Paper forms for SCI ETC

Paper forms for the Kerry Town Ebola Treatment Centre run by Save the Children.

The "patient and work flow" file [pptx, pdf] gives an overview.  The other files are forms.  They are:

  1. Triage [word, pdf] (info collected by a medic with partial PPE behind plexiglass with a laptop)

  2. Assessment [word,pdf] (info collected by doctor and/or nurse in full PPE probably using tablet)

  3. Inpatient [word, pdf] (collected in wards with full PPE and tablet)

  4. Drug request form [word, pdf] (sent from wards or assessment using PPE+tablet)

  5. Lab request form [word, pdf] (sent from wards or assessment using PPE+tablet)

  6. Discharge/death form [word, pdf] (from wards using PPE+tablet)

  7. Exit form [word, pdf] (in exit tent, no PPE, laptop or tablet, probably not medical staff)

  8. Ward Assessment form [word, pdf]: A combination of 1+2 for transfer patients who enter with confirmed cases of Ebola, and with a CIF (case investigation form) filled out from the holding centre that transferred them.  For now, this is not being used because many patients arrive without CIFs.

Nov 5 update:  Forms have been recently updated, and now are starting to be used.  As we get feedback from clinicians, we expect further changes.

 

  File Modified

Microsoft Word Document SCI-KT-ETC_Drug_Request_Form_v1.0.docx

Oct 27, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Drug_Request_Form_v1.0.pdf

Oct 27, 2014 by Aram Harrow

Microsoft Word Document SCI-KT_ETC_Discharge_Form_v2.0.docx

Nov 05, 2014 by Aram Harrow

PDF File SCI-KT_ETC_Discharge_Form_v2.0.pdf

Nov 05, 2014 by Aram Harrow

Microsoft Word Document SCI-KT_ETC_Exit_Form_v2.0.docx

Nov 05, 2014 by Aram Harrow

PDF File SCI-KT_ETC_Exit_Form_v2.0.pdf

Nov 05, 2014 by Aram Harrow

Microsoft Word Document SCI-KT-ETC_Inpatient_Form_v1.1.docx

Nov 05, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Inpatient_Form_v1.1.pdf

Nov 05, 2014 by Aram Harrow

Microsoft Word Document SCI-KT-ETC_Triage_Form_v2.0.docx

Nov 05, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Triage_Form_v2.0.pdf

Nov 05, 2014 by Aram Harrow

PDF File Patient_and_work_flow_KerryTown_2014_11_4.pdf

Nov 05, 2014 by Aram Harrow

Microsoft Powerpoint Presentation Patient_and_work_flow_KerryTown_2014_11_4.pptx

Nov 05, 2014 by Aram Harrow

Microsoft Word Document SCI-KT-ETC_Ward_Assessment_Form_v1.0.docx

Nov 05, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Ward_Assessment_Form_v1.0.pdf

Nov 05, 2014 by Aram Harrow

Microsoft Word Document SCI-KT-ETC_Assessment_Form_v2.0.docx

Nov 06, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Assessment_Form_v2.0.pdf

Nov 06, 2014 by Aram Harrow

Microsoft Word Document SCI-KT-ETC_Lab_Request_Form_v2.0.docx

Nov 15, 2014 by Aram Harrow

PDF File SCI-KT-ETC_Lab_Request_Form_v2.0.pdf

Nov 15, 2014 by Aram Harrow