HWC-CHO Monthly Performance Monitoring Format

Health Institution Information

ManPower

Infrastructure

Equipments(Please tick the options)

Training/Capacity Building(Y/N)

Community outreach & Social Mobilization:

Reproductive Health Services

Maternal Health Services

Child Health Services

NCD Services

Diagnostic Services

Total number of patients availed Diagnostic Services

Drugs

OPD Services

Total No. of OPD Cases
(As per OPD Register & Screening Register)
Attended by OPD Screening Total
CHO
ANM
MPW (M)
Total
Out of OPD no. of pateints sent for sputum for AFB (Proportion of cases referred for TB screening)
No. of patients found positive for TB out of suspected cases
No. of patients currently taking DOTS and being followed up
No. of TB casesĀ  completed treatment
No. of Fever cases examined for Malaria ( Blood Slide /RDK)