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HOLY FAMILY MISION HOSPITAL NANGINA MATERNITY REPORT- TOTAL

Admissions Mothers
Discharges Mothers
Discharge in TOTAL DELIVERIES
Normal delieries
Breech deliveries
C/S
Assisted virginal delivery
NBU Babies Adm/Disc/Death
Live Births
Fresh still birth
Macereted Still birth
Birth with deformities
No with low APGAR score
underweight(under2500g)
No of babies given tetracycline at birth
Pre-term Babies
No. of babies discharged alive
No. of infants initiated on breastfeeding within 1hr after birth
Total deliveries from HIV +ve women
Neonatal death(s)
No. of adolescents10-19yrs Maternal death
Maternal death(S)
Maternal death(s)audited
Maternal Complications
APH Alive/Death
PPH Alive/Death
Eclampsia Alive/Death
Raptured Uterus Alive/Death
Obstracted labor Alive/Death
Sepsis Alive/Death
No. of referral From Other health Facility
from community unit
To other health facility
To Community unit
Maternity-PMTCT
No. women Counselled
Total no tested
No newly positives
No of women issued with preventive ARVs
No of Infants issued with preventive ARVs
Women
No Initiated withCotrimoxaxole Infant
Adolescents 10-19 accessing PAC services
Total receiving PAC services
Total given CHX

Compiled by……………………………………………….. Designation……………………………


.
OUTPATIENT REPORT TOTAL
Visit Status New Revisit
Dressings
Stitches
Removal of stitches
Injections
Catheterization
Casualty's
OPERATIONS No. Booked
No. Operated
Minor Surgeries(Exclude
circumcision
Emergencies
Cold Cases
Circumcisions
Major surgeries

Compiled by………………………… Designation………………..

PHYSIO DEPARTMENT

New Revisit
PHYSIOTHERAPY CLINIC
P.O.P
<5Yrs 5-19ayrs 20+ Yrs
OPD
No. of PWDs identified and receiving physiotherapyIPD
OPD
No. of other client/pts receiving physiotherapy IPD
Total No. of treatments
PWDs assessed for registraion

Compiled by………………………………………….Designation………………………………………………
National AIDS & STI Control Programme
Comprehensive HIV/AIDS Facility Reporting Form - (MOH 731 Version August 2016)
County Month
Sub County Year
Facility Holy Family Nangina Hospital MFL Code

1. HIV Testing & Prevention Services


1.1 HIV Testing
Tested 1-9 HV01-01
Tested 10-14 (M) HV01-02 (F) HV01-03
Tested 15-19 (M) HV01-04 (F) HV01-05
Tested 20-24 (M) HV01-06 (F) HV01-07
Tested 25+ (M) HV01-08 (F) HV01-09
Tested Total HV01-10
Tested Facility HV01-11
Tested Community HV01-12
Tested New HV01-13
Tested Repeat HV01-14
Tested Couples HV01-15
Tested KeyPop HV01-16
1.2 HIV Positive Results
Positive 1-9 HV01-17
Positive 10-14 (M) HV01-18 (F) HV01-19
Positive 15-19 (M) HV01-20 (F) HV01-21
Positive 20-24 (M) HV01-22 (F) HV01-23
Positive 25+ (M) HV01-24 (F) HV01-25
Positive Total HV01-26
Negative Total HV01-27
Discordant HV01-28
Positive KeyPop HV01-29
1.3 HIV Positive 3 Months ago Linked to Care
Linked 1-9 HV01-30
Linked 10-14 HV01-31
Linked 15-19 HV01-32
Linked 20-24 HV01-33
Linked 25+ HV01-34
Linked Total HV01-35
Total Tested Positive (3 HV01-36
SELF TESTING Number assesed for HIV risk
15-24 (M)= Assesed 15-19 (M)= (F)=
15-25 (F)= Assesed 20-24 (M)= (F)=
25+ (M)= Assesed 25-29 (M)= (F)=
25+ (F)= Assesed 30 & older (M)= (F)=
Total Total Assesed for HIV Risk
Compiled by……………………………………………….. Designation………………
HOLY FAMILY NANGINA TB MONTHLY REPORT-
3.8 Starting IPT
Start IPT <1 HV03-59
Start IPT 1-9 HV03-60
Start IPT 10-14 HV03-61
Start IPT 15-19 HV03-62
Start IPT 20-24 HV03-63
Start IPT 25+ HV03-64
Start IPT Total HV03-65
Completed IPT 12 months HV03-66

3.10 HIV in TB Clinic


TB Cases New HV03-76
TB Cases KP HV03-77
TB Cases Tested HIV HV03-78
TB Known Status HV03-79
TB New HIV+ HV03-80
TB Total HIV+ HV03-81
TB Already on HAART HV03-82
TB Start HAART HV03-83
TB Total on HAART HV03-84

TB CLINIC
New Revisit
TB CLINIC

TB SCREENING
0-14yrs 15yrs Total
Total Number of people screened
Total Number of presumptive TB cases
Total Number already on TB treatment
Total Number of people not bscreened

Compiled by……………………………………………….. Designation………………


Designation………………
THEATRE REPORT
OPERATIONS No. Booked No. Operated
Minor Surgeries
Emergencies
Cold Cases
MVA
Major surgeries
Elective C/S
Emergency C/S

Compiled by……………………………………….Designation…………………..

THEATRE REPORT
OPERATIONS No. Booked No. Operated
Minor Surgeries
Emergencies
Cold Cases
MVA
Major surgeries
Elective C/S
Emergency C/S

Compiled by……………………………………….Designation…………………..

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