ADELA HEALTH CENTER PHEM Weekly Report Format For SAM Cases of OTP From 03/11/2015 To 09/11/2015

Name of kebele All Total No.of SAM New Admision Total discharge Total Stook
total site case on OTP at OTP
site report the beginning case at
to ed of the week end of
repo the
rt Age 0- Age 0-59 Return Transfe Cure Death Defaulter Trasfer week PNCT F-75 F-100 Am Amox
59 >5yrs ed after r in out oxsu
month Month from tosc Sacket sp. Tab.
6 defulter Sc
Adala H/C 1 1
Adalaa HP 1 1 3 0 0 0 0 0 0 0 0 3 300 0 0 0 25
Q/Xulee HP 1 1 6 0 2 0 0 3 0 0 0 5 348 0 0 0 0
H/Adii HP 1 1 3 0 0 0 0 0 0 0 0 3 382 0 0 0 0
Aanolee HP 1 1 2 0 2 0 0 2 0 0 0 2 574 0 0 0 0
J/Torbii HP 1 1 8 0 4 0 0 1 0 0 0 11 0 0 0 0 0
Total PHCU 6 6 22 0 8 0 0 6 0 0 0 24 1604 0 0 0 25

Reported By:- Mohammed Adem Phone Number 0912624425 Reported Date 10/11/2015 signature__________
orted Period from 03/11/2015 to 09/11/2015 Weekly Report Format For SAM cases OTP Zone :East Bale Woreda :Rayitu kebele ADELA HC Date 10/11/2015.E.C
S/n Name of All total site Total No.of SAM case New Admision Total discharge Total Stook
kebele to report site on OTP at the case at
reporte beginning of the end of
d Age
week0- Age 0-59 >5yrs Cure Death Defaulte the week PNCT F-75 F- Amox Amox
59 >5yrs Month6 r Sacket 100 susp. Tab.
month
1 H/C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
WEEKLY Report Format For SAM cases SC Zone :East BaleWoreda Rayitu PHCU ADELA HC_
Name of All total site Total No.of SAM case New Admision Total discharge Total Stook
kebele to report site on SC at the SC
reporte beginning of the case at
d week end of
Age 0- Age 0-59 >5yrs Cure Death Defaulte Medical Stablized the PNC F-75 F-100 Amo Amox
59 >5yrs r transfer to OTP week T xsusp
month .
Month Sack Tab.
et
1 1 1 2 0 0 0 0 0 0 0 2 0 35 0 8 0 500
Adela HC
Total 1 1 2 0 0 0 0 0 0 0 2 0 0 0 0 0 0

Reported by Mohammed Adem Tel._0912624425 date_10/11/015 Signature._______

Weekly Report Format for Health extention Worker (WR-HEW )
H/C Name Adela
Healthy post Woreda Rayitu
name/health centre
name
Facility Adelaa PCHU
Zone E/Bale
Start of week from Monday 03/_11/ 2015 to Sunday 09/11 /2015 E.C
1.record below the total no of case or each disease/condition for the curret weeks
Indicators Out pt In pt
Total malaria (confirmed RDT+ clinically diagnosed as malaria 2 0
Total malaria suspected fever cases examination by RDT or miscroscopy 5 0
Number cases fever positive for malaria RDT P.F 2 0
P.V 0 0
Mixed 0 0
Meningitis (suspected) 0 0
Bloody diahrrea 0 0
Acute febrile illness other than malaria 0 0
Thyphoid fever 0 0
Relapsing fever 0 0
Epidemic thyphus 0 0
Severe Acute malnutrition/MAUC<11.5cm and /or bilateral edema in under 5 years children 0 2
new cases only
2.summery for immediate reportable/ condition
Disease C D Disease C D Disease C D
AFP/polio 0 0 FEVERE +RASH 0 0 Hemortha
gic
0 0

disease
Antrahax 0 0 Neonatal Tetanus 0 0 Dracunac
ulis/
0 0

(AWD) 0 0 Influenza like illness 0 0 guinea

Other 0 0
worm
(specify)
Rabies 0 0 Scabies 0 0 Other 0 0
Maternal Death 0 Measle 0 0 (specify) 0 0

Perinatal Death 0 0 0 0 0
Reported By:- Mohammed Adem Phone Number 0912624425 Reported Date 10/11/2015 signature__________