواية اإلرواء الفموي (الجهة المحال منها)‪............................... :‬‬

‫إسم مركز معالجة اإلسهاالت المائية الحاده (الجهة المحال إليها)‪......................... :‬‬
‫‪ ‬وسيلة مواصالت ‪ ‬أخرى تذكر ‪.............‬‬ ‫سيارة إسعاف‬ ‫‪‬‬ ‫الوسيلة المستخدمة لإلحالة‪:‬‬
‫اليوم‪ ........... :‬الموافق‪2017/..../............... :‬م‪.‬‬ ‫تاريخ بدء أعراض اإلسهال المائي الحاد‪:‬‬
‫أسباب اإلحالة‪................................................................................................................ :‬‬
‫‪...............................................................................................................‬‬
‫مدير المرفق الصحي‬ ‫المسئول المباشر على زاوية المعالجه‬
‫اإلسم‪.......................... :‬‬ ‫اإلسم‪.......................... :‬‬
‫الصفة‪......................... :‬‬ ‫الصفة‪......................... :‬‬
‫التوقيع‪............................. :‬‬ ‫التوقيع‪............................. :‬‬

‫مالحظة‪ :‬المعلومات التالية تعبئ في كال النسختين من قبل مركز معالجة اإلسهاالت الحاده‪ ،‬وذلك لحظة وصول المريض‪،‬‬
‫اإلصل لمركز المعالجه ونسخة للمريض‪ .‬معلومات وصول المريض لمركز المعالجه‬

‫اسم مركز معالجة اإلسهاالت المائية الحاده المستقبل للحاله‪........................................... :‬‬

‫تاريخ وساعة وصول المريض لمركز المعالجة‪2017 /...../... :‬م‪ ،‬الساعة‪......... :‬‬

‫اسم المسئول المناوب‪............................ :‬‬

‫الصفة‪.............................. :‬‬
‫التوقيع‪................................. :‬‬

‫▪ النسخة األصل لمركز معالجة اإلسهاالت المائية الحاده (الجهة المحال إليها)‬
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 ‫▪ نسخة للمريض‬
‫▪ نسخة لزاوية اإلرواء الفموي (الجهة المحال منها)‬
‫)‪Annex 10 Stock monitoring form (TO BE SHARED ASAP‬‬

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