Questions | Concepts |
|---|---|
Contact Date ␣␣-␣␣-␣␣␣␣ 📆 | |
Contact Method *** 🔘 Physical contact/client tracing 🔘 Telephone contact/client tracing 🔘 Other non-coded |
|
Contacted Successfully *** 🔘 Yes 🔘 No 🔘 Unknown | |
Reasons for missing an appointment *** 🔽 Client could not get an off from work/school 🔽 COVID-19 Restrictions 🔽 Exposure to COVID-19 🔽 Had enough medications 🔽 Felt better and stopped taking medication 🔽 Inpatient care or hospitalization 🔽 Patient forgot to attend appointment 🔽 Patient was seen in another health center 🔽 Traveling 🔽 Other | 160582 Reason for poor treatment adherence |
Expected Return Date ␣␣-␣␣-␣␣␣␣ 📆 | |
Outcome | |
Final Tracing Outcome reached (After successful or multiple unsuccessful tracing attempts) *** 🔘 Yes 🔘 No | |
Final tracing outcome - Patient *** 🔘 Dead (Create a Death Form) 🔘 Undocumented/Silent transfer-out (Create a Transfer-Out Form) 🔘 Refused (stopped) treatment (Update ART Therapy Form) 🔘 Interruption in Treatment (Lost to follow-up) 🔘 Currently taking ARV | |
Notes __________________________________ |
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