WORKBOOKS 1 & 2 FOR MODULE FACILITATORS — FOR MODULE G MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS by Alexander Pascual

MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS

WORKBOOKS 1 & 2 FOR FACILITATORS

TRAINING FOR HEALTH FACILITY STAFF IN THE PHILIPPINES

FOR MODULE G

WB F

Management of Drug-Resistant Tuberculosis Training for Health Facility Staff in the Philippines

Workbook 1 FOR FACILITATORS

WORKBOOK FOR MODULE G

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

07/05/06

Tineda, Allyn

980 Novena St, Navotas, NCR

02-06-07-0002

07/08/06

Lalic, Juan

729 Santolan, Sta Mesa, Manila, NCR

02-06-07-0003

07/09/06

Luna, Marina

34 Riverside St., Marikina City, NCR

02-06-07-0004

07/10/06

Fabia, Marlon

345 Tayuman St, Sta Cruz, Manila, NCR

02-06-07-0005

07/16/06

Danilo, Carlo

34 Onyx St., Pandacan Manila, NCR

02-06-07-0006

07/19/06

Dusta, Kelly

456 Carvajal St., Tonco Manila, NCR

02-06-07-0007

07/28/06

Justo, Caroline

56 Libertad, Malate, Manila, NCR

02-06-07-0008

07/31/06

Jenabe, Silvia

546 TM Kalaw Manila, NCR

02-06-08-0001

08/15/06

Conde, Macario

6 Limay St., Tondo Manila, NCR

02-06-08-0002

08/15/06

Zaldivar, Annie

42 Mira Nila Homes, Tandang Sora QC, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-1

52 07/15/54 35 07/14/71 50 07/18/56 36 07/16/70 31 07/21/75 47 07/28/59 50 08/06/56 19 08/02/87 57 08/26/49 18 08/16/88

(6)

(7)

(8)

(9)

Rosal HC

Quirino Memorial Hospital

Manila Doctors’ DOTS Clinic

Canossa DOTS Clinic

Dr. Panelo

Aguilar HC

Canossa DOTS Clinic

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Site where last treated for TB (11) Name of Health Facility/ Private MD

Private MD Manila NCR Marikina NCR Manila NCR Manila NCR

Rosal HC

City/ Region

Navotas NCR Manila NCR

Quirino Memorial Marikina Hospital NCR Manila Doctors’ DOTS Clinic Canossa DOTS Clinic Dr. Sanchez

Manila NCR Manila NCR Manila NCR

Registration group (12)

10.1 7 3 3 3 10.1 1

Manila NCR Manila NCR Manila NCR

(9) Source of referral 1- Govt. DOTS Facility 2- Govt. Non-DOTS Facility 3- Private DOTS Facility 4- Private Non-DOTS Facility 5- Faith-based unit/NGO DOTS Facility 6- Faith-based unit/NGO Non-DOTS Facility 7- Walk - in

Dr. Panelo Aguilar HC Private MD

Manila NCR Manila NCR Q.C. NCR

10.1 3 7

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-07-0001

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

07/05/06

1, 2, 3, 4, 5, 6

07/11/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,3,5

1,2,4

1,2,3

06/30/06 2

1,2 1,8

Mtb

3 (14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

12/05/06

12/12/06

12/06/06

12/13/06

12/07/06

12/14/06

12/13/06

12/20/06

12/16/06

12/23/06

12/28/06

01/04/07

01/12/07

01/19/07

01/12/07

01/19/07

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

ND 07/29/06

Mtb

Mtb 08/01/06

Mtb

8/15/06 0

08/10/06

07/31/06

08/10/06

Mtb 07/20/06

Mtb

07/28/06

07/26/06 2,3

1+ 07/17/06

Mtb

Mtb 07/11/06

07/19/06

07/23/06 2,3

07/16/06

Mtb 07/10/06

Mtb

07/10/06

07/14/06 3

07/09/06

Pre-enrollment No. (YY-NNNN) (19)

07/09/06 Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

07/06/06 Mtb

8,2

07/08/06

07/04/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

0 07/05/06

07/03/06

S NE PI

F THE PHI LIP IC O BL

Mtb 8/16/06

Mtb 8/15/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 08/16/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

Summary Number of DR-TB suspects Suspects with 2 sputum specimens tested Suspects with at least 1 culture done Suspects with at least 1 culture positive result Suspects with HR resistance Number of suspects with Pre-enrollment No. Number of patients with treatment start date

9 9 9 8 6 0 0

W1-1

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

08/18/06

Agustin, Johnny Sy

45 7th Ave. Grace park Caloocan City, NCR

02-06-08-0004

08/18/06

Gonzales, Emilia Laing

Lot 10 Blk 25 Marikina Heights, Marikina, NCR

02-06-08-0005

08/20/06

Posadas, Gretchen Reyes

101 Sampaguita St, Tandang Sora, San Juan, NCR

02-06-08-0006

08/28/06

Conde, Jeanne Padilla

167 Venus St., Corinthian garden Quezon City, NCR

02-06-08-0007

08/29/06

Barredo, Juana Pilipil

5 Pedro Gil St. Manila, NCR

02-06-09-0001

09/02/06

Sauyo, Samuel Hufana

89 New Jersey St. St. Cubao, Quezon City, NCR

02-06-09-0002

09/03/06

Bambao, Ignacio Cantera

23 Roxas St, Kamuning, Quezon City, NCR

09/12/56

02-06-09-0003

09/03/06

Ricaforte, Josue Andres

78 GoldenVille St. Bagong Bario, Caloocan City, NCR

09/15/46

02-06-09-0004

09/03/06

Canizares, Dino Luna

36 Leon Guinto St., Manila

02-06-09-0005

09/04/06

Ambrosia, Bobby Rosal

875 Mayon St, Bago Bantay, Caloocan City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-2

08/29/48 48 08/27/58 59 09/01/47 32 09/02/74 33 09/03/73 38 09/08/68 50 60 33 09/08/73 37 09/10/69

(6)

(7)

(8)

(9)

Name of Health Facility/ Private City/ Region MD

Grace Park HC

Dreamland DOTS Q.C. Center NCR

Sampaguita HC

San Lorenzo DOTS Clinic

Dr. Pilar

Kamuning HC

Bagong Bario HC

Padre Faura HC

Chiniki HC

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Caloocan NCR

Site where last treated for TB (11) Name of Health Facility/ Private MD

Grace Park HC Dreamland DOTS Center

San Juan

Sampaguita HC

NCR Q.C.

San Lorenzo DOTS Clinic

NCR Manila

Dr. Pilar

NCR

City/ Region

Caloocan NCR Q.C. NCR San Juan NCR Q.C. NCR Manila NCR

Registration group (12)

3 3 2 5 10.1 1

Q.C.

Kamuning HC

NCR Manila

Private MD

NCR Manila

Padre Faura HC

NCR Caloocan NCR

Chiniki HC

Q.C. NCR Manila NCR Manila NCR Caloocan NCR

5 10.1 2 3

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-08-0003

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1,2

1, 2, 3, 4, 5, 6

08/23/06

1, 2, 3, 4, 5, 6

08/24/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

08/13/06 2

1,2 1,2

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

01/15/07

01/22/07

01/15/07

01/22/07

01/17/07

01/24/07

01/26/07

02/02/07

01/31/07

02/07/07

01/31/07

02/07/07

02/01/07

02/08/07

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

Mtb 09/04/06

0 09/03/06

08/29/06 08/30/06

09/03/06 Mtb

2,8

09/03/06

08/29/06

Mtb 08/30/06

09/02/06

08/29/06

Pre-enrollment No. (YY-NNNN) (19)

08/29/06 Mtb

08/29/06 0

Mtb 08/21/06

08/28/06

08/28/06 3

08/20/06

Mtb 08/99/06

Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

08/19/06 Mtb

2,8

08/18/06

08/15/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

Mtb 08/18/06

08/13/06

S NE PI

F THE PHI LIP IC O BL

Mtb 8/29/06

09/03/06 Mtb

09/04/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 09/05/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 7 9 7 5 0 0

W1-2

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

09/22/06

Perez, Criselda

321 Acacia Lane , Grace park, Caloocan City, NCR

02-06-09-0007

09/23/06

Castillo, Rommel

38 Agham Road, QC, NCR

02-06-09-0008

09/25/06

Camillo, Amma

27 Juan de la Cruz St, Greenhills, San Juan City, NCR

02-06-09-0009

09/25/06

Tan, Mila

235 Ilang Ilang St. richville subdivision Lipa City, Batangas, Region IV A

02-06-09-0010

09/26/06

Lipata, Susan

56A Remedios St., Ermita Manila, NCR

02-06-09-0011

09/27/06

Caracas, Sonny

798 Panama St, Project 7, Quezon City, NCR

02-06-09-0012

09/27/06

Caracas, Dunah

798 Panama St, Project 7, Quezon City, NCR

10/06/56

02-06-09-0013

09/28/06

Banal, Custodio Diaz

54 Peninsula St., Bago bantay Caloocan City, NCR

10/12/39

02-06-09-0014

09/28/06

Ilagan, Cynthia marie

67 Sampaloc St., Sta Cruz manila

02-06-09-0015

09/29/06

Nobel, Norberto Sula

Blk 47 Lot 7 Kabalikat homes, Caloocan City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-3

10/02/52 32 09/28/74 59 10/07/47 39 10/02/67 33 10/01/73 47 10/06/59 50 67 27 10/02/79 35 06/11/72

(6)

(7)

(8)

(9)

Acacia DOTS Center

Mabisa HC

La Salle DOTS Center

Holy Grace DOTS Clinic

Dr. Carta

Santol HC

Bago Bantay HC

Banaba HC

Caloocan Doctors DOTS Clinic

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Caloocan NCR Q.C. San Juan NCR Lipa City IV A Manila

Acacia DOTS Center

Q.C. Q.C. Manila Manila

Banaba HC

NCR Caloocan

Q.C. NCR

Lipa City

Private MD

NCR

Holy Grace DOTS Clinic

Santol HC

NCR

Caloocan

San Juan

Santol HC

NCR

City/ Region

La Salle DOTS Center

Self-medication

NCR

Name of Health Facility/ Private MD

Mabisa HC

NCR

Site where last treated for TB (11)

Caloocan Doctors DOTS Clinic

NCR IV A Manila NCR Q.C. NCR Q.C. NCR Manila NCR Manila NCR Caloocan NCR

Registration group (12)

7 3 2 5 10.1 2 5 10.1 2 3

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-09-0006

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1,2

1, 2, 3, 4, 5, 6

09/20/06

1, 2, 3, 4, 5, 6

09/21/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

09/17/06 2

1,2 1,8 3

Mtb

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Mtb 09/28/06

09/23/06 09/17/06

Mtb 09/28/06

Mtb

2,8

Mtb

09/27/06

09/23/06 6

0 09/27/06

Mtb

Mtb 09/26/06

09/27/06

08/15/06

Mtb

09/26/06

09/25/06

09/22/06

Mtb 09/28/06

Mtb

09/26/06 Mtb

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

Pre-enrollment No. (YY-NNNN) (19) Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

09/25/06

Pending

09/24/06 Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

09/23/06 Mtb

2,8

09/23/06

09/20/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

0 09/22/06

09/18/06

S NE PI

F THE PHI LIP IC O BL

Mtb 09/29/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 09/30/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

