Appendix B: Purpose-build clinical consultation record Consultation details Respondent name / clinic identifier CCDATE Consultation date DD / MM / YY CLINICIAN Clinician name DIAGNOSES Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 ADVICE Advice for patient CCTX# Prescriptions Medication name Dose/day Duration _NAME #1 _DOSE _DAYS #2 #3 CCREFO Details of referrals CNOTE Other notes
Appendix B: Purpose-build clinical consultation record Consultation details Respondent name / clinic identifier Consultation date DD / MM / YY CCDATE Clinician name CLINICIAN Diagnosis 1 DIAGNOSES Diagnosis 2 Diagnosis 3 Diagnosis 4 Advice for patient ADVICE Prescriptions Medication name Dose/day Duration CCTX# _NAME _DOSE _DAYS #1 #2 #3 Details of referrals CCREFO Other notes CNOTE
FACILITY%20DETECTION%20STUDY_FINAL_July%202018.docx