Age* Px No. No. No. A/b Inj Vit No. items No. Drug names (preferably generic names but brand names Cost per # Diagnosis (yrs) Y/N items generics TRM (1/0) (1/0) (1/0) on dispensed if generic names unknown) Px 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Totals Average % % of % of % of % of % of % of % of % of total items total total total total total total cases items items cases cases cases items *If <1 year indicate as follows: 3 months = 3/12, 5 months = 5/12, etc.; TRM=Traditional Medicine; AB=Antibiotic; INJ=Injection; VIT=Vitamin; Px=Prescription
# Diagnosis Age* (yrs) Px Y/N No. items No. generics No. TRM A/b (1/0) Inj (1/0) Vit (1/0) No. items on No. dispensed Drug names (preferably generic names but brand names if generic names unknown) Cost per Px 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Totals Average % % of total cases % of items % of total items % of total cases % of total cases % of total cases % of total items % of total items *If <1 year indicate as follows: 3 months = 3/12, 5 months = 5/12, etc.; TRM=Traditional Medicine; AB=Antibiotic; INJ=Injection; VIT=Vitamin; Px=Prescription
tool_7_medicines_in_health_care_delivery_10mar2016.docx