02/22/07

03/01/07

02/22/07

03/01/07

02/23/07

03/02/07

02/24/07

03/03/07

02/24/07

03/03/07

02/25/07

03/04/07

02/25/07

03/04/07

02/26/07

03/05/07

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

10 8 10 9 7 0 0

W1-3

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

10/05/06

Villa, Antonette

17 NBBN, Navotas City, NCR

02-06-10-0002

10/07/06

Mauricio, Esteban

724 Listo St, Sta Mesa, Manila, NCR

02-06-10-0003

10/09/06

Lina, Cita

Blk 5 Kaingin Marikina City, NCR

02-06-10-0004

10/10/06

Fabul, Rey

167 Mandaue St., Sta Cruz Manila, NCR

02-06-10-0005

10/16/06

Dacuycuy, Jonas

40 Esguerra St, Sta Ana, Manila, NCR

02-06-10-0006

10/19/06

Dela Vega, Justina

333 Landicho St. Tondo, Manila , NCR

02-06-10-0007

10/28/06

Jala, Onesta

315 FB Harisson St, Ermita, Manila, NCR

11/06/56

02-06-10-0008

10/31/06

Jala, Crispina

315 FB Harisson St, Ermita, Manila, NCR

11/02/87

02-06-11-0001

11/05/06

Cavite, Sol

3 Solis St., Tondo Manila, NCR

02-06-11-0002

11/08/06

Lapa, Candido

13 de Ocampo., Tatalon,Quezon City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-4

10/16/51 35 10/13/71 50 10/18/56 36 10/16/70 31 10/21/75 47 10/28/59 50 19 57 11/16/49 18 11/09/88

(6)

(7)

(8)

(9)

Dr. Suntay

Malugay HC

Marikina Gen. Hospital

Dr. Felix

Unilab DOTS Center

Sacred Heart Orphanage

Dr. Panelo

UST DOTS Center

PLM DOTS Center

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Navotas NCR Manila NCR Marikina NCR Manila NCR Manila NCR

Site where last treated for TB (11) Name of Health Facility/ Private MD

Dr. Suntay Malugay HC Marikina Gen. Hospital Dr. Felix Unilab DOTS Center

City/ Region

Navotas NCR Manila NCR Marikina NCR Manila NCR Manila NCR

Registration group (12)

10.1 6 10.1 10.1 3 1

Private MD Manila NCR Manila NCR Q.C. NCR

Dr. Panelo UST DOTS Center PLM DOTS Center

Manila NCR Manila NCR Manila NCR Q.C. NCR

10.1 10.1 3 2

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-10-0001

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

10/05/06

1, 2, 3, 4, 5, 6

10/11/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,3,5

3,4

1,2,4

1,2,3

09/30/06 2

1,2 1,8 3

Mtb

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

Mtb

Mtb 10/17/06

10/19/06

10/23/06

10/11/06

10/16/06

Mtb

10/10/06

10/14/06

10/10/06 Mtb

Mtb

10/09/06

10/08/06 Mtb

Pre-enrollment No. (YY-NNNN) (19)

10/07/06

10/04/06

Registration date (mm/dd/yy) (18)

DST results (17)

10/06/06 Mtb

8,2

10/05/06

10/02/06

S NE PI

F THE PHI LIP IC O BL

ND 10/20/06

Mtb

10/28/06

Mtb 10/29/06

2,3 10/26/06 2,3 10/31/06 3

11/03/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Mtb 11/08/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 11/09/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 7 7 6 0 0 0

W1-4

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

11/16/06

Panto, Christy

321 Roxas Lane, Sta Quiteria, Caloocan City, NCR

02-06-11-0004

11/17/06

Calilio, Roman

35 Agham Road, QC, NCR

02-06-11-0005

11/19/06

Canda, Carina

23 La Salle Lane, Greenhills, San Juan, NCR

02-06-11-0006

11/20/06

Sy, Chok

Recto Compound, Lipa City, Region 4A

02-06-11-0007

11/26/06

Lalig, Lani

555 UN Ave. Manila, NCR

02-06-11-0008

11/29/06

Lapitan, Niko

798 Santolan, Quezon City, NCR

02-06-12-0001

12/02/06

Lapitan, Nila

798 Santolan, Quezon City, NCR

02-06-12-0002

12/11/06

Borja, Martina Banzuela

64 Consular St., Bago bantay Caloocan City, NCR

02-06-12-0003

12/12/06

Igot, Rosanna Insular

26 Luxemborg St. Bliss, Manila, NCR

02-06-12-0004

12/16/06

Navarro, Adolfo Ramos

Blk 47 Lot 7 palmera homes, Caloocan City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-5

54 11/26/52 32 11/22/74 59 12/01/47 36 11/26/70 33 12/01/73 47 12/08/59 50 12/11/56 67 12/25/39 27 12/16/79 35 12/22/71

(6)

(7)

(8)

(9)

Mabisa HC

La Salle DOTS Center

Holy Grace DOTS Clinic

Dr Carta

Balimbing HC

Bago Bantay HC

Bliss HC

Caloocan Doctors DOTS Clinic

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Site where last treated for TB (11) Name of Health Facility/ Private MD

City/ Region

Registration group (12)

1 Q.C.

Mabisa HC

NCR Cavite IVA Lipa IVA Manila Q.C.

La Salle DOTS Center

Cavite

Holy Grace DOTS Clinic

Lipa

Balimbing HC

NCR Q.C.

Balimbing HC

NCR Caloocan NCR Manila

Private MD Bliss HC

NCR Caloocan

NCR IVA IVA

self-medication

NCR

Q.C.

Caloocan Doctors DOTS Clinic

3 2 5 10.1

Q.C. NCR Q.C. NCR Manila NCR Manila NCR Caloocan NCR

5 5 10.1 2 3

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-11-0003

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

11/15/06

1, 2, 3, 4, 5, 6

11/21/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

11/11/06 2

1,2 1,8 3 2

Mtb

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Other Other

Date DST released

Consilium date

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

Mtb

Mtb 12/03/06

Mtb 12/11/06

12/07/06 12/11/06

Lfx

11/30/06 Mtb

8,2

Cfx

Mtb

12/02/06

12/06/06

Ofx

11/27/06 Mtb

11/21/06

11/29/06

11/27/06

Mtb

11/26/06

Mtb

11/20/06

11/24/06

11/20/06 Mtb

11/19/06

Pre-enrollment No. (YY-NNNN) (19)

11/18/06 Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

11/17/06 Mtb

8,2

11/17/06

11/14/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

ND 11/16/06

11/12/06

S NE PI

F THE PHI LIP IC O BL

Mtb 12/12/06

Mtb 12/16/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 12/17/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 7 9 9 0 0 0

W1-5

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

12/17/06

Agustin, Marlon Campos

35 6th Ave. Grace park Caloocan City, NCR

02-06-12-0006

12/17/06

Tomasito, Veronica Gler

Lot 10 Blk 25 Dreamland Subdivision, Marikina City, NCR

02-06-12-0007

12/27/06

Gasapos, Claire Danes

101 Botanical garden, Tandang Sora, San Juan City, NCR

02-06-12-0008

12/18/06

Maramba, Jennelyn Galvez

167 Swallow Drive, Greenmeadows, Q.C., NCR

02-06-12-0009

12/28/06

Barredo, Juana Pilipil

5 Pedro Gil St. Manila, NCR

02-06-12-0010

12/28/06

Divinagracia, Aniceto Lucas

798 New york St. Cubao, Quezon City, NCR

02-06-12-0011

12/29/06

Villarasa, Anthony Mandigma

56 Merville St, Kamuning, Quezon City, NCR

01/08/55

02-06-12-0012

12/29/06

Cancino, Ronald Dones

78 Sta Rosa St. Bagong Bario ,Caloocan City, NCR

01/11/42

02-06-12-0013

12/29/06

Salipsip, Emilia Posadas

35 Padre Faura St., Manila, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-6

12/27/53 38 12/23/68 59 01/08/48 32 12/23/74 33 01/02/74 47 01/06/60 52 65 27 01/02/80

(6)

(7)

(8)

(9)

Dreamland DOTS Q.C. Center NCR

Sampaguita HC

San Lorenzo DOTS Clinic

Dr. Pilar

Kamuning HC

Bagong Bario HC

Padre Faura HC

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Grace Park HC

Caloocan NCR

San Juan NCR Q.C. NCR Manila NCR

Site where last treated for TB (11) Name of Health Facility/ Private MD

Grace Park HC Dreamland DOTS Center Sampaguita HC San Lorenzo DOTS Clinic Dr. Pilar

City/ Region

Caloocan NCR Q.C. NCR San Juan NCR Q.C. NCR Manila NCR

Registration group (12)

3 3 2 5 10.1 1

Q.C. NCR Manila NCR Manila NCR

Kamuning HC Private MD Padre Faura HC

Q.C. NCR Manila NCR Manila NCR

5 10.1 2

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-12-0005

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

12/13/06

1, 2, 3, 4, 5, 6

12/23/06

1,2,3,4

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

12/12/06 2

1,2 1,8 3 2

Mtb

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Lfx

Other Other

Date DST released

Consilium date

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

Mtb

Mtb 12/30/06

0 12/29/06

12/24/06

Cfx

12/29/06

12/24/06

Ofx

12/29/06 ND

12/19/06

12/28/06

12/24/06

12/28/06

12/18/06

12/23/06

12/28/06 Mtb

Mtb

12/27/06

Pre-enrollment No. (YY-NNNN) (19)

12/18/06 Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

12/18/06 P

8,2

12/17/06

12/22/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

Mtb 12/17/06

12/12/06

S NE PI

F THE PHI LIP IC O BL

0 12/29/06

(15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

8 6 8 5 0 0 0

W1-6

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

01/06/07

Ponti, Juvy Villa

417 NBBN, Navotas City, NCR

02-07-01-0002

01/07/07

Jerencio, Andy Roxas

7 Panganiban St, Sta Mesa, Manila, NCR

02-07-01-0003

01/09/07

Madura, Mahinhin

Blk 5 Tumana, Marikina City, NCR

02-07-01-0004

01/10/07

Elijio, Ramon

1677 Laguna St., Sta Cruz Manila, NCR

02-07-01-0005

01/16/07

Benedicto, John

40 E Narciso St, Sta Ana, Manila, NCR

02-07-01-0006

01/19/07

De los Santos, Cresencia

313 Int. 8, Sandico St. Tondo, Manila , NCR

02-07-01-0007

01/28/07

Jose, Christine

315 Mabini St, Ermita, Manila, NCR

02-07-01-0008

01/28/07

Jose, Rosemarie

315 Mabini St, Ermita, Manila, NCR

02-07-02-0001

02/15/07

Eala, Mario

315 Matiisin St., Cavite City, Region IV-A

02-07-02-0002

02/15/07

Ruiz, Felipe

109 Mamunggal St., Tatalon,Quezon City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-7

56 01/17/51 35 01/13/72 50 01/18/57 36 01/16/71 31 01/21/76 47 01/28/60 50 02/06/57 19 01/30/88 57 02/26/50 18 02/16/89

(6)

(7)

(8)

(9)

Posadas HC

Tumana HC

Dr. Reyes

Dr. Cruz

Private MD

self medication

DLSU DOTS Clinic

St. Mary's DOTS Center

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Name of Health Facility/ Private MD

City/ Region

Registration group (12)

