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NATION VICTOR BORNE DISEASECONTROL PROGRAMME CUDDALORE

PRIMARY HEALTH CENTRE : KUNDIYAMALLUR

MONTHLY TECHNICAL REPORT ON LABORATORY ACTIVITES

FOR MONTH OF :

PASSIVE - NEW OP CASES -

ACTIVE - H . O W -

G.TOTAL -

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DEPARTMENT OF PUBLIC HEALTH AND PREVENTIVE MEDICINE

DEPUTY DIRECTOR OF HEALTH SERVICES

CUDDALORE

From :-

GOVT. PRIMARY HEALTH CENTRE

KUNDIYMALLUR607301

CUDDALORE

Madam,

Sub: Public Health and Preventive Medicine National Vector Borne Diseases Control Programme

Laboratory Services at primary Health Centre Monthly Technical Report for the Month of

Submitted Regarding

I am here with submitting technical Report of Laboratory Information of the PHC KUNDIYMALLUR

For the month of :

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MALARIA MONTHLY TECHNICAL REPORT OF PHC HIGHLIGHTS

IDEMOGRAPHY OF PHC

1 Population

2 No Of HSC

3 No Of Village Panchayat

4 No Of Town Panchayat

5 No Of Villages

II

A

MALARIA

PASSIVE SURVEILLANCE

1 New Op Cases

2Total Fever Cases

3 No Of Fever Cases Screened

4 Other Related Cases Screened

5 BS Collected & Exam

6 Total Blood Smear Collect & Exam

7 Positive Cases Delected

Pv

Pf

TotalTreated

Refered

Referal Place

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B ACTIVE SURVEILLANCE

1 Bs Collection

Health Inspectors

Village Health Nurse

2 Positive Cases Detected

Pv

Pf

Total

Treated

C REFFERAL CASES

1 No Of Cases

InsliutionRefered From

1 Places

Details

VI HIGHER OFFICIAL VISITED DETAILS

1

2

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1 Contact

BS

Positive

Species2 Mass BS

Positive

Species

3 Follow Up BS No

Positive

Treated

II STOCK OF ANTIMALARIALS & MATERIALS

4 AQ8 AQ 2.5mg

7.5mg

slides

III PILARISIS

1 No Of Provocative BS

Positive

Treated

2 Night Blood Slides

No examined

No positive

No Treated

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IV OTHER LABORATORY ACTIVITIES

SAMPLES ABNORMAL / STATUS

1 Sputum

2 Grouping & Typing

3 Blood Serumfor Vbd

4 Widal

5 VDRL

6 Urine Analysis

7 Pregnancy Test

8 Brochemical Test

9 Slool Examination10 Bile Salt

11 Bile Pigment

12 Bs Hb

13 Hb Sag

14 Hiv

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PASSIVE SURVEILLANCE REPORT (FORM-1)

PHC: KUNDIYAMALLUR Month:

SL.

NOName of the Village

Village

code

OPD

New

Cases

15%

of

NOP

Cases

Total

Fever

Cases

Fever

Cases

Screened

Other

related

cases

screened

Total B.S

CollectionExamined Result

Details

of

positive

Treated

Short

fall

(Nos)

Short

fall %

1 Kundiyamallur

2 Kothavachery

3 Kallan kuppam

4 Ayyanthur

5 Adoor agaram

6 Periya kannadi7 Paratham pattu

8 Manjampettai

9 Virupatchi

10 Pudukuppam

11 Pottaveli

12 M.mettukuppam

13 M.Pudupettai

14 Velavinayakar kuppam

15 Kuruvappanpettai

16 Varatharajanpettai17 Boothampadi

18 Kalkunam

19 Rettipalayam

20 T .V.Nallur

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TOTAL

ACTIVE SURVEILLANCE REPORT (FORM 2)

