{BEGIN container_all}
{END container_all}
{BEGIN container_edit}
{BEGIN editheader}
{END editheader}{BEGIN message_block}
{END message_block}
{END container_edit}{$pagetitlelabel ppr edit}
{BEGIN container_fields}
{BEGIN editbuttons}{END editbuttons}{END container_fields}
|
PATIENT PER REGIMEN FORM |
| SiteName | {$SiteName_editcontrol} |  |
Data Consultant Name {$ValidateEntry_editcontrol} | ||
| Facility Code | {$formid_editcontrol} | Funding Source | {$Funding_Source_editcontrol} | ||
| State | {$State_editcontrol} | Service Type | {$Service_Type_editcontrol} | ||
| Phase | {$Phase_editcontrol} | IPName | {$IPName_editcontrol} | ||
| Current Number of Patients(Adults) on HAART | {$AdultHaart_editcontrol} |
| Current Number of Patients(Paediatric) on HAART | {$PeadsHaart_editcontrol} |
| Current Number of patients(Adults) on PMTCT | {$AdultPMTCT_editcontrol} |
| Current Number of Patients(Paediatric) on PMTCT | {$PeadsPMTCT_editcontrol} |
| HIV-exposed infants | {$ExposedInfant_editcontrol} |
| Number of Persons that received PEP in the Period | {$PEP_editcontrol} |
| ADULT FIRST LINE | |
|
REGIMEN |
Current No. of Patients |
| {$regimen_1_editcontrol} | {$TotalPatient_1_editcontrol} |
| {$regimen_2_editcontrol} | {$TotalPatient_2_editcontrol} |
| {$regimen_3_editcontrol} | {$TotalPatient_3_editcontrol} |
| ADULT SECOND LINE | |
| {$regimen_4_editcontrol} | {$TotalPatient_4_editcontrol} |
| {$regimen_5_editcontrol} | {$TotalPatient_5_editcontrol} |
| {$regimen_6_editcontrol} | {$TotalPatient_6_editcontrol} |
| {$regimen_7_editcontrol} | {$TotalPatient_7_editcontrol} |
| {$regimen_8_editcontrol} | {$TotalPatient_8_editcontrol} |
| PEDIATRIC FIRST LINE | |
| {$regimen_9_editcontrol} | {$TotalPatient_9_editcontrol} |
| {$regimen_10_editcontrol} | {$TotalPatient_10_editcontrol} |
| {$regimen_11_editcontrol} | {$TotalPatient_11_editcontrol} |
| {$regimen_12_editcontrol} | {$TotalPatient_12_editcontrol} |
| PEDIATRIC SECOND LINE | |
| {$regimen_13_editcontrol} | {$TotalPatient_13_editcontrol} |
| {$regimen_14_editcontrol} | {$TotalPatient_14_editcontrol} |
| {$regimen_15_editcontrol} | {$TotalPatient_15_editcontrol} |
| PMTCT | |
| {$regimen_16_editcontrol} | {$TotalPatient_16_editcontrol} |
| HIV-EXPOSED INFANTS | |
| {$regimen_17_editcontrol} | {$TotalPatient_17_editcontrol} |
| {$regimen_18_editcontrol} | {$TotalPatient_18_editcontrol} |
| ENTRY FOR OTHER REGIMEN NOT STATED ABOVE | ||
| REGIMEN | CURRENT No. of patients | REGIMEN CATEGORY |
| {$regimen_19_editcontrol} | {$TotalPatient_19_editcontrol} | {$RegCat19_editcontrol} |
| {$regimen_20_editcontrol} | {$TotalPatient_20_editcontrol} | {$Regcat20_editcontrol} |
| {$regimen_21_editcontrol} | {$TotalPatient_21_editcontrol} | {$RegCat21_editcontrol} |
| {$regimen_22_editcontrol} | {$TotalPatient_22_editcontrol} | {$RegCat22_editcontrol} |
| {$regimen_23_editcontrol} | {$TotalPatient_23_editcontrol} | {$RegCat23_editcontrol} |
| {$regimen_24_editcontrol} | {$TotalPatient_24_editcontrol} | {$RegCat24_editcontrol} |
| {$regimen_25_editcontrol} | {$TotalPatient_25_editcontrol} | {$RegCat25_editcontrol} |
| {$regimen_26_editcontrol} | {$TotalPatient_26_editcontrol} | {$RegCat26_editcontrol} |
| {$regimen_27_editcontrol} | {$TotalPatient_27_editcontrol} | {$RegCat27_editcontrol} |
| {$regimen_28_editcontrol} | {$TotalPatient_28_editcontrol} | {$RegCat28_editcontrol} |
| {$regimen_29_editcontrol} | {$TotalPatient_29_editcontrol} | {$RegCat29_editcontrol} |
| {$regimen_30_editcontrol} | {$TotalPatient_30_editcontrol} | {$RegCat30_editcontrol} |