1 Manila NCR Marikina NCR Manila NCR Manila NCR

Cavite IVA Q.C. NCR

Posadas HC Tumana HC Private MD Dr. Cruz

DLSU DOTS Clinic Private MD

Manila NCR Marikina NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Cavite IVA Q.C. NCR

3 3 10.2 10.1 10.1 1 10.3 3 3

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-07-01-0001

Site where last treated for TB (11)

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

01/05/07

1, 2, 3, 4, 5, 6

01/11/07

1,2,3,4

1, 2, 3, 4, 5, 6

1,3,5

4,3

1,2,4

1,2,3

01/01/07 2

1,2 1,8 3

2,3

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

Cfx

Lfx

Other Other

Date DST released

Consilium date

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

01/17/07 3+

01/19/07

01/20/07 1+

01/28/07 0

01/29/07 0

01/28/07 0

01/29/07 4+

02/15/07 3+

02/10/07

Ofx

01/11/07

01/16/07

02/10/07

01/10/07

01/23/07

2,3

01/23/07

01/08/07

01/09/07

01/14/07

8,2

Pre-enrollment No. (YY-NNNN) (19)

01/06/07

01/07/07

01/04/07

Registration date (mm/dd/yy) (18)

DST results (17)

0 01/06/07

01/02/07

S NE PI

F THE PHI LIP IC O BL

01/16/07 0

02/15/07 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

01/16/07 9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 9 0 0 0 0 0

W1-7

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

02/19/07

Bongol, Marie Nieves

27 Miller St, Filinvest Caloocan City, NCR

02-07-02-0004

02/20/07

Sandejas, Drew Silva

17 A Soriano St. Mira Nila Homes QC, NCR

02-07-02-0005

02/21/07

Perez, Juniefer Castel

Brgy. Pag-asa, San Juan, NCR

02-07-02-0006

02/21/07

Juanco, Jeoffrey Dantes

Brgy Bagong Pook, San Pablo City, Region 4A

02-07-02-0007

02/21/07

Zobel, Virginia Lopez

2178 Int. 1 Leveriza St. Malate, Manila, NCR

02-07-02-0008

02/23/07

Wong, Virgilio Romulo

167 Gotamco St., Balara, QC, NCR

02-07-02-0009

02/26/07

Jimenez, Diether Flores

6 Molave St., Brgy Guadalupe, QC, NCR

02-07-02-0010

02/26/07

Martines, Dolores Quisimbing

13K Lanzones St, Teacher's Village, QC, NCR

02-07-02-0011

02/26/07

Lanting, Rogel Sta. Maria

39 De La Calzada Compound, Sta Ana, Manila, NCR

02-07-02-0012

02/28/07

Sequia, Rodolfo

47 Mahinhin St. Brgy Cruz na Ligas, Balara QC, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-8

50 02/28/57 36 02/26/71 59 03/04/48 36 02/27/71 33 02/26/74 49 03/04/58 55 03/08/52 29 03/02/78 47 03/06/60 29 03/04/78

(6)

(7)

(8)

(9)

Dr. Perlas

East Ave. Medical Center

Dahlia HC

Bagong Pook HC

Dr. Sta Ana

Balara HC

Sampaloc HC

Private MD

Tsampaka HC

Veteran's Hostpital

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Caloocan NCR QC San Juan

Dahlia HC

NCR San Pablo City

Manila NCR QC NCR

Dr. Perlas East Ave. Medical Center

NCR

IV A

Name of Health Facility/ Private MD

Bagong Pook HC Dr. Sta Ana Balara HC

City/ Region Caloocan NCR QC NCR San Juan NCR San Pablo City IV A Manila NCR QC NCR

10.1 3 3 3 10.1 2 1

NCR

Registration group (12)

QC NCR Manila NCR QC NCR

10.3 3 10.1

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-07-02-0003

Site where last treated for TB (11)

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

02/16/07

1, 2, 3, 4, 5, 6

02/16/07

1,2,3,4

1,2

4,1

1,3,5

1,2,4

1,2,3

02/14/07 2

Registration date (mm/dd/yy) (18)

DST results (17)

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

Pre-enrollment No. (YY-NNNN) (19) Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

0 02/19/07

02/15/07

S NE PI

F THE PHI LIP IC O BL

02/20/07 2+

02/20/07

02/21/07

02/16/07

02/21/07

8,2 1,2 1,8

1+ 0

02/18/07 3

1+ 02/21/07 0 02/23/07

02/21/07 2,3

02/22/07 02/24/07 3+

02/26/07 2+

02/21/07

02/27/07 3+

02/26/07

02/27/07

2,3 02/21/07 3

02/23/07

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

02/28/07 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 5 0 0 0 0 0

W1-8

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

03/06/07

Chatuk, Ana

379 de Castro Compound, Sta Quiteria, Caloocan, NCR

02-07-03-0002

03/07/07

Castillo, Josephine

79 Quirino St. Diliman QC, NCR

02-07-03-0003

03/09/07

Falta, Cesar

39C Narciso St, Corazon de Jesus, San Juan, NCR

02-07-03-0004

03/10/07

Lapu-Lapu, Ritchel

Brgy Adija, Lipa City, Region 4A

02-07-03-0005

03/16/07

Tuano, Belen

316 Malambing St., Tondo Manila, NCR

02-07-03-0006

03/19/07

Dika, Pedro

11 B Bohol Brigade, Tatalon, QC, NCR

02-07-03-0007

03/08/07

Dika, Maria

11 B Bohol Brigade, Tatalon, QC, NCR

02-07-03-0008

03/25/07

Dika, May

11 C Bohol Brigade, Tatalon, QC, NCR

02-07-03-0009

03/28/07

Cailao, Jesus

1000 Bicol St, Sampaloc, Manila, NCR

02-07-03-0010

03/30/07

Sequia, Rodolfo

234 Matimtiman St, Teacher's Village, Diliman, QC, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W1-9

54 03/16/53 32 03/12/75 59 03/20/48 36 03/16/71 33 03/21/74 47 03/27/60 50 03/17/57 19 03/26/88 57 04/08/50 18 03/31/89

(6)

(7)

(8)

(9)

Dr. Chan

Quirino General Hospital

Q.C.

San Juan Medical Center

San Juan

Alangilan HC

Dr Carta

Sta. Ines HC

Santillan HC

Veteran's Hostpital

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD Caloocan NCR

NCR

NCR Lipa City IVA Manila NCR Q.C. NCR

Name of Health Facility/ Private MD

Dr. Chan Quirino General Hospital San Juan Medical Center Alangilan HC Dr Carta Sta. Ines HC

City/ Region

Caloocan NCR Q.C. NCR San Juan NCR Lipa City IVA Manila NCR Q.C. NCR

Registration group (12)

10.1 3 10.1 3 10.2 2 1

Dr. Solis

Q.C.

NCR

Manila NCR Q.C. NCR

3 10.1

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-07-03-0001

Site where last treated for TB (11)

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

(13)

(14)

1, 2, 3, 4, 5, 6

1,2,5,6

1, 2, 3, 4, 5, 6

03/05/07

1, 2, 3, 4, 5, 6

03/11/07

1,2,3,4

1, 2, 3, 4, 5, 6

1,3,5

1,2,4

1,2,3

03/01/07 2

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

Pre-enrollment No. (YY-NNNN) (19) Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

03/06/07 2+

03/07/07 2+

03/04/07

Registration date (mm/dd/yy) (18)

DST results (17)

0 03/06/07

03/02/07

S NE PI

F THE PHI LIP IC O BL

03/08/07 0

03/09/07

03/10/07

8,2 1,2 1,8

1+ 0

03/14/07 3

1+ 03/16/07 0 03/19/07

03/03/07 2,3

03/17/07 03/20/07 3+

03/08/07 2+

03/20/07

03/09/07 3+

03/25/07

03/26/07

2,3 03/23/07 3

03/25/07

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

0 03/30/07 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

03/31/07 9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

9 7 0 0 0 0 0

W1-9

WB F

Management of Drug-Resistant Tuberculosis Training for Health Facility Staff in the Philippines

Workbook 2 FOR FACILITATORS

WORKBOOK FOR MODULE G

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

04/18/06

Larios, Jane Alcero

100 Roxas St., Tondo,Manila, NCR

02-06-04-0002

04/23/06

Del Rosario Simeon Reyes

47 NIA Road, Quezonc City, NCR

02-06-04-0003

04/27/06

Ulma, Antonio Pagarigan

32 GMA Batulao, Tatalon, Quezon City, NCR

02-06-05-0001

05/02/06

Rubio, Roberto Landicho

32 Batong Buhay, San Mateo, Rizal, Region IVA

02-06-05-0002

05/02/06

Erdallo, Jerry Tubo

07 Liwayway St, Project 6, Quezon City, NCR

02-06-05-0003

05/04/06

Celestino, Fernando Mano

328 Bonifacio City, Cainta Rizal, Region IVA

02-06-05-0004

05/04/06

Villa, Romelia Mercado

209 Old St. Balut, Tondo Manila, NCR

02-06-05-0005

05/16/06

Gurinda, Rommel Alejandro

537 Delia St., Sampaloc, Manila, NCR

02-06-05-0006

05/21/06

Olson, Rosa Villena

619 B. M de laCruz St, Sampaloc, Manila, NCR

02-06-05-0007

05/21/06

Paco, Rhene Ann Carola

123 KKK St. Bagong Barrio Caloocan City, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W2-1

22 05/08/84 41 08/11/65 63 02/03/43 37 02/26/69 39 08/04/67 31 09/29/75 16 03/15/90 35 09/16/70 85 04/11/21 25 12/07/81

(6)

(7)

(8)

(9)

Dr. de Leon

Dr Santos

Tumana HC

Jose De Leon HC

Plaridel HC

Holy Trinity Orphanage

Sampaloc HC

Dr. Literal

Tambo HC

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Navotas

Site where last treated for TB (11) Name of Health Facility/ Private MD

Rosario HC

NCR Manila

Private MD

NCR Marikina

Tumana HC

NCR Manila

Jose De Leon HC

NCR Manila

Plaridel HC

NCR

Private MD Manila

Tayuman HC

NCR Manila

Private MD

NCR Manila

Private MD

NCR Caloocan NCR

Tayuman HC

City/ Region

Navotas NCR Manila NCR Marikina NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Q.C. NCR

Registration group (12)

7 10.1 6 3 3 10.1 3 10.1 10.1 2

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-04-0001

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

(13)

(14)

1,2,4,6

1,2,5,6

1, 2, 3, 4, 5, 6

1,2,3,4

1, 2, 3, 4, 5, 6

1,2,3,4

1, 2, 3, 4, 5, 6

1,3,5

1,2,4

1,2,3

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

04/03/06 2

1,2

Mtb

05/06/06 (14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

0 05/17/06

Mtb

05/21/06 0

Mtb 05/05/06

Mtb

05/16/06

05/06/06 3

0 05/05/06

Mtb

Mtb 05/03/06

05/04/06

05/01/06 2,3

05/04/06

04/19/06

Mtb 05/03/06

Mtb

2,3

05/02/06

04/19/06 3

Mtb

Mtb 04/28/06

05/02/06

04/17/06 1,8

04/27/06

04/17/06

Mtb 04/24/06

Mtb

0 05/22/06

0 05/21/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Registration date (mm/dd/yy) (18)

DST results (17)

