HANDOUT 10.4. Sample NACS Monthly Report Form NACS Monthly Report Form Province: District: Facility: Reporting period: Month [__][__] 20[__][__] Person reporting: Contact telephone: Email: Number of Number of clients receiving Number of clients Number of clients exiting, by reason malnourished clients specialized food products Group Treatment Assessed Counseled Severely Moderately F-75 F-100 RUTF RUSF or FBF Graduated Lost to Died Transferred failure follow-up 0–< 6 months 6–59 months 5–14 years 15–17 years ≥ 18 years Pregnant/ postpartum Total male Total female Total Remarks
NACS Monthly Report Form Province: District: Facility: Reporting period: Month [__][__] 20[__][__] Person reporting: Contact telephone: Email: Group Number of clients Number of malnourished clients Number of clients receiving specialized food products Number of clients exiting, by reason Assessed Counseled Severely Moderately F-75 F-100 RUTF RUSF or FBF Graduated Lost to follow-up Died Transferred Treatment failure 0–< 6 months 6–59 months 5–14 years 15–17 years ≥ 18 years Pregnant/ postpartum Total male Total female Total Remarks HANDOUT 10.4. Sample NACS Monthly Report Form
Generic-NACS-Participant-Handouts-Dec2015.docx