Emergency Service Report

📋

Basic Information

Department *

Month *

Year *

👥

OPD Visits

Number of visits *

OPD visits by age and gender

Age Group	Male	Female
OPD visits <5
OPD visits 5-10
OPD visits 11-19
OPD visits 20-29
OPD visits 30-45
OPD visits 46-65
OPD visits >=66

🚗

Road Traffic Injuries

Number of road traffic injury cases disaggregated by accident type *

Vehicle Occupant

Motor Cyclist

Pedestrian

Others

🔄

Referrals

Number of people referred to other health facility *

Emergency referral

Non-emergency referral

Total number of referral-ins *

Emergency referral

Non-emergency referral

🚑

Ambulance

Number of clients that came to health facility using ambulance *

Pre-facility

Between facility

Total number of Ambulance dispatched in the reporting period - by technician *

:with Emergency Medical Technicians (EMT)

:With out Emergency Medical Technicians (EMT)

Total number of Ambulance dispatched in the reporting period - by Case *

: Labor & Obstetrics Emergency

: Road Traffic Accident

: Trauma

: Burn & Poisoning

: Others Non-traumatic emergency

Total number of ambulance requests made during the reporting period *

💔

Emergency Unit Mortality

Emergency unit mortality *

Total death in the emergency unit *

Death breakdown by timing and age

Category	Male	Female
<24 hours death <15 yr
>=24 hours death <15 yr
<24 hours death >=15 yr
>=24 hours death >=15 yr

📊

Attendance & Discharges

Total number of emergency unit attendance during the reporting period *

Emergency attendance with more than 24 hours stay *

Total number of Emergency attendance with more than 24 hours stay *

Total number of emergency room discharges *

👶

Under-5 Pneumonia & Malnutrition PER only

Under-five children with pneumonia received antibiotic treatment

Number of under 5 years children treated for pneumonia

Number of sick young infants 0-2 months treated for Critical illness

Treated for Very Severe Diseases

Treated for Local bacterial infection (LBI)

Treated for Pneumonia

Children treated with Zinc and ORS for diarrhea

Treated by ORS & Zinc

Treated by ORS only

Growth Monitoring and Promotion (GMP)

Proportion of <2 year children who have participated in growth monitoring and promotion (GMP)

Number of children less than 2 yr weighted during GMP session

Age: 0-5 Months

Age: 6-23 Months

Number of weights recorded with moderate malnutrition, by age (Z-score between -2 and -3) : moderate Underweight

Age: 0-5 Months

Age: 6-23 Months

Number of weights recorded with severe malnutrition, by age (Z-score below (-3) : Severely underweight

Age: 0-5 Months

Age: 6-23 Months

Vitamin A Supplementation

Proportion of children aged 6–59 months who received two doses of vitamin A supplement

Total number of children aged 6-59 months who received Vitamin A supplementation disaggregated by age

Age: 6–11 months

Age: 12–59 Months

Total number of children aged 6-59 months who received Vitamin A supplementation disaggregated by dose

:First dose

:Second dose

Deworming

Proportion of children 24-59 months de-wormed

Total number of children aged 24–59 months dewormed

:First dose

:Second dose

Acute Malnutrition Screening (<5 yr)

Children aged <5 yr screened for acute malnutrition

Total Number of children <5 yr screened for acute malnutrition

Age: 0–5 Months

Age: 6-23 Months

Age: 24-59 Months

Number of <5yr children screened and have moderate acute malnutrition

Age: 0–5 Months

Age: 6-23 Months

Age: 24-59 Months

Number of <5 yr children screened and have severe acute malnutrition

Age: 0–5 Months

Age: 6-23 Months

Age: 24-59 Months

🔬

HIV Prevention and Control

Number of individuals who have been tested for HIV and who received their results (total) *

Clients receiving HIV test results (at PITC)

Age Group	Male	Female
<1 yr
1-4 yr
5-9 yr
10-14 yr
15-19 yr
20-24 yr
25-29 yr
30-34 yr
35-39 yr
40-44 yr
45-49 yr
50+ yr

Clients testing positive for HIV (at PITC)

Age Group	Male	Female
<1 yr
1-4 yr
5-9 yr
10-14 yr
15-19 yr
20-24 yr
25-29 yr
30-34 yr
35-39 yr
40-44 yr
45-49 yr
50+ yr

HIV Testing Service by Population Group

HIV testing service - HTS who received result by population group (total) *

HIV testing service - HTS who tested positive by population group *

Female commercial Sex workers

Received result

positive

Long distance drivers

Received result

positive

Mobile/Daily Laborers

Received result

positive

OVC of PLHIV

Received result

positive

Children of PLHIV

Received result

positive

Prisoners

Received result

positive

Partners of PLHIV

Received result

positive

Other MARPs

Received result

positive

General population

Received result

positive

💊

NCD

Hypertension

Number of Individuals screened for hypertension by age Category

Age Group	Male	Female
18-29 yrs
30-39 yrs
40-69 yrs
>=70 yrs

Number of Individuals screened for hypertension by result of screening

- Raised BP

- Normal BP

Number of hypertensive patients enrolled to care by Type of Treatment

Healthy life style counciling (HLC) only

Pharmacological management and HLC

Number of hypertensive patients enrolled to care by Age category

Age Group	Male	Female
18-29 yrs
30-39 yrs
40-69 yrs
>=70 yrs

Number of hypertensive patients enrolled to care by Timing of enrollment

Newly enrolled to care

previously in care

Six-monthly control of blood pressure among people treated for hypertension

Total number of cohort of hypertensive patients registered for hypertension treatment six months prior to the reporting period

Treatment outcome for cohort of patient registered for hypertension treatment six months prior to the reporting period

Controlled

uncontrolled

lost to follow up

died

transferred out

Not evaluated

Cardiovascular Disease

Number of individuals in high CVD risk by type of risk category

Lab based risk category (>=20%)

Non-Lab based category (>=10%)

Number of individuals in high CVD risk by Age Category

Age Group	Male	Female
40-59 yrs
60-74 yrs

Number of patients with high CVD risk who received treatment by type of treatment

With Statin

Without Statin

Patients with high CVD risk who received treatment by Age Category

Age Group	Male	Female
40-59 yrs
60-74 yrs

Diabetes Mellitus

Number of individuals screened for Diabetes Mellitus by Result of screening

Raised blood sugar

Normal blood sugar

Total number of individuals screened for diabetes by Age category

Age Group	Male	Female
<40 years
>=40 years

Diabetic patients enrolled to care by Types of Diabetes

Type I

Type II

Gestational DM

Diabetic patients enrolled to care by Type of treatment

Healthy life style counciling (HLC) only

Pharmacological management plus HLC

Diabetic patients enrolled to care by Age Category

Age Group	Male	Female
<15 yrs
15-29 yrs
30-39 yrs
>=40 yrs

Diabetic patients enrolled to care by Timing of enrollment

Newly enrolled to care

previously in care

Six-monthly control of diabetes among individuals treated for diabetes

Total number of cohort of patients registered for diabetes treatment six months prior to the reporting period

Treatment outcome for cohort of patient registered for diabetes treatment six months prior to the reporting period

Controlled

uncontrolled

lost to follow up

died

transferred out

Not evaluated