04/19/06 Mtb

2,8

04/23/06

04/12/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

Mtb 04/18/06

04/08/06

S NE PI

F THE PHI LIP IC O BL

Mtb 05/22/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

Ofx

Cfx

Lfx

(17) DST results S = susceptible R = resistant ND = not done

Other Other

Date DST released

Consilium date

09/16/06

09/23/06

09/21/06

09/28/06

09/25/06

09/28/06

09/30/06

10/07/06

09/30/06

10/07/06

10/02/06

10/07/06

10/02/06

10/07/06

10/14/06

10/21/06

10/19/06

10/21/06

10/19/06

10/21/06

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

Pre-enrollment No. (YY-NNNN) (19) Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

06-301 09/29/06 06-150 04/28/06 Enrolled in DOTS 09/26/06 06-304 09/26/06 06-307 refused treatment (10/30/06)

06-308 10/28/06 06-309 12/23/06 06-311 12/22/06 06-312 12/28/06 06-313 died (11/30/06) 10 10 10 10 9 9 7

W2-1

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

05/21/06

De Veza, Primo Cruz

1967 G. Impreso St., Tondo, Manila, NCR

02-06-05-0009

05/21/06

Angol, Lulu Gamba

2 Kamias St, Cauayan, Isabela, Region 2

02-06-05-0010

05/23/06

Quintana, Raul Mondejar

45 Galutera St., Navotas, NCR

02-06-05-0011

05/28/06

Ramon, Rene Alonzo

229 Bambang St., Sta Cruz, Manila, NCR

02-06-05-0012

05/28/06

Sy, Angelita Angeles

128-E Lardizabal St., Sampaloc, Manila NCR

02-06-05-0013

05/29/06

Pamilar, Eden Marie Ingga

1978 F. Ma Guerrero St., Tondo, Manila, NCR

02-06-06-0001

06/04/06

Fulgoso, Juanita Fontanilla

48 Casoy St., Manresa, Q.C., NCR

02-06-06-0002

06/04/06

Fulgoso, Lea Fontanilla

48 Casoy St., Manresa, Q.C., NCR

02-06-06-0003

06/04/06

Beleña, Eduardo Fulgoso

48 Casoy St., Manresa, Q.C., NCR

02-06-06-0004

06/07/06

Paco, Rene Carlo

323 Sta. Anna St., Sampaloc, Manila, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W2-2

44 12/08/63 58 12/01/48 32 06/25/75 33 01/13/74 59 07/10/48 10 09/10/96 48 02/11/58 27 01/07/80 16 01/07/80 50 10/10/56

(6)

(7)

(8)

(9)

Sampaloc Doctos Hospital DOTS Clinic

Manila

Sisters of Charity DOTS Center

Manila

Private MD

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Dr. Sanchez

Manila NCR

Name of Health Facility/ Private MD

Private MD

City/ Region

Manila NCR

Registration group (12)

10.1 1

Dahlia HC

Manila NCR

Dahlia HC Sto Tomas HC

NCR

Private MD

Manila NCR Batangas IV A Manila NCR

7 3 10.1 1

NCR

Bangka HC

Manila NCR

Bangka HC

Manila NCR Manila NCR Manila NCR

10.1 10.1 3

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-05-0008

Site where last treated for TB (11)

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

(13)

(14)

1,2,4,6

1, 2, 3, 4, 5, 6

1,2,5

1,4

1, 2, 3, 4, 5, 6

1,2,5

1,3

1,2,3,5

1,4

1,2,4

1, 2, 3, 4, 5, 6

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

05/06/06 2

1,10 2,8

2,5,10

05/23/06 (14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

06/04/06 0

06/04/06

Mtb 06/05/06

Mtb

06/04/06 3+

Mtb 06/05/06

Mtb

Mtb 05/30/06

Mtb

05/29/06

05/20/06 1,8

2+ 05/29/06

Mtb

Mtb 05/29/06

Mtb

05/20/06 2,3,7

05/28/06

05/20/06 2,13

Mtb

Mtb 05/24/06

05/28/06

05/14/06 2,7

05/23/06

05/13/06

Mtb 05/22/06

Mtb

Mtb 06/05/06

Mtb 06/07/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Registration date (mm/dd/yy) (18)

DST results (17)

Mtb 06/08/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

Pre-enrollment No. (YY-NNNN) (19) Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

Pending

05/22/06 Mtb

05/13/06 1,2

05/21/06

05/08/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

Mtb 05/21/06

05/06/06

S NE PI

F THE PHI LIP IC O BL

10/19/06

10/26/06

10/21/06

10/26/06

11/02/06

10/26/06

11/02/06

10/27/06

11/02/06

11/09/06

11/02/06

11/09/06

11/02/06

11/09/06

11/05/06

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

06-316 lost (12/27/06) 06-319 12/05/06 06-305 09/26/06 06-310 12/12/06 06-306 09/26/06 06-314 12/12/06 06-315 12/02/06 06-318 12/11/06 06-320 Died (11/01/06) 10 10 10 10 9 9 7

W2-2

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

TB Symptomatics Masterlist

06/11/06

Asilo, Josue Falcon

129 Bunot St., Sto Domingo, Camarines Norte, Region V

02-06-06-0006

06/12/06

Cancio, Marlon Basilan

45 Sipocot St., Brgy San Bartolome, Quezon City, NCR

02-06-06-0007

06/13/06

Fulgar, Marion Fule

32 Brgy San Antonio, Novaliches, Quezon City, NCR

02-06-06-0008

06/14/06

Garong, Gaidee Aladin

459 Kadiwa St, Quiapo, Manila, NCR

02-06-06-0009

06/15/06

Ramos, Villa Andres

1608 Batangas St., Sta Cruz, Manila, NCR

02-06-06-0010

06/16/06

Ramos, Crisanto Lacap

678 Laguna St., Sta Cruz, Manila, NCR

02-06-06-0011

06/17/06

Bitangcol, Ma. Elena Galla

1256 Castañas St., Sampaloc, Manila, NCR

02-06-06-0012

06/20/06

Sabado, Roger Santos

3427 Roxas St., Tondo Manila, NCR

02-06-06-0013

06/22/06

Sanedrin, Rose Petal San Juan

48 Marcos St, Sta Cruz, Manila, NCR

02-06-06-0014

06/29/06

Pilar, Alexexander Lina

987 M de la Fuente St, Sta Mesa, Manila, NCR

(1) TX Center: 01 - TDF-MMC DOTS Clinic 02 - KASAKA-QI MDR-TB Housing Facility 03 - LCP-PHDU DOTS Center 04 - DJNRMH DOTS Center 05 - PTSI Tayuman DOTS Center 06 - ________ 07 - ________

W2-3

55 05/17/52 25 04/08/82 21 03/22/86 20 11/26/86 59 02/02/49 64 07/31/42 29 07/19/78 60 04/22/46 16 03/13/90 50 03/10/56

(6)

(7)

(8)

(9)

Dr. Perez

Dr Santos

UDMC DOTS Clinic

Jose De Leon HC

MDH DOTS Clinic

Dr. San Jose

Rosal HC

Sampaguita HC

Dr. King

Bantog HC

(6) Sex: 1- Male 2- Female (8) Funding: 0- Gen fund 2- Round 2 5- Round 5 99- Others; specify ____________

Name of Health Facility/ Private City/ Region MD

Daet Reg. V

Site where last treated for TB (11) Name of Health Facility/ Private MD

Private MD

City/ Region

Daet Reg. V

Q.C.

NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR

10.1 1

NCR Q.C.

Registration group (12)

UDMC DOTS Clinic Bagong Pook HC MDH DOTS Clinic Private MD Rosal HC Sampaguita HC Private MD Bantog HC

Q.C. NCR San Pablo IV A Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR Manila NCR

3 3 3 10.1 1 3 10.1 7

(12) Registration group 1 - New 2 - After Cat I failure 3 - After Cat II failure 4 - After Cat IV failure 5 - After default 6 - Cat I relapse 7 - Cat II relapse

8 - Cat IV relapse 9 - Transfer-in 10 - Other patient w/ 10.1 Non-DOTS 10.2 Others (+) 10.3 Others (-)

TB Symptomatics Masterlist / Page 1 of 2

02-06-06-0005

Source of referral

No. of street, street, City, Region (4)

Date of birth (mm/dd/yy) (5)

Referring site or referring doctor (10)

Funding

Last, First and Middle name (3)

Age (completed yrs)

No. of previous TB treatment

Screening Code Date screened (TC-YY-MM-NNNN) (mm/dd/yy) (1) (2)

Address

Sex

Name

REP U

Symptoms

Risk factors

TB Symptomatics Masterlist | page 2 of 2

(13)

(14)

1,2,4,6

1, 2, 3, 4, 5, 6

1,2,5

1, 2, 3, 4, 5, 6

1,2,5

1,3

1,2,3,5

1,2,4

1, 2, 3, 4, 5, 6

Programmatic Management of Drug - Resistant TB (PMDT)

CXR results

Screening (DSSM/ culture results) (16)

Date done (mm/dd/yy) (15)

Date sputum collected (mm/dd/yy)

1,9

05/27/06 2 1,10

2,5,10

06/14/06

(13) Risk factors 0 - None 1 - Household contact of MDR 2 - Non-converter Cat II 3 - HIV-positive 4- ≥ 2 non-DOTS treatment courses

(14) Symptoms: 0- None 1- Cough 2- Fever 3- Chest/back pain 4- Hemoptysis 5- Weight loss 6- Night sweats

06/17/06

Ofx

Cfx

Lfx

Other Other

Date DST released

Consilium date

11/09/06

11/17/06

11/10/06

11/11/06

11/17/06

11/12/06

11/17/06

Pending

Enrolled? If YES, indicate treatment start date. If NO, indicate reason.

06-321 12/19/06 Enrolled in DOTS 12/12/06

11/17/06

11/14/06

11/17/06

11/18/06

11/24/06

11/20/06

11/24/06

11/27/06

12/01/06

06-323 Died (11/17/06) 06-324 12/12/06 06-325 Lost (2/3/07) 06-326 12/15/06

06/20/06

Mtb 06/21/06

Mtb

06/22/06 1+

Pre-enrollment No. (YY-NNNN) (19)

06/18/06 Mtb

Mtb 06/17/06

Mtb

06/16/06

06/07/06 1,8

06/16/06 Mtb

Mtb 06/15/06

Mtb

06/05/06 2,3,7

06/15/06

06/02/06 2,13

Mtb

Mtb 06/14/06

06/14/06

06/01/06 2,7

06/13/06

05/31/06

Mtb 06/13/06

Mtb

Registration date (mm/dd/yy) (18)

DST results (17)

06/12/06 Mtb

05/30/06 1,2

06/12/06

05/29/06 2,8

Mtb 06/11/06

05/28/06

S NE PI

F THE PHI LIP IC O BL

Mtb 06/23/06

Mtb 06/29/06 (15) CXR results 0 - Normal 1 - Cavitary 2 - Infiltrate 3 - Nodule 4 - Miliary TB 5 - Intrathoracic lymphadenopathy 6 - Endobronchial spread 7 - Fibrosis 8 - Fibrothorax

Mtb 06/30/06

9 - Bullae 10 - Pleural effusion 11 - Pneumothorax 12 - Bronchiectasis 13 - Atelectasis 14 - Consolidation 15 - Mass 16 - others, specify ______________

(17) DST results S = susceptible R = resistant ND = not done

H - Isoniazid R - Rifampicin Z - Pyrazinamide E - Ethambutol S - Streptomycin Km - Kanamycin Ofx - Ofloxacin Cfx - Cifloxacin Lfx - Levofloxacin

1. 2. 3. 4. 5. 6. 7.

