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*** DRTB Registered Cases Report should be submitted every 5th of the month to your respective

PBSP Program Officer and Regional Technical Staff copy furnish your Team Leader. Failure to
comply may result in disciplinary action.***

Label your report as (facility code_facility name_drtb registered cases_as of date accomplished)
e.g. 03 LCP TC drtb registered cases as of 020519

Reporting Date Enrolled Patients 6th Month Interim


Outcome and Final
Outcome
Feb 5, 2019 Jan-19
Mar 5, 2019 Feb-19
Apr 5, 2019 Mar-19
May 5, 2019 Apr-19
Jun 5, 2019 May-19
Should be updated regularly
Jul 5, 2019 Jun-19 and whenever there is a
Aug 5, 2019 Jul-19 change in patient's
treatment status.
Sep 5, 2019 Aug-19
Oct 5, 2019 Sep-19
Nov 5, 2019 Oct-19
Dec 5, 2019 Nov-19
Jan 5, 2020 Dec-19
Instructions:
1. This database should be maintained and updated by PMDT Satellite / Treatment Centers.
2. One sheet is equivalent to 2 quarters or 6 months.
3. Encode the Facility Name and Code in "Summary" Sheet. All facility name entries in other sheet
are linked in "Summary" Sheet.
4. "Summary" sheet will show the value and percentage of accomplishments, these are
automatically computed.
5. All DRTB Registered Cases should be encoded in this Database.
6. The following data should be encoded and updated; patient code, name of patient (observe
proper format), treatment start date, LPA info, treatment regimen, complete address and contact
number.

7. Columns 6th Month Interim Outcome, Status/Final Outcome, Reason (if outcome is LTFU), date of
outcome and remarks should be updated regularly whenever there is a change in patient's treatment
status.
Facility Name and Code: 03 Lung Center of the Philippines
LPA Tested Jan-Jun 2018 Percentage Jul-Dec 2018 Percentage Jan-Jun 2019
TOTAL 0 0 0
Yes 0 #DIV/0! 0 #DIV/0! 0
No 0 #DIV/0! 0 #DIV/0! 0

6th Month Interim Outcome Jan-Jun 2018 Percentage Jul-Dec 2018 Percentage Jan-Jun 2019
TOTAL 0 0 0
Negative 0 #DIV/0! 0 #DIV/0! 0
Positive 0 #DIV/0! 0 #DIV/0! 0
Not Evaluated 0 #DIV/0! 0 #DIV/0! 0
Failed 0 #DIV/0! 0 #DIV/0! 0
Died 0 #DIV/0! 0 #DIV/0! 0
Lost to Follow-up 0 #DIV/0! 0 #DIV/0! 0
Pending 0 #DIV/0! 0 #DIV/0! 0

Final Treatment Outcome Jan-Jun 2018 Percentage Jul-Dec 2018 Percentage Jan-Jun 2019
TOTAL 0 0 0
Cured 0 #DIV/0! 0 #DIV/0! 0
Treatment Completed 0 #DIV/0! 0 #DIV/0! 0
Died 0 #DIV/0! 0 #DIV/0! 0
Ongoing 0 #DIV/0! 0 #DIV/0! 0
Lost to Follow-up 0 #DIV/0! 0 #DIV/0! 0
Trans-out 0 #DIV/0! 0 #DIV/0! 0
Treatment Failed 0 #DIV/0! 0 #DIV/0! 0
Withdrawn 0 #DIV/0! 0 #DIV/0! 0
Excluded 0 #DIV/0! 0 #DIV/0! 0

Reason for LTFU Jan-Jun 2018 Percentage Jul-Dec 2018 Percentage Jan-Jun 2019
TOTAL 0 0 0
ADRs 0 #DIV/0! 0 #DIV/0! 0
Bedridden / Immobility due to other 0 #DIV/0! 0 #DIV/0! 0
disease
Co-morbidities 0 #DIV/0! 0 #DIV/0! 0
Died 0 #DIV/0! 0 #DIV/0! 0
Family-related issues 0 #DIV/0! 0 #DIV/0! 0
Far distance to S/TC or iDOTS 0 #DIV/0! 0 #DIV/0! 0
Financial problems 0 #DIV/0! 0 #DIV/0! 0
Intentional hiding 0 #DIV/0! 0 #DIV/0! 0
Old Age 0 #DIV/0! 0 #DIV/0! 0
Preferred Other Healers/Spiritual 0 #DIV/0! 0 #DIV/0! 0
Belief/Religious Belief
Preferred Private MD 0 #DIV/0! 0 #DIV/0! 0
Pregnancy / Miscarriage 0 #DIV/0! 0 #DIV/0! 0
Privacy Issues 0 #DIV/0! 0 #DIV/0! 0
Personal 0 #DIV/0! 0 #DIV/0! 0
Relocated to Other Place/Wrong 0 #DIV/0! 0 #DIV/0! 0
Address
S/TC or iDOTS staff related-issues 0 #DIV/0! 0 #DIV/0! 0
Substance abuse 0 #DIV/0! 0 #DIV/0! 0
Work/School conflict 0 #DIV/0! 0 #DIV/0! 0
Wrong/No Contact Number 0 #DIV/0! 0 #DIV/0! 0
Percentage Jul-Dec 2019 Percentage
0
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

Percentage Jul-Dec 2019 Percentage


0
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

Percentage Jul-Dec 2019 Percentage


0
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!

Percentage Jul-Dec 2019 Percentage


0
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
#DIV/0! 0 #DIV/0!
Facility Name and Code: 03 Lung Center of the Philippines

Name of Patient Treatment Start


# Patient Code LPA Tested
(Surname, First Name MI.) Date

1
2
3
4
5
Reason if not Treatment Complete Address Contact Number
tested for LPA Regimen
Reason (if 6th Month
6th Month Interim Status / Final
Interim Outcome is NOT
Outcome Outcome
DONE)
Reason (if outcome is LTFU) Date of Outcome
Remarks / Reason (if outcome is DIED and
specify if reason for LTFU is ADR)
Facility Name and Code: 03 Lung Center of the Philippines

Name of Patient Treatment Start


# Patient Code LPA Tested
(Surname, First Name MI.) Date

1
2
3
4
5
Reason if not Treatment Complete Address Contact Number
tested for LPA Regimen
Reason (if 6th Month
6th Month Interim Interim Outcome is NOT Status / Outcome
Outcome DONE)
Reason (if outcome is LTFU) Date of Outcome
Remarks / Reason (if outcome is DIED and
specify if reason for LTFU is ADR)
Facility Name and Code: 03 Lung Center of the Philippines

Name of Patient Treatment Start


# Patient Code LPA Tested
(Surname, First Name MI.) Date

1
2
3
4
5
Reason if not Treatment Complete Address Contact Number
tested for LPA Regimen
Reason (if 6th Month
6th Month Interim Interim Outcome is NOT Status / Outcome
Outcome DONE)
Reason (if outcome is LTFU) Date of Outcome
Remarks / Reason (if outcome is DIED and
specify if reason for LTFU is ADR)
Facility Name and Code: 03 Lung Center of the Philippines

Name of Patient Treatment Start


# Patient Code LPA Tested
(Surname, First Name MI.) Date

1
2
3
4
5
Reason if not Treatment Complete Address Contact Number
tested for LPA Regimen
Reason (if 6th Month
6th Month Interim Interim Outcome is NOT Status / Outcome
Outcome DONE)
Reason (if outcome is LTFU) Date of Outcome
Remarks / Reason (if outcome is DIED and
specify if reason for LTFU is ADR)