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  • Record Form For Oral Manifestations in HIV/AIDS, 2013: World Health Organization

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    (1) This document is a record form from the World Health Organization for documenting oral manifestations seen in patients with HIV/AIDS. (2) It collects information like patient demographics, medical history, oral exam findings including presence or absence of various oral lesions, and is meant to standardize data collection on oral health issues related to HIV/AIDS. (3) The form includes sections for general patient information, community details, physical measurements, common oral conditions seen in HIV like candidiasis and Kaposi's sarcoma, and space for other relevant notes.

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    (1) This document is a record form from the World Health Organization for documenting oral manifestations seen in patients with HIV/AIDS. (2) It collects information like patient demographics, medical history, oral exam findings including presence or absence of various oral lesions, and is meant to standardize data collection on oral health issues related to HIV/AIDS. (3) The form includes sections for general patient information, community details, physical measurements, common oral conditions seen in HIV like candidiasis and Kaposi's sarcoma, and space for other relevant notes.

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    © All Rights Reserved
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    12 views2 pages

    Record Form For Oral Manifestations in HIV/AIDS, 2013: World Health Organization

    Uploaded by

    Anonymous RnuIUjP
    (1) This document is a record form from the World Health Organization for documenting oral manifestations seen in patients with HIV/AIDS. (2) It collects information like patient demographics, medical history, oral exam findings including presence or absence of various oral lesions, and is meant to standardize data collection on oral health issues related to HIV/AIDS. (3) The form includes sections for general patient information, community details, physical measurements, common oral conditions seen in HIV like candidiasis and Kaposi's sarcoma, and space for other relevant notes.

    Copyright:

    © All Rights Reserved
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    of 2

    World Health Organization

    Record Form for Oral Manifestations in HIV/AIDS, 2013

    Annex 5

    Country:

    Leave blank Year Month Day Identification No. Orig/Dupl Examiner


    (1) (4) (5) (10) (11) (14) (15) (16) (17)

    General information: Sex 1=M, 2=F Date of birth Age in years


    _________________________________________________ (18) (19) (24) (25) (26)
    (Name)

    Ethnic group (27) (28) Other group (29) (30) Years in school (31) (32) Occupation (33)

    Community (geographical location) (34) (35) Location Urban (1) Periurban (2) Rural (3) (36)

    Other data _____________________ (37) (38) Other data ____________________ (39) (40)

    Other data _____________________ (41) (42) Other data ____________________ (43) (44)

    Other data _____________________ (45) (46) Other data ____________________ (47) (48)

    Weight in kg (49–50)
    Fever (54)

    Height in cm (51–53) 1 = Present 2 = Absent

    Candidiasis

    1 = Present 2 = Absent

    Erythematous Hyperplastic Pseudomembranous

    (55) (56) (57)

    Location of lesion

    1 = Present 2 = Absent

    (58) (59) (60) (61) (62)


    Tongue Gingiva Lip/buccal mucosa Palate Pharynx
    World Health Organization
    Record Form for Oral Manifestations in HIV/AIDS, 2013

    1 = Present 2 = Absent
     tick  tick

    Angular cheilitis ............................................................................... (63)

    Oral hairy leukoplakia ..................................................................... (64)

    Necrotizing ulcerative gingivitis (NUG) ........................................... (65)

    Necrotizing ulcerative periodontitis (NUP) ..................................... (66)

    Necrotizing stomatitis ..................................................................... (67)

    Herpetic stomatitis/gingivitis and/or labial ................................... (68)

    Herpes zoster ................................................................................... (69)

    Molluscum contagiosum ................................................................. (70)

    Cytomegalovirus .............................................................................. (71)

    Warty-like lesions/human papillomavirus ..................................... (72)

    Kaposi sarcoma ................................................................................ (73)

    Aphthous ulcers ............................................................................... (74)

    Other ulcerations ............................................................................. (75)

    Dry mouth due to decreased salivary flow ..................................... (76)

    Unilateral or bilateral swelling of major salivary glands ................ (77)

    Other(s) ............................................................................................ (78)

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