Month & Year : PHC : KUNDIYAMALLUR

Block PHC Code No : 605 A

Sl

NO

HSC

CodeNo

Name of the

HSC/Village

Villag

ecode

Popula

tion

Name

Of the

HIV/VH

N

Blood sample CollectionTotal Blood

SmearsPositive

Detected

Positive

TreatedStaff Centers

Cod

e

Exa

mHI VHN FTD Govt

Hospi

tal

PVt

Hospi

tal

Oth

ers

1 028 Kundiyamallur

2 Kothavacher

3 Kallankuppam

4 Ayyanthur

TOTAL

5 029 Adoor Agaram6 Periyakannadi

7 Parathampattu

8 Manjapettai

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TOTAL

ACTIVE SURVEILLANCE REPORT (FORM 3)Month & Year PHC : KUNDIYAMALLUR

Block PHC Code No : 605 A

Sl

NO

HSC

Cod

e No

Name of the

HSC/Village

Villag

e

code

Popula

tion

Name

Of the

HIV/VH

N

Blood sample CollectionTotal Blood

SmearsPositive

Detecte

d

Positive

TreatedStaff Centers

Cod

e

Exa

mHI VHN FTD Govt

Hospi

tal

PVt

Hospi

tal

Oth

ers

9 030 Virupatchi

10 Velavinayakar kuppam

11 Pudukuppam

12 Pottaveli

13 M.mettukuppam

14 M.Pudupettai

TOTAL

15 031 Kuruvappanpettai

16 Varatharajanpettai

17 Boothampadi18 Kalkunam

19 Rettipalayam

20 T .V.Nallur

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TOTAL

HEALTH INSPECTOR PERFOMANCE REPORTS (FORM VI)

Month & Year:

PHC : KUNDIYAMALLUR PHC Code No : 605 A

SL

NOName of theH I HSC Name

NO.OfVillag

es

Population Target

BS Taken

Noofvillages

covered

NO Of Villages un

covered continuously

Remarks

During

the

month

Shortfall

during

the

Uptothe

month

2months

3-6

months

7-12

months

1 Mr.Anbazhagan Kundiyamallur 4

2 Mr.Anbazhagan Adur agaram 4

Total 8

3 Mrs.Rajeswari Virupatchi 6

4 Mrs.Rajeswari Kuruvapanpet

TOTAL

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GRAND TOTAL

STOCK REPORT (EQUIPMENTS) (FORM VII B)

BPHC :KUNDIYAMALLUR MONTH:

SI

NOItems

OB Received

during

month

Issued

PHC Use

Issued to

Field Use

Total

Issued

Closing

Balance in

PHC

Closing

Balance In

Field

Total

Balance

Condition

Of The

Instruments

1 Microscope

2 Centifige

3 Calorimeter

4 Semiauto Analyser

5 Glucometer

6 ESR Tube

7 ESR Stand

8 Dc Counting Chamber

9 HB Meter

10 Capillary Tube

11 Hagedorn Needle

12 Landset

13 Micro Slide(New)

14 Micro Slide(Old)

15 Serum Vials

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16 Pegion hole

17 Staining jar

18 Filter paper

19 Fogging machine(Pulse)

20 Fogging machine(Mini )

STOCK REPORT DRUGS AND CHEMICALS (FORM VII B)

BPHC :KUNDIYAMALLUR MONTH:

SI

NODrugs

OB Received

during

month

Issued

PHC Use

Issued to

Field Use

Total

Issued

Closing

Balance in

PHC

Closing

Balance In

Field

Total

Balance

Batch No Date Of

Expiry

1 Tab chloroquine

2 Tab primaquine 2.5mg

3 Tab primaquine 2.7mg

4 Artesunate

5 Sulfadoxine

pyremethamin

6 DEC

7 Albendozole

8 JSB I

9 Eosin powder

10 Liquid paraffin11 Sprit

12 methonol

13 Buffer solution

14 Urine stick

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15 Glucostick

16 Widal kit

17 VDRL Kit

18 Grouping kit

19 Technical malathion

20 Temephose21 Pyrethrum

LABORATORY ACTIVITIES UNDER TAKEN (VII-B)

Name of the Lab Technician : R.AMUTHA PHC: KUNDIYAMALLUR Month :

SL

NODetails of the activites

Samples

collected

/recived

Sampleles

analysedBack log

Results

Test done

averge/day

Samples

analysed

upto the

monyth

Samples

analysedpreviousyear

Remarks

Normal

Abnorma

l(specify

the

value/nat

ure

During

the

month

Up to

the

month

1 Malaria BS

2 Filarial BS

3 Sputum

4 Leprosy

5 Total count (TC)6 Diffrential Count (DC)

7 Plated Count

8 Bleeding &clotting time

9 ESR

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10 HB

11 Grouping &Typing

12 Blood serum for VBD

13 Widal

14 VDRL

15 Urine Albumin16 U Sugar

17 Urine BS &BP

18 Urine Deposite

19 Pregnency Test

20 Sugar

21 Bilirubin

22 Cholesttrol

23 Creatinine

24 Stool Examination

25 Motion Sugar

26 Semen Analysis

27 H I V

28 HB Sag

29

30

31

32

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LABORATORY ACTIVITIES UNDER TAKEN (VII-B)

