Our Clinical Record System follows a few basic principles:

-the forms serve as concise, efficient cues to remind providers  of the appropriate approach.

-any data recorded should be easily entered into a data and analyzable. 

-the data should not be repetitive; no double-entry for busy providers.

-the data should be useful for follow-up and continuity of care. 

-the forms should be easily integrated into our future EMR. 

 

You may download our current forms here:  Clinical Records

Currently, this document has the following sections

(in case you don't have a fast internet connection to download and you would like to know how it is basically organized):

 

Sanfe Bagar Clinic Records System

 

Logistics

 

•           Intake Card

 

•           Laboratory Requisition Form

 

•           Referral to Higher-Level Facility Form

 

•           Death Certificate

 

 

Routine Follow-up

 

•           General Visit Brief Note

 

•           Active Problem List

 

•           Medication List

 

•           Diagnostics List

 

 

Maternal and Reproductive Health

 

•           OB High-Risk Screening Form

 

•           Antenatal Record

 

•           Antenatal Visits Notes

 

•           PMTCT Intake and Follow-up

 

•           Pregnancy Social History Screening Form [Filled out by VHW outside of clinic]

 

•           Delivery Record

 

•           Partograph

 

•           Family Planning Evaluation

 

 

Pediatrics

 

•           Live Newborn Record

 

•           Routine Infant and Child Care [Nepal National Form]

 

•           IMCI: 1 week to 2 months

 

•           IMCI: 2 months to 5 years

 

•           VCTC Form [Nepal National Form]

 

 

Miscellaneous

 

•           ARV Intake and Follow-up [Nepal National Form]

 

•           DOTS Forms [Nepal National Form]

 

•           Uterine Prolapse Evaluation—[Use PHECT Form]

 

•           STD Evaluation Form [Nepal National Form]