Federal Ministry of Health (JCHEW) Standing Order,
2010 Edition
2010 Edition
Patient’s Data
Name: R.D.
Age: 17 years
Sex: Female
Address: 20 Ekuku Agbor
Road
Road
Occupation: Student
Tribe: Agbor
Religion: Christianity
Nationality: Nigerian
Date: 14th
November, 2014
November, 2014
Complaint: Night sweat,
coughing, weakness of the body
coughing, weakness of the body
History Taking
Has
there been coughing? Yes
there been coughing? Yes
How
long? Yes
long? Yes
Has
there been fever? Yes
there been fever? Yes
Sweating
at night? Yes
at night? Yes
Were
you given BCG vaccine? No
you given BCG vaccine? No
Is
your sputum stained with blood? Yes
your sputum stained with blood? Yes
Any
loss of appetite? Yes
loss of appetite? Yes
Does
anyone in your family coughs? No
anyone in your family coughs? No
Have
you taken any medication? Yes
you taken any medication? Yes
What type? Herbal
medicine and paracetamol
medicine and paracetamol
Management
Finding 1/Action 1
Refer to clinic for sputum examination (Adult)
Refer children under 6 years of age to tuberculosis clinic for
assessment.
assessment.
Rank:
JCHEW-in-Training
JCHEW-in-Training
Date:
_________________
_________________
Signature:
_____________
_____________
Two Way Referral
System
System
From
Primary Health Care Centre
Primary Health Care Centre
Abavo
town
town
Delta
State
State
Nigeria
16/11/2014
The Medical Officer
Tuberculosis Section
General Hospital
Personal No: Nil
Client name: R.D.
Address: 20 Ekuku Agbor Road
Age: 17 years
This patient has been receiving treatment for
cough, bloody sputum and night sweating. Temp. 37oC, pulse 96 b/m,
blood pressure 130/80 mmHg, Immuni. nil.
cough, bloody sputum and night sweating. Temp. 37oC, pulse 96 b/m,
blood pressure 130/80 mmHg, Immuni. nil.
Reason for Referral
For further treatment: She has been receiving
treatment but there is no improvement.
treatment but there is no improvement.
Please
let me know if there is any further information you need.
let me know if there is any further information you need.
Name:
_____________________
_____________________
Designation:
JCHEW-in-Training
JCHEW-in-Training
Signature:
__________________
__________________
Date:
______________________
______________________