Name of the Lab Technician : R.AMUTHA PHC : KUNDIYAMALLUR Month :

Total Working days Days Worked Days AttentedWorks at lab

Days Attented

Works atcamps/field

Name of the other

PHC Visited /no ofdays visited

Name of the other

PHC ,S Worksdiverted

Remarks

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TAMILNADU .M4 Monthly Report of Malaria Cases

Name of the PHC : KUNDIYAMALLUR Month & Year : PHC CODE : 605-A

.

Name of the HSC

HSCCode

pop

Total

fever

cases

recorded

during

Number of

Blood slides

collected &

Examined

Numberofslidesreported

within24hoursofslides

Positives Distribution of total malaria cases

PfCasesTreatedwithACT

Severecasestreated

withlnj

arteether

Outbreaksreported

(Y/N)

Stockoutof

an

timalarials

RDTSs

Noofmalariacasesr

eferred

Noofdeaths

Name/Age/SexofDe

athCases

IF.N

IIF.N

Total

Active

Passive

Mass&contact

Total

PV p

f

Mixed

Total

0-4 5-1415&ab

ove

Passivecases

S

C

S

T

Pregnantwomen

RDTpresent(y/n)

ACTPRESENT(y/n)

M F M F M F

KUNDIYAMALLYR

ADOOR AGARAM

VIRUPATCHI

KURUVAPPANPETTAI

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TOTAL

MPW M :

MPWM :

MPW F :

SC Subtotal :

PHC (DIST TOTAL) :

TOTAL :

TAMILNADU .M4 Monthly Report of Malaria Cases

Name of the PHC : KUNDIYAMALLUR Month & Year :

STOCK POSITION

Stock positionRDT

Combiblis

terpack

CQ

ACTpacks

AStablets

SPtablets

Inj

Arteether

atPHC

PQsmall

PQLarge

Slides

Lancets

Opening Balance

Received during the

month

Total of above

Utilization

Balance

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NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEM

Name of the PHC : KUNDIYAMALLUR Month & Year :

FORTNIGHT -I

SL.

NOName of the HSC

Total

Blood

Smear

Cool.&

Exam

RDT Performed

Passive

Blood

Smear

Slide Reported

Within 24 Hr of

Slide collection

Positive Case Age wise

Malaria

Reffered

Case

Pf ACT

Treated

Death

due to

malariaRDT

BS

Exam

RDT

Pv

RDT

Pf

Total

Bs

Coll&

Exam

Pv Pf

0 to 4 5 to 14 15 & Above

Male Female Male Female MaleFemale

ADOOR AGARAM

KUNDIYAMALLUR

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KURUVAPPANPETTAI

VIRUPATCHI

TOTAL

NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEM

Name of the PHC : KUNDIYAMALLUR Month & Year :

FORTNIGHT -II

SL.

NOName of the HSC

Total

Blood

Smear

Cool.&

Exam

RDT Performed

Passive

Blood

Smear

Slide Reported

Within 24 Hr of

Slide collection

Positive Case Age wise

Malaria

Reffered

Case

Pf ACT

Treated

Death

due to

malariaRDT

BS

Exam

RDT

Pv

RDT

Pf

Total

Bs

Coll&

Exam

Pv Pf

0 to 4 5 to 14 15 & Above

Male Female Male Female MaleFemale

ADOOR AGARAM

KUNDIYAMALLUR

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KURUVAPPANPETTAI

VIRUPATCHI

TOTAL

NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEMHO CUDDALORE (FORM-III)

Name of the PHC : KUNDIYAMALLUR Month & Year :

SL

NOName of the HSC

Active passive

Total

Active Passive

TotalI-II FN Grand

TotalI FN I FN II FN II FN

BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve

1 ADOOR AGARAM

2 KUNDIYAMALLUR

3 KURUVAPPANPETTAI4 VIRUPATCHI

5

6

7

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8

9

10

11

12

TOTAL