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