Nascop: If Yes To Q2 Go To Section A If No To Q2 Go To Section B
Nascop: If Yes To Q2 Go To Section A If No To Q2 Go To Section B
Nascop: If Yes To Q2 Go To Section A If No To Q2 Go To Section B
Section B
4. Does the hospital administration have any plans of starting and equipping an
adolescent clinic?
a) Yes
b) No
Section c
7. Approximately how much would it cost to refurbish (flooring, painting etc) the
room?
____________500,000__________________________________________________________
______________________________________________________________________________
________
8. Are there any equipments or furniture in the facility that can be availed to
furnish the room once it is refurbished in order to open an adolescent friendly
clinic?
a) Yes
b) No
9. If yes to Q8 above what are some of these equipments and furniture?(please
tick appropriately)
a) Television
b) DVD player
c) Darts
2
d) Pool table
e) Chairs/benches
f) Others (specify)__________________________________
10.Any Remarks or Comments
____Currently the clients meet once a month in the hospital resource room but
there is no special clinic for
them____________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
______
CCC in charge Details
Name: ___PETER MWATHI__________________________________________
Designation: ___SCO__________________________
Contacts:
Mobile _0720212618___________________________________
[email protected]___________________________________
Date: ___12-4-2013___________________________________