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ANM/Counselor training July 2003, 2012. 1. FORM AHRG registration form 2. FORM BPeer Educator Weekly Planning & Activity Sheet) 3. FORM CPE wise individual.

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Presentation on theme: "ANM/Counselor training July 2003, 2012. 1. FORM AHRG registration form 2. FORM BPeer Educator Weekly Planning & Activity Sheet) 3. FORM CPE wise individual."— Presentation transcript:

1 ANM/Counselor training July 2003, 2012

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3 1. FORM AHRG registration form 2. FORM BPeer Educator Weekly Planning & Activity Sheet) 3. FORM CPE wise individual HRG compiled monthly sheet 4. FORM C 1Monthly summary sheet 5. FORM DOutreach weekly report 6. FORM EHRG master register 7. FORM FPatient register format 8. FORM FFClinic daily summary sheet 9. FORM GMedicine stock register 10. FORM HReferral slip and Register 11. FORM ICounseling register 12. FORM JAdvocacy activity report 13. FORM KCrisis Management Register 14. FORM LTraining register 15. FORM MDrop in center register 16. FORM NCommodity stock register 17. FORM OMovement register 18. FROM PCommunity mobilization activity register

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5 Condom Promotion Management of STIs Community Mobilization Enabling Environment Referrals & Linkages Behaviour Change Communication HRGs

6 National AIDS Control Organisation, Ministry of Health & Family Welfare, Govt. of India DateSTI / RTI Patient wise Record Provider NameMarrital Status: UM / M / Single / Divorced / Widow(er)Patient ID Number__ __ __ __ / __ __ --- __ __ Clinic NameEducation: UE / interPatient OP Number Clinic Unique ID No.OccupationHRG ID Number Patient NameIncome: Patient Details:6.STI / RTI Risk Assessment:7.STI / RTI Syndromic diagnosis : 8.Lab Test performed: 1.Age Medical History Taken Urethral Discharge (UD) Vagino-Cervical Discharge(VCD) RPR Reactive 2.Sex Sexual History Taken GUD - Herpis(GUD-H) Genital Pediculosis Titre Male Physical Exam. Conducted GUD - Non Herpis(GUD-NH) Genital Warts Confirmed with TPHA Female Speculum and/or Proctoscopic exam conducted Scrotal Swellings(SS) Lower Abdominal Pain(LAP) Gram Stain ICDC Transgender Known HIV Positive Inguinal Bubo(IB) Asymptomatic WBC 3.Type of Client/Pt. Significant points in bullets from Medical & Sexual History: Genital scabies Syphilis Screening Nugent's Score New Anorectal Discharges(ARD) Presumptive Theraphy (PT) H.ducreyi Old Gen. Molluscum Others (specify) - None 4.Category of the Pt. Examination findings : KOH Whiff test +ve Gen. Population Psedohypha/Spores Bridge Population None Mention: Wet Mount Motile Trichomoniasis HRG Clue cells FSW12.Type of visit None MSM New STI/RTI HIV Non Reactive IDU Follow up visit Reactive 5. Patient Flow Asymptomatic if reactive, Direct Walkin General Stage of PLHA from ART Centre Referred Regular Medical Checkup (RMC)11.Others services provided From: Syphilis screening11.1.Patient Education11.4.Referrals 10.If kits are not available Drugs Prescribed/ Issued Partner TreatmentFromTo 9.Details of STI/ RTI Treatment givenPIPI Condom Usage ICTC Kit (If available) Acyclovir 400 mg Permethrin 5% & 1% Other risk reduction ICTC (PPTCT) Kit 1 (Grey for UD/ARD/CD/PT) Amoxicillin 500 mg Podophyllin 20% DMC (1Tab.Azithromycin.1gr+1Tab.Cefixime.400mg) Azithromycin 1gm Tricloroacetic acid 30%11.2.Partner Treatment Care & Support Centre Kit 2 (Green for Vag.Discharge) Benz. Penicillin 2.4 MUGeneral Medicines Prescription written ART Centre (1tab.Flconazole.150mg+2tab.Secnidazole.1gr) Benzyl Benzoate 25% Adrenaline Medication given PLHA network Kit 3 - White for GUD(NH) Cefixime 400 mg Antihistaminics Refferalslip provided NGO (1vial of Inj.Benzathiene Pencillin 2.4MU+1tab.Azithromycin 1gr) Ceftriaxone 250 mg & 1 gm Hydrocortisone Others Kit 4 (Blue for GUD(NH) Ciprofloxacin 500 mg Ibuprofen Specify: (30 tab.Doxycycline.100mg+1 tab.Azithromycin 1gr) Clotrimazole 500 mg Metoclopramide11.3.Condom Kit 5 (Red for GUD(H) - (21 tab.Acyclovir 400mg) Doxycycline 100 mg Ranitidine Given free IEC material given Kit 6 (Yellow for LAP) Erythromycin 500 mgOther treatment given Sold / Social Marketed Append result if any (1tab.Cefixime 400mg+28 tab.Metronidazole 400mg+28 cap.Doxycycline 100mg) Fluconazole 150 mg Prescribed other tests performed Kit 7 (Black for IB) Metronidazole 400 mg Demonstrated (42 tab.Doxycycline+1 tab.Azithromycin 1gr) Secnidazole 2gr Next Follow Up day: 3 / 7 / 14 / 21 days


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