06-327 Refused tx (12/25/06) 06-201 Refused tx (12/20/06) Died (11/1/06) 9 9 9 9 6 7 3

W2-3

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Tiangco, 07/12/03 02-04-0001 01/15/04

Criselda de Leon

Ana Marie

Noemi Aguilar

Jessica Chua

W2-4

Andrew Matts

25 02/06/79

James, 07/25/03 02-04-0005 01/28/04

22 02/02/82

Enrile, 07/21/03 02-04-0004 01/24/04

21 01/30/83

Halili, 07/18/03 02-04-0003 01/21/04

(8)

9 Putting Bato, Quiapo, Manila, NCR

01/30/70

Madamba, 07/15/03 02-04-0002 01/18/04

Street No. and name Brgy. City, Region

21 02/09/83

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 3

(10) (11) 2

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

07/12/03

R R S R R S

S S ND ND

12/09/03

12/16/03

01/15/04

R R S R R S

S S ND ND

06/13/04

06/20/04

07/15/03

R R R R R R

S S ND ND

12/12/03

12/19/03

01/18/04

R R R R R R

S S ND ND

06/16/04

06/23/04

05/12/05

R R R R R R

R R ND ND

10/09/05

10/16/05

07/18/03

R R S S R S

S S ND ND

12/15/03

12/22/03

01/21/04

R R S S R S

S S ND ND

06/19/04

06/26/04

01/10/04 39 Malapitan St, Royal Homes, Navotas, Metro Manila, NCR

Purok 5 San Roque, San Luis, Pampanga, Region 3

23 Countryside St., Brokenshire Subdivision, Davao City Region 12

33 San Martin St., Angono Rizal, Region IVA

01/13/04

01/16/04

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S R S S

S S ND ND

12/18/03

12/25/03

01/24/04

R R S R S S

S S ND ND

06/22/04

06/29/04

07/25/03

R R S R R R

S S ND ND

12/22/03

12/29/03

01/28/04

R R S R R R

S S ND ND

06/26/04

07/03/04

01/23/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

07/21/03

01/19/04 7

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 01/15/04 2+ Mtb 1+ Mtb 01/18/04 1+ Mtb 0

Mtb

01/21/04 1+ Mtb 3+ Mtb 01/24/04 2+ Mtb 3+ Mtb 01/28/04

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Row 1: Screening DST or DST result available pre-treatment Row 2: Baseline DST or DST done within 30 days prior to treatment start or 7 days post-treatment start (result not yet available upon treatment) Rows 3 and 4: Other DSTs during treatment H-Isoniazid Km-Kanamycin R-Rifampicin Ofx-Ofloxacin Z-Pyrazinamide Cfx-Ciprofloxacin E-Ethambutol Lfx-Levofloxacin S-Streptomycin

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

1+ Mtb 1+ Mtb

Died

02/14/04 03/15/04

04/06/04

2+ Mtb 2+ Mtb 1+ Mtb 0 Mtb 0 0

0 0

0 ND 0 ND 0 0

0 0

0 ND 0 0

02/20/04 03/21/04 04/20/04 05/20/04 06/19/04 07/19/04 08/18/04 09/17/04 10/17/04 11/16/04 12/16/04 01/15/05 02/14/05 03/16/05 04/15/05 05/15/05 06/14/05 07/14/05

0 0

0 ND 0 0

02/23/04 03/24/04 04/23/04 05/23/04 06/22/04 07/22/04 08/21/04 09/20/04 10/20/04 11/19/04 12/19/04 01/18/05 02/17/05 03/19/05 04/18/05 05/18/05 06/17/05 07/17/05

01/18/06

07/28/05

Defaulted

02/27/04 03/28/04 04/27/04 05/27/04 06/26/04 07/26/04 08/25/04 09/24/04

09/29/04 SUMMARY Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

4+ Mtb

1 DIED 01/10/06 07/09/06 01/05/07 07/04/07

S 0

As 0

1 3 3 3 01/13/06 07/12/06 01/08/07 07/07/07

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ m 1+ m 1+ 0 1+ 0

TBC - TB Culture

07/17/06 01/13/06

Cured 07/24/05

(19)

0 ND 0 ND 0 Mtb 0 ND 0 Mtb 0 Mtb 1+ Mtb 1+ Mtb 2+ Mtb 3+ Mtb 4+ Mtb Failed

02/17/04 03/18/04 04/17/04 05/17/04 06/16/04 07/16/04 08/15/04 09/14/04 10/14/04 11/13/04 12/13/04 01/12/05 02/11/05 03/13/05 04/12/05 05/12/05 06/11/05 07/11/05 08/10/05 09/09/05 10/09/05 11/08/05 12/08/05 01/07/06

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

Treatment outcome mo 1 mo 2 mo 3 mo 4 mo 5 mo 6 mo 7 mo 8 mo 9 mo 10 mo 11 mo 12 mo 13 mo 14 mo 15 mo 16 mo 17 mo 18 mo 19 mo 20 mo 21 mo 22 mo 23 mo 24 Post-treatment follow-up monitoring (17) (18) Date of last intake of meds mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy mm/dd/yy Ff up 1 Ff up 2 Ff up 3 Ff up 4

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 3

As 3

(18) Post-treatment follow-up

(19) HIV status

Row 1: Date : mm/dd/yy Row 2: Symptoms: S- Symptomatic As- Asymptomatic Row 3: Smear/ Culture Result Row 4: CXR compared with last film done 1 - Improved 2- Progressed, specify using codes in (9) 3 - Stable

0-Negative 1-Positive 2-Unknown

W2-4

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Zabala, 08/09/03 02-04-0006 02/12/04

Lon Silva

John Henry Pili

Kenneth Chan

Renante Cabuya

W2-5

Marimar San Tibanez

32 03/10/72

Castila, 08/25/03 02-04-0010 02/28/04

33 03/06/71

Monfero, 08/21/03 02-04-0009 02/24/04

35 03/01/69

Lapuz, 08/16/03 02-04-0008 02/19/04

(8)

34 Plaridel St., Quiapo, Manila, NCR

02/27/70

Yuzon, 08/11/03 02-04-0007 02/14/04

Street No. and name Brgy. City, Region

31 03/14/73

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 3

(10) (11) 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

08/09/03

R R S R R S

S S ND ND

01/06/04

01/13/04

02/12/04

R R S R R S

S S ND ND

07/11/04

07/18/04

08/11/03

R R R S R S

R R ND ND

01/08/04

01/15/04

02/14/04

R R R S R S

R R ND ND

07/13/04

07/20/04

08/16/03

R R S R R S

S S ND ND

01/13/04

01/20/04

02/19/04

R R S R R S

S S ND ND

07/18/04

07/25/04

02/07/04 34 Pulo pulo, Brgy 168, Navotas, Metro Manila, NCR

2 Wheel St.,Brgy. Bagong Silang, Cavite City, Region IVA

45 M. Leonor St., San Rafael, Bulacan, Region 3

33 Jupiter St. Monte Mar Village, Antipolo, Rizal, Region IVA

02/09/04

02/14/04

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S S S

S S ND ND

01/18/04

01/25/04

02/24/04

R R S S S S

S S ND ND

07/23/04

07/30/04

08/25/03

R R S R R R

S S ND ND

01/22/04

01/29/04

02/28/04

R R S R R R

S S ND ND

07/27/04

08/03/04

10.2 2

02/23/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

08/21/03

02/19/04 7

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 02/12/04 2+ Mtb 1+ Mtb 02/14/04 1+ Mtb 0

Mtb

02/19/04 1+ Mtb 3+ Mtb 02/24/04 2+ Mtb 3+ Mtb 02/28/04

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

1+ Mtb 1+ 0

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

10/28/05

0 ND 0 0

03/15/04 04/14/04 05/14/04 06/13/04 07/13/04 08/12/04 09/11/04 10/11/04 11/10/04 12/10/04 01/09/05 02/08/05 03/10/05 04/09/05 05/09/05 06/08/05 07/08/05 08/07/05 09/06/05 10/06/05 11/05/05 12/05/05 01/04/06 02/03/06

0 0

0 ND 0 0

03/20/04 04/19/04 05/19/04 06/18/04 07/18/04 08/17/04 09/16/04 10/16/04 11/15/04 12/15/04 01/14/05 02/13/05 03/15/05 04/14/05 05/14/05 06/13/05 07/13/05 08/12/05

0 0

0 ND 0 0

03/25/04 04/24/04 05/24/04 06/23/04 07/23/04 08/22/04 09/21/04 10/21/04 11/20/04 12/20/04 01/19/05 02/18/05 03/20/05 04/19/05 05/19/05 06/18/05 07/18/05 08/17/05

02/18/06

08/20/05

03/29/04 04/28/04 05/28/04 06/27/04 07/27/04 08/26/04 09/25/04

10/28/04 SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

As 0

S 0

1 3 3 3 02/16/06 08/15/06 02/11/07 08/10/07

S 0

As 0

1 3 3 Died 03/11/06 09/07/06 03/06/07 09/02/07

Cured 09/12/05

S 0

1 3 3 3 08/17/06 02/13/07 08/12/07 02/08/08

Cured

Defaulted

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0

TBC - TB Culture

Cured

03/13/04 04/12/04 05/12/04 06/11/04 07/11/04 08/10/04 09/09/04 10/09/04 11/08/04 12/08/04 01/07/05 02/06/05 03/08/05 04/07/05 05/07/05 06/06/05 07/06/05 08/05/05 09/04/05 10/04/05

2+ Mtb 2+ Mtb 1+ Mtb 0 Mtb 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 3

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-5

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Castro, 09/29/03 02-04-0011 04/03/04

Christina Villaz

Jocelyn Mola

Mon Peter Lina

Matilde

W2-6

Evangeline Ducay

25 04/21/79

Conde, 10/04/03 02-04-0015 04/08/04

22 04/19/82

Matilde, 10/03/03 02-04-0014 04/07/04

41 04/22/63

Brigida, 10/02/03 02-04-0013 04/06/04

(8)

45 Pulang Lupa, Quiapo, Manila, NCR

04/21/60

Villaz, 09/30/03 02-04-0012 04/04/04

Street No. and name Brgy. City, Region

31 04/23/73

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 3

(10) (11) 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

09/29/03

R R R R R S

S S ND ND

02/26/04

03/04/04

04/03/04

R R R R R S

S S ND ND

08/31/04

09/07/04

09/30/03

R R S S R S

R R ND ND

02/27/04

03/05/04

04/04/04

R R S S R S

R R ND ND

09/01/04

09/08/04

10/02/03

R R S R R S

S S ND ND

02/29/04

03/07/04

04/06/04

R R S R R S

S S ND ND

09/03/04

09/10/04

03/29/04 39 Sampaguita St., Navotas, Metro Manila, NCR

San Pascual Ibaba, Sta Ines, Pampanga, Region 3

23 Pinto St. Brgy Pampanga, Davao City Region 12

33 San Rafael St., Antipolo, Rizal, Region IVA

10.1 3

03/30/04

04/01/04

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S S S

S S ND ND

03/01/04

03/08/04

04/07/04

R R S S S S

S S ND ND

09/04/04

09/11/04

10/04/03

R R S R R R

S S ND ND

03/02/04

03/09/04

04/08/04

R R S R R R

S S ND ND

09/05/04

09/12/04

10.2 2

04/03/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

10/03/03

04/02/04 7

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 04/03/04 2+ Mtb 1+ Mtb 04/04/04 1+ Mtb 0

