Third Philippine Tuberculosis Drug Resistance Survey

End of Survey Performance Report

Reporting Period Start of cluster survey until (Cluster’s last date of

patient enrollment)
Region
Province
Accomplished by

A. Survey Performance of DOTS Facilities

Presumptive TB (All ages) Presumptive TB (15yo and above) Enrollment

Indicate number
Xpert-positive
and reasons for
Name of DOTS (+) (+) (-) enrolled / referred DRS-Enrolled
Start Date Tested Tested non-enrollment of
Facility Seen Xpert Seen Xpert Xpert to treatment
by Xpert by Xpert DRS-eligible
result result result Re Re
New New Patients
treatment treatment
1.

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10.