• Ready for review
  • Service Delivery Model Form✅

    Questions

    Concepts

    Questions

    Concepts

    Date enrolled to DSD

    ␣␣-␣␣-␣␣␣␣ 📆

    160753 Date of event

    Date disenrolled from DSD

    ␣␣-␣␣-␣␣␣␣ 📆

    160753 Date of event

    Reason for disenrolling from DSD

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    163513 Reason for discontinuing service (text)

    Antiretroviral treatment refill model

    🔘 Community medication distribution, healthcare worker led

    🔘 Community medication distribution, peer led

    🔘 Express pharmacy pickup without clinician visit

    🔘 Facility group medication distribution

    🔘 Standard pharmacy pickup following clinician visit

    166448 Antiretroviral treatment refill model

    Notes

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    165095 General patient note