Mtb

04/06/04 1+ Mtb 3+ Mtb 04/07/04 2+ Mtb 3+ Mtb 04/08/04

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

1+ Mtb 1+ 0

Died

05/03/04 06/02/04

06/07/04

2+ Mtb 2+ Mtb 1+ Mtb 0 Mtb 0 0

0 0

0 ND 0 0

05/04/04 06/03/04 07/03/04 08/02/04 09/01/04 10/01/04 10/31/04 11/30/04 12/30/04 01/29/05 02/28/05 03/30/05 04/29/05 05/29/05 06/28/05 07/28/05 08/27/05 09/26/05 10/26/05 11/25/05 12/25/05 01/24/06 02/23/06 03/25/06

0 0

0 ND 0 0

05/06/04 06/05/04 07/05/04 08/04/04 09/03/04 10/03/04 11/02/04 12/02/04 01/01/05 01/31/05 03/02/05 04/01/05 05/01/05 05/31/05 06/30/05 07/30/05 08/29/05 09/28/05

0 0

0 ND 0 0

05/07/04 06/06/04 07/06/04 08/05/04 09/04/04 10/04/04 11/03/04 12/03/04 01/02/05 02/01/05 03/03/05 04/02/05 05/02/05 06/01/05 07/01/05 07/31/05 08/30/05 09/29/05

10/15/05

Died

05/08/04 06/07/04 07/07/04 08/06/04 09/05/04 10/05/04 11/04/04 12/04/04

12/31/04 SUMMARY Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

As 0

S 0

1 3 3 3 03/31/06 09/27/06 03/26/07 09/22/07

S 0

As 0

1 3 3 3 04/13/06 10/10/06 04/08/07 10/05/07

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0

TBC - TB Culture

10/05/06 04/03/07 09/30/07 03/28/08

Cured 10/02/05

(19)

Cured 04/08/06

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 3

As 3

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-6

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Yap, 10/09/03 02-04-0016 04/13/04

Christina Duce

Zaldy Rocha

Bryan Silva

Lopez, 10/14/03 02-04-0019 04/18/04

Rosa Melchor

W2-7

Jennifer Cuy

(8)

35 Isla Putting Bato St., Quiapo, Manila, NCR

37 Batanes St., Navotas, Metro Manila, NCR

45 Amber St., Ususan Pasig City, NCR

Date done (mm/dd/yy) (9) 3

10.1 3

04/11/04

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

908 Onyx St., Sta Mesa, Manila, NCR

10.2 2

R R R R R S

S S ND ND

03/07/04

03/14/04

04/13/04

R R R R R S

S S ND ND

09/10/04

09/17/04

10/10/03

R R S S R S

R R ND ND

03/08/04

03/15/04

04/14/04

R R S S R S

R R ND ND

09/11/04

09/18/04

10/12/03

R R S R R S

S S ND ND

03/10/04

03/17/04

04/16/04

R R S R R S

S S ND ND

09/13/04

09/20/04

10/14/03

R R S S S S

S S ND ND

03/12/04

03/19/04

04/18/04

R R S S S S

S S ND ND

09/15/04

09/22/04

10/26/03

R R S R R R

S S ND ND

03/24/04

03/31/04

04/30/04

R R R R R R

S S ND ND

09/27/04

10/04/04

04/25/04 (10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

10/09/03

04/13/04

05/15/72

(5) Sex

S - Susceptible R - Resistant ND - Not Done

(13)

04/09/04

04/29/83

49 Pearl St., Ususan Pasig City, NCR

(10) (11)

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

04/08/04

04/30/86

Mantel, 10/26/03 02-04-0020 04/30/04

40 05/01/64

Colpe, 10/12/03 02-04-0018 04/16/04

44 05/01/60

Marudo, 10/10/03 02-04-0017 04/14/04

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 04/13/04 2+ Mtb 1+ Mtb 04/14/04 1+ Mtb 0

Mtb

04/16/04 1+ Mtb 3+ Mtb 04/18/04 2+ Mtb 3+ Mtb 04/30/04

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

05/13/04 06/12/04 07/12/04 08/11/04 09/10/04 10/10/04 11/09/04 12/09/04 01/08/05 02/07/05 03/09/05 04/08/05 05/08/05 06/07/05 07/07/05 08/06/05 09/05/05 10/05/05

0 0

0 ND 0 0

0 ND 0

05/14/04 06/13/04 07/13/04 08/12/04 09/11/04 10/11/04 11/10/04 12/10/04 01/09/05 02/08/05 03/10/05 04/09/05 05/09/05 06/08/05 07/08/05 08/07/05 09/06/05 10/06/05

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

10/15/05

10/20/05

0 ND 0 0

As 0

S 0

11/20/05

Defaulted

05/30/04 06/29/04 07/29/04 08/28/04 09/27/04 10/27/04 11/26/04 12/26/04 01/25/05 02/24/05 03/26/05

03/26/05

SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

1 3 3 3 04/18/06 10/15/06 04/13/07 10/10/07

As 0

As 3

S 3

2 05/19/06 11/15/06 05/14/07 11/10/07

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0 1+ Mtb 1+ Mtb 1+ Mtb

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

05/10/05

05/18/04 06/17/04 07/17/04 08/16/04 09/15/04 10/15/04 11/14/04 12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05 07/12/05 08/11/05 09/10/05 10/10/05 11/09/05

TBC - TB Culture

Cured

Defaulted

05/16/04 06/15/04 07/15/04 08/14/04 09/13/04 10/13/04 11/12/04 12/12/04 01/11/05 02/10/05 03/12/05 04/11/05 05/11/05

1+ Mtb 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 0

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-7

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Enriquez, 11/05/03 02-04-0021 05/10/04

Jose Salamat

Rafael Quinto

Fortunato Asis

Alona Roses

W2-8

Alvin San Jose

56 06/15/48

Quintana, 11/25/03 02-04-0025 05/30/04

30 06/02/74

Katigbak, 11/20/03 02-04-0024 05/25/04

19 05/27/85

Garduce, 11/13/03 02-04-0023 05/18/04

(8)

345 Welfareville St., Mandaluyong City

05/27/64

Bravo, 11/10/03 02-04-0022 05/15/04

Street No. and name Brgy. City, Region

28 06/13/76

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 1,2

(10) (11) 6

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

11/05/03

R R S R R S

S S ND ND

04/03/04

04/10/04

05/10/04

R R S R R S

S S ND ND

10/07/04

10/14/04

05/05/04 45 P Burgos St., San Juan M. Manila, NCR

590 M. Reyes St. Brgy Poblacion, Sta Ana, Manila, NCR

98 Capitulo St., Bo. Capitolio, Pasig City, NCR

333 Conde St, San Marcelino Subdivision, Sta mesa, manila, NCR

1,8

10.1 2

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R R R R S

S S ND ND

04/08/04

04/15/04

R R R R R S

S S ND ND

10/12/04

10/19/04

11/13/03

R R R R R S

S S ND ND

04/11/04

04/18/04

05/18/04

R R R R R S

S S ND ND

10/15/04

10/22/04

11/20/03

R R S S S S

R S ND ND

04/18/04

04/25/04

05/25/04

R R S S S S

R S ND ND

10/22/04

10/29/04

11/25/03

R R S S S S

S S ND ND

04/23/04

04/30/04

05/30/04

R R S S S S

S S ND ND

10/27/04

11/03/04

05/13/04

05/20/04

1,8,2

10.2 2

05/25/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

11/10/03 05/15/04

05/10/04 1,2,9

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

2+ Mtb 0

Mtb

05/10/04 2+ Mtb 0

Mtb

05/15/04 1+ Mtb 3+ Mtb 05/18/04 2+ Mtb 3+ Mtb 05/25/04 2+ Mtb 0

Mtb

05/30/04 (11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

06/09/04 07/09/04 08/08/04 09/07/04 10/07/04 11/06/04 12/06/04 01/05/05 02/04/05 03/06/05 04/05/05 05/05/05 06/04/05 07/04/05 08/03/05 09/02/05 10/02/05 11/01/05

0 0

0 ND 0 0

0 ND 0

06/14/04 07/14/04 08/13/04 09/12/04 10/12/04 11/11/04 12/11/04 01/10/05 02/09/05 03/11/05 04/10/05 05/10/05 06/09/05 07/09/05 08/08/05 09/07/05 10/07/05 11/06/05

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

11/02/05

11/20/05

0 ND 0 0

As 0

S 0

12/28/05

Defaulted

06/29/04 07/29/04 08/28/04 09/27/04 10/27/04 11/26/04 12/26/04 01/25/05 02/24/05 03/26/05 04/25/05

04/31/05

SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

1 3 3 3 05/19/06 11/15/06 05/14/07 11/10/07

As 0

As 3

S 3

2 06/26/06 12/23/06 06/21/07 12/18/07

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0 1+ Mtb 1+ Mtb 1+ Mtb

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

06/12/05

06/24/04 07/24/04 08/23/04 09/22/04 10/22/04 11/21/04 12/21/04 01/20/05 02/19/05 03/21/05 04/20/05 05/20/05 06/19/05 07/19/05 08/18/05 09/17/05 10/17/05 11/16/05 12/16/05

TBC - TB Culture

Cured

Died

06/17/04 07/17/04 08/16/04 09/15/04 10/15/04 11/14/04 12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05

1+ Mtb 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 0

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-8

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

De Vega, 12/06/03 02-04-0026 06/10/04

Roniel Sy

Cladualdo Paras

Brigida Reyes

Danilo de Mesa

W2-9

Donato Sta Anna

56 07/06/48

Candelaria, 12/11/03 02-04-0030 06/15/04

76 Ibarra St., Caloocan City, NCR

28 06/29/76

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Date done (mm/dd/yy) (9) 2,3,9

(10) (11) 10.1 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

576 Dahlia ST, Countryside Village, Pasog City, NCR

245 Valerio St., Pasay City, NCR

1,2,8

R R S R R S

S S ND ND

05/04/04

05/11/04

06/10/04

R R S R R S

S S ND ND

11/07/04

11/14/04

12/08/03

R R R S R S

R R ND ND

05/06/04

05/13/04

06/12/04

R R R S R S

R R ND ND

11/09/04

11/16/04

06/07/04

1,2,8

12/09/03

R R S S R S

S S ND ND

05/07/04

05/14/04

06/13/04

R R S S R S

S S ND ND

11/10/04

11/17/04

12/11/03

R R S R R S

S S ND ND

05/09/04

05/16/04

06/08/04 298 jupiter St. Moonville Subdivision, Sta Mesa Manila, NCR

Area 6 Bldg 4 Brgy Biliran, Tondo, Manila, NCR

10.2 2

06/10/04

1,2

12/11/03 2

06/10/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

R R S R R S

S S ND ND

mo 0

mm/dd/yy

12/06/03

06/05/04

06/28/74

Santiago, 12/11/03 02-04-0029 06/15/04

19 06/24/85

Sonda, 12/09/03 02-04-0028 06/13/04

(8)

06/26/69

Pante, 12/08/03 02-04-0027 06/12/04

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

05/09/04

05/16/04

06/15/04

R R S R R S

S S ND ND

11/12/04

11/19/04

02/10/05

R R R R R R

R R ND ND

07/10/05

07/17/05

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Row 1: Screening DST or DST result available pre-treatment

