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Questions

Concepts

Contact Date

␣␣-␣␣-␣␣␣␣ 📆

160753 Date of event

Contact Method

🔘 Physical contact/client tracing

🔘 Telephone contact/client tracing

🔘 Other non-coded

166456 Mode of contact/client tracing

Contacted Successfully

🔘 Yes

🔘 No

🔘 Unknown

67011 167011 Status of call attempt

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

␣␣-␣␣-␣␣␣␣ 📆

5096 Return visit date

Outcome

Final Tracing Outcome reached (After successful or multiple unsuccessful tracing attempts)

🔘 Yes

🔘 No

160721 Procedure outcome

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

160433 Patient outcome status

Notes

__________________________________

165095 General patient note