MINISTRY OF HEALTH

TANZANIA PROJECT ECHO®HIVLAB ECHO TELEECHO™ SESSION

HIV –RT TRAINING REGISTRATION FORM/SHEET THROUGH PROJECT ECHO

HEALTH FACILITY NAME_____________________________________DISTRICT/COUNCIL______________________ REGION________________ TRAINING COHORT NUMBER___________

SN Participant Full Name Professional HIV Phone Module Module Module Module Module Module Module Module Module Module Module Module
Title Testing number 1 2 3 4 5 6 7 8 9 10 11 12
Site Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Date: Date:
name

Name of HTS Focal Person_____________________________________________________Phone number__________________________________Signature__________________

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