4+ Mtb 2+ Mtb 06/10/04 2+ Mtb 0

Mtb

06/12/04 1+ Mtb 3+ Mtb 06/13/04 2+

06/15/04 3+ Mtb 3+ Mtb 06/15/04

Row 2: Baseline DST or DST done within 30 days prior to treatment start or 7 days post-treatment start (result not yet available upon treatment) Rows 3 and 4: Other DSTs during treatment H-Isoniazid Km-Kanamycin R-Rifampicin Ofx-Ofloxacin Z-Pyrazinamide Cfx-Ciprofloxacin E-Ethambutol Lfx-Levofloxacin S-Streptomycin

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

01/15/06

0 ND 0 0

0 0

0 ND 0 ND ND ND ND ND 0 0

0 0

0 ND ND ND ND ND 0 0 ND ND ND ND 0 0 1+ 0

12/16/05

0 0

0 ND 0 ND 0 0

0 0

0 ND 0 0

Treatment completed

07/15/04 08/14/04 09/13/04 10/13/04 11/12/04 12/12/04 01/11/05 02/10/05 03/12/05 04/11/05 05/11/05 06/10/05 07/10/05 08/09/05 09/08/05 10/08/05 11/07/05 12/07/05

12/15/05

0 Mtb 0 Mtb ND ND 0 0 1+ Mtb 1+ 0

Failed

1+ Mtb 1+ 0

0 0

0 Mtb 0 Mtb 0 Mtb 0 Mtb

07/15/04 08/14/04 09/13/04 10/13/04 11/12/04 12/12/04 01/11/05 02/10/05 03/12/05 04/11/05 05/11/05 06/10/05 07/10/05 08/09/05 09/08/05 10/08/05 11/07/05 12/07/05 TBC - TB Culture

SUMMARY Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

As 0

12/15/05

1 3 3 3 06/14/06 12/11/06 06/09/07 12/06/07

As 0

S 3

As 3

Still on treatment due to frequent interruptions

07/13/04 08/12/04 09/11/04 10/11/04 11/10/04 12/10/04 01/09/05 02/08/05 03/10/05 04/09/05 05/09/05 06/08/05 07/08/05 08/07/05 09/06/05 10/06/05 11/05/05 12/05/05 01/04/06 02/03/06 03/05/06 04/04/06 05/04/06 06/03/06

0 0

Cured

07/12/04 08/11/04 09/10/04 10/10/04 11/09/04 12/09/04 01/08/05 02/07/05 03/09/05 04/08/05 05/08/05 06/07/05 07/07/05 08/06/05 09/05/05 10/05/05 11/04/05 12/04/05

0 0

Cured

07/10/04 08/09/04 09/08/04 10/08/04 11/07/04 12/07/04 01/06/05 02/05/05 03/07/05 04/06/05 05/06/05 06/05/05 07/05/05 08/04/05 09/03/05 10/03/05 11/02/05 12/02/05 01/01/06

0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

2 06/13/06 12/10/06 06/08/07 12/05/07

S 0

1 06/13/06

As 0

S 0 Mtb 2

2 no

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-9

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Bayan, 12/12/03 02-04-0031 06/16/04

Laurence Isip

Joey manotoc

Juan de Leon

John Kenneth Liu

W2-10

Mary Joy Sanchez

35 07/04/69

Katigbak, 12/15/03 02-04-0035 06/19/04

22 06/30/82

Montemar, 12/14/03 02-04-0034 06/18/04

37 07/04/67

Lapiz, 12/13/03 02-04-0033 06/17/04

(8)

95 General Luna St., Quiapo, Manila, NCR

07/04/60

Maravilla, 12/13/03 02-04-0032 06/17/04

Street No. and name Brgy. City, Region

31 07/04/73

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 3

(10) (11) 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

12/12/03

R R R R R S

S S ND ND

05/10/04

05/17/04

06/16/04

R R R R R S

S S ND ND

11/13/04

11/20/04

12/13/03

R R S S R S

R R ND ND

05/11/04

05/18/04

06/17/04

R R S S R S

R R ND ND

11/14/04

11/21/04

12/13/03

R R S R R S

S S ND ND

05/11/04

05/18/04

06/17/04

R R S R R S

S S ND ND

11/14/04

11/21/04

06/11/04 34 Daang Bakal St. Brgy. 124, Navotas, Metro Manila, NCR

2 Fortune St.,Brgy. Bagong Silang, Cavite City, Region IVA

5 Kalibato St. Barangay IVA, San Rafael, Bulacan, Region 3

33 Jupiter St. Cherry Hills Subdivision, Antipolo, Rizal, Region IVA

06/12/04

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S S S

S S ND ND

05/12/04

05/19/04

06/18/04

R R S S S S

S S ND ND

11/15/04

11/22/04

12/15/03

R R S R R R

S S ND ND

05/13/04

05/20/04

06/19/04

R R S R R R

S S ND ND

11/16/04

11/23/04

10.2 3

06/14/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

12/14/03

06/13/04 7

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 06/16/04 2+ Mtb 1+ Mtb 06/17/04 1+ Mtb 0

Mtb

06/17/04 1+ Mtb 3+ Mtb 06/18/04 2+ Mtb 3+ Mtb 06/19/04

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

1+ Mtb 1+ 0

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

02/25/06

0 ND 0 0

07/17/04 08/16/04 09/15/04 10/15/04 11/14/04 12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05 07/12/05 08/11/05 09/10/05 10/10/05 11/09/05 12/09/05 01/08/06 02/07/06 03/09/06 04/08/06 05/08/06 06/07/06

0 0

0 ND 0 0

07/17/04 08/16/04 09/15/04 10/15/04 11/14/04 12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05 07/12/05 08/11/05 09/10/05 10/10/05 11/09/05 12/09/05

0 0

0 ND 0 0

07/18/04 08/17/04 09/16/04 10/16/04 11/15/04 12/15/04 01/14/05 02/13/05 03/15/05 04/14/05 05/14/05 06/13/05 07/13/05 08/12/05 09/11/05 10/11/05 11/10/05 12/10/05

06/30/06

12/24/05

07/19/04 08/18/04 09/17/04 10/17/04 11/16/04 12/16/04 01/15/05 02/14/05

12/31/04 SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

As 0

S 0

1 3 3 3 06/22/06 12/19/06 06/17/07 12/14/07

S 0

As 0

1 3 3 3 06/23/06 12/20/06 06/18/07 12/15/07

Cured 12/15/05

S 0

1 3 3 3 12/27/06 06/25/07 12/22/07 06/19/08

Cured

Died

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0

TBC - TB Culture

Cured

07/16/04 08/15/04 09/14/04 10/14/04 11/13/04 12/13/04 01/12/05 02/11/05 03/13/05 04/12/05 05/12/05 06/11/05 07/11/05 08/10/05 09/09/05 10/09/05 11/08/05 12/08/05 01/07/06 02/06/06

2+ Mtb 2+ Mtb 1+ Mtb 0 Mtb 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 3

As 3

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-10

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Deniega, 02/05/04 02-04-0036 08/10/04

Roniel Arias

Jana Lina

Rosanna Rosal

Lydia de Gala

W2-11

Chris Mina

45 09/13/59

San Luis, 02/24/04 02-04-0040 08/29/04

30 09/07/74

Libertad, 02/20/04 02-04-0039 08/25/04

29 08/27/75

Ganda, 02/18/04 02-04-0038 08/23/04

(8)

76 Itaas ST, Brgy. 45, Caloocan City, NCR

08/27/67

Sales, 02/07/04 02-04-0037 08/12/04

Street No. and name Brgy. City, Region

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Date done (mm/dd/yy) (9) 2,3,9

(10) (11) 10.2 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

576 Dahlia ST, Countryside Village, Pasog City, NCR

245 Nuebe de Pebrero St., Pasay City, NCR

298 Mars St. Moonville Subdivision, Sta Mesa Manila, NCR

Purok 5 Brgy. 167, Tondo, Manila, NCR

1,2,8

R R R R R S

S S ND ND

07/04/04

07/11/04

08/10/04

R R R R R S

S S ND ND

01/07/05

01/14/05

02/07/04

R R R S R S

R R ND ND

07/06/04

07/13/04

08/12/04

R R R S R S

R R ND ND

01/09/05

01/16/05

08/07/04

1,2,8

10.2 2

1,2

(10) Registration group Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S R S

S S ND ND

07/17/04

07/24/04

R R S S R S

S S ND ND

01/20/05

01/27/05

02/20/04

R R S R R S

S S ND ND

07/19/04

07/26/04

08/25/04

R R S R R S

S S ND ND

01/22/05

01/29/05

02/24/04

R R S R R S

S S ND ND

07/23/04

07/30/04

08/29/04

R R S R R S

S S ND ND

01/26/05

02/02/05

04/26/05

R R R R R R

R R ND ND

09/23/05

09/30/05

08/20/04

08/24/04

8– 9– 10– 11– 12– 13– 14– 15– 16–

02/18/04 08/23/04

08/18/04 6

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

02/05/04

08/05/04

09/12/76

(5) Sex

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Row 1: Screening DST or DST result available pre-treatment

4+ Mtb 2+ Mtb 08/10/04 2+ Mtb 0

Mtb

08/12/04 1+ Mtb 3+ Mtb 08/23/04 2+ Mtb 3+ Mtb 08/25/04 3+ Mtb 3+ Mtb 08/29/04

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

03/15/06

0 ND 0 0

0 0

0 ND 0 ND ND ND ND ND 0 0

09/22/04 10/22/04 11/21/04 12/21/04 01/20/05 02/19/05 03/21/05 04/20/05

0 0

0 ND 0 0

0 0

0 ND 0 0

02/15/06

0 ND ND ND ND ND 0 0 ND ND ND ND 0 0 1+ 0

07/19/05 08/18/05 09/17/05

12/16/05

0 ND 0 0

0 0

0 ND 0 ND 0 0

0 Mtb 0 Mtb ND ND 0 0 1+ Mtb 1+ 0

0 Mtb 0 Mtb 0 Mtb 0 Mtb

Failed

09/28/04 10/28/04 11/27/04 12/27/04 01/26/05 02/25/05 03/27/05 04/26/05 05/26/05 06/25/05 07/25/05 08/24/05 09/23/05 10/23/05 11/22/05 12/22/05 01/21/06 02/20/06

03/10/06

TBC - TB Culture

0 0

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

As 0

1 3 3 3 08/14/06 02/10/07 08/09/07 02/05/08

As 0

S 3

As 3

S 3

Cured 03/07/06

0 0

09/03/06 03/02/07 08/29/07 02/25/08

09/24/04 10/24/04 11/23/04 12/23/04 01/22/05 02/21/05 03/23/05 04/22/05 05/22/05 06/21/05 07/21/05 08/20/05 09/19/05 10/19/05 11/18/05 12/18/05 01/17/06 02/16/06

1+ Mtb 1+ 0

As 0

Still on treatment due to frequent interruptions

03/16/06 04/15/06 05/15/06 06/14/06 07/14/06 08/13/06

0 ND 0 0

Cured

09/11/04 10/11/04 11/10/04 12/10/04 01/09/05 02/08/05 03/10/05 04/09/05 05/09/05 06/08/05 07/08/05 08/07/05 09/06/05 10/06/05 11/05/05 12/05/05 01/04/06 02/03/06

0 0

Cured

09/09/04 10/09/04 11/08/04 12/08/04 01/07/05 02/06/05 03/08/05 04/07/05 05/07/05 06/06/05 07/06/05 08/05/05 09/04/05 10/04/05 11/03/05 12/03/05 01/02/06 02/01/06 03/03/06

0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 0

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-11

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Novelino, 04/06/04 02-04-0041 10/10/04

Joey Sayo

Marsha Dewey

Efren Don

Alicia Dy

W2-12

Aljohn Jim

56 11/15/48

Almazan, 04/26/04 02-04-0045 10/30/04

30 11/02/74

Kohler, 04/21/04 02-04-0044 10/25/04

19 10/27/85

Koh, 04/14/04 02-04-0043 10/18/04

28 11/13/76

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

(8)

45 Manzanas St. Bo. Pulilan, Mandaluyong City

10/29/59

Mar, 04/11/04 02-04-0042 10/15/04

Street No. and name Brgy. City, Region

45 P Burgos St., San Juan M. Manila, NCR

590 M. Reyes St. Brgy Poblacion, Sta Ana, Manila, NCR

98 Capitulo St., Bo. Capitolio, Pasig City, NCR

333 Conde St, San Marcelino Subdivision, Sta mesa, manila, NCR

Chest x-ray result Date done (mm/dd/yy) (9) 1,2

(10) (11) 7

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

1,8

10.1 2

R R R S S S

S S ND ND

09/03/04

09/10/04

10/10/04

R R R S S S

S S ND ND

03/09/05

03/16/05

04/11/04

R R R R R S

S S ND ND

09/08/04

09/15/04

10/15/04

R R R R R S

S S ND ND

03/14/05

03/21/05

10/10/04

1,2,9

04/14/04

R R R R R S

S S ND ND

09/11/04

09/18/04

10/18/04

R R R R R S

S S ND ND

03/17/05

03/24/05

04/21/04

R R S S S S

R S ND ND

09/18/04

09/25/04

10/25/04

R R S S S S

R S ND ND

03/24/05

03/31/05

04/26/04

R R S S S S

S S ND ND

09/23/04

09/30/04

10/30/04

R R S S S S

S S ND ND

03/29/05

04/05/05

04/28/05

R R R R R R

R R ND ND

09/25/05

10/02/05

10/13/04

10/20/04

1,8,2

10.2 2

10/25/04

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

04/06/04

10/05/04

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Row 1: Screening DST or DST result available pre-treatment

2+ Mtb 0

Mtb

10/10/04 2+ Mtb 0

Mtb

10/15/04 1+ Mtb 3+ Mtb 10/18/04 2+ Mtb 3+ Mtb 10/25/04 2+ Mtb 0

Mtb

10/30/04

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

11/09/04 12/09/04 01/08/05 02/07/05 03/09/05 04/08/05 05/08/05 06/07/05 07/07/05 08/06/05 09/05/05 10/05/05 11/04/05 12/04/05 01/03/06 02/02/06 03/04/06 04/03/06

0 0

0 ND 0 0

11/14/04 12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05 07/12/05 08/11/05 09/10/05 10/10/05 11/09/05 12/09/05 01/08/06 02/07/06 03/09/06 04/08/06

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

04/15/06

04/20/06

0 ND 0 0

As 0

S 0

05/28/06

Defaulted

11/29/04 12/29/04 01/28/05 02/27/05 03/29/05 04/28/05 05/28/05 06/27/05 07/27/05 08/26/05 09/25/05

09/30/05

SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

1 3 3 3 10/17/06 04/15/07 10/12/07 04/09/08

As 0

As 3

S 3

2 11/24/06 05/23/07 11/19/07 05/17/08

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0 1+ Mtb 1+ Mtb 1+ Mtb

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

12/10/05

11/24/04 12/24/04 01/23/05 02/22/05 03/24/05 04/23/05 05/23/05 06/22/05 07/22/05 08/21/05 09/20/05 10/20/05 11/19/05 12/19/05 01/18/06 02/17/06 03/19/06 04/18/06 05/18/06

TBC - TB Culture

Cured

Defaulted

11/17/04 12/17/04 01/16/05 02/15/05 03/17/05 04/16/05 05/16/05 06/15/05 07/15/05 08/14/05 09/13/05 10/13/05 11/12/05

1+ Mtb 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 0

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-12

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Yazon, 05/10/04 02-03-0046 11/13/04

Madel Dulce

Sonny Roman

Billy Don

Lopez, 05/15/04 02-03-0049 11/18/04

Joanna Marie

W2-13

Luis Cantar

35 Cruzada St., Quiapo, Manila, NCR

Date done (mm/dd/yy) (9) 3

Purok 10 Brgy. 112, Navotas, Metro Manila, NCR

45 Yellow Bell St., Ususan Pasig City, NCR

10.1 3

11/11/04

49 Ruby St., Ususan Pasig City, NCR

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

908 Amethyst St., Sta Mesa, Manila, NCR

10.1 3

11/25/04 (10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

05/10/04

R R R R R S

S S ND ND

10/07/04

10/14/04

11/13/04

R R R R R S

S S ND ND

04/12/05

04/19/05

05/11/04

R R S S R S

R R ND ND

10/08/04

10/15/04

11/14/04

R R S S R S

R R ND ND

04/13/05

04/20/05

05/13/04

R R S R R S

S S ND ND

10/10/04

10/17/04

11/16/04

R R S R R S

S S ND ND

04/15/05

04/22/05

05/15/04

R R S S S S

S S ND ND

10/12/04

10/19/04

11/18/04

R R S S S S

S S ND ND

04/17/05

04/24/05

05/27/04

R R S R R R

S S ND ND

10/24/04

10/31/04

11/30/04

R R S R R R

S S ND ND

04/29/05

05/06/05

05/29/05

R R R R R R

R R ND ND

10/26/05

11/02/05

11/13/04

12/15/72

(5) Sex

S - Susceptible R - Resistant ND - Not Done

(13)

11/09/04

11/29/83

(10) (11)

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

11/08/04

11/30/86

Gamilla, 05/27/04 02-03-0050 11/30/04

39 12/01/65

Cruz, 05/13/04 02-03-0048 11/16/04

(8)

11/29/70

Molino, 05/11/04 02-03-0047 11/14/04

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Row 1: Screening DST or DST result available pre-treatment

4+ Mtb 3+ Mtb 11/13/04 2+ Mtb 1+ Mtb 11/14/04 1+ Mtb 0

Mtb

11/16/04 1+ Mtb 3+ Mtb 11/18/04 2+ Mtb 3+ Mtb 11/30/04

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

0 ND 0 0

12/13/04 01/12/05 02/11/05 03/13/05 04/12/05 05/12/05 06/11/05 07/11/05 08/10/05 09/09/05 10/09/05 11/08/05 12/08/05 01/07/06 02/06/06 03/08/06 04/07/06 05/07/06

0 0

0 ND 0 0

12/14/04 01/13/05 02/12/05 03/14/05 04/13/05 05/13/05 06/12/05 07/12/05 08/11/05 09/10/05 10/10/05 11/09/05 12/09/05 01/08/06 02/07/06 03/09/06 04/08/06 05/08/06

0 0

0 ND 0 0

0 ND

0 0

0 ND 0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

05/10/06

05/12/06

0 ND 0 0

As 0

S 0

06/23/06

Defaulted

12/30/04 01/29/05 02/28/05 03/30/05 04/29/05 05/29/05 06/28/05 07/28/05 08/27/05 09/26/05 10/26/05

11/05/05

SUMMARY

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

1 3 3 3 11/08/06 05/07/07 11/03/07 05/01/08

As 0

As 3

S 3

2 12/20/06 06/18/07 12/15/07 06/12/08

Cured

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ 0 1+ 0 1+ Mtb 1+ Mtb 1+ Mtb

Interim Outcome 1. Culture-positive at month 0 2. Culture-negative at month 6 Final Outcome 1. Cured 2. Treatment completed 3. Died 4. Failed 5. Defaulted 6. Transferred out Still receiving treatment

Cured

12/24/05

12/18/04 01/17/05 02/16/05 03/18/05 04/17/05 05/17/05 06/16/05 07/16/05 08/15/05 09/14/05 10/14/05 11/13/05 12/13/05 01/12/06 02/11/06 03/13/06 04/12/06 05/12/06 06/11/06

TBC - TB Culture

Cured

Defaulted

12/16/04 01/15/05 02/14/05 03/16/05 04/15/05 05/15/05 06/14/05 07/14/05 08/13/05 09/12/05 10/12/05 11/11/05 12/11/05

1+ Mtb 0 0

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 ND 0 0

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

S 0

As 0

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-13

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Castillo, 06/30/05 02-01-0001 01/03/06

Tessie Villa

Josefa Milano

Moises De la Paz

Pilar Gandi

W2-14

Eva Francia

27 01/21/79

Concha, 07/05/05 02-01-0005 01/08/06

24 01/19/82

Mahatma, 07/04/05 02-01-0004 01/07/06

(8)

23 Pulong Bato, Brgy Ibaba, Malabon, NCR

44 Ooroquita St., Quiapo, Manila, NCR

33 01/23/73

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Date done (mm/dd/yy) (9) 3

(10) (11) 7

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

10.1 3

R R R R R S

S S ND ND

11/27/05

12/04/05

01/03/06

R R R R R S

S S ND ND

06/02/06

06/09/06

07/01/05

R R S S R S

R R ND ND

11/28/05

12/05/05

01/04/06

R R S S R S

R R ND ND

06/03/06

06/10/06

07/03/05

R R S R R S

S S ND ND

11/30/05

12/07/05

01/06/06

R R S R R S

S S ND ND

06/05/06

06/12/06

12/30/05 Bo. San Miguel, San Marcelino, Zambales, Reg 3

89 West Bungahan, Tubod, Iligan City, Region 12

Sitio Balumbon, Montalban, Rizal, Region IVA

01/01/06

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S S S

S S ND ND

12/01/05

12/08/05

01/07/06

R R S S S S

S S ND ND

06/06/06

06/13/06

07/05/05

R R S R R R

S S ND ND

12/02/05

12/09/05

01/08/06

R R S R R R

S S ND ND

06/07/06

06/14/06

10.1 3

01/03/06

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

07/04/05

01/02/06 7

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

06/30/05

12/29/05

01/22/63

Balde, 07/03/05 02-01-0003 01/06/06

46 01/22/60

Mirano, 07/01/05 02-01-0002 01/04/06

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 3+ Mtb 01/03/06 2+ Mtb 1+ Mtb 01/04/06 1+ Mtb 0

Mtb

01/06/06 1+ Mtb 3+ Mtb 01/07/06 2+ Mtb 3+ Mtb 01/08/06

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

1+ Mtb 1+ 0

0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

(19)

02/02/06 03/04/06 04/03/06 05/03/06 06/02/06 07/02/06 08/01/06 08/31/06

0 0

02/03/06 03/05/06 04/04/06 05/04/06 06/03/06 07/03/06 08/02/06 09/01/06

0 0

02/05/06 03/07/06 04/06/06 05/06/06 06/05/06 07/05/06 08/04/06 09/03/06

0 0

02/06/06 03/08/06 04/07/06 05/07/06 06/06/06 07/06/06 08/05/06 09/04/06

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+

02/07/06 03/09/06 04/08/06 05/08/06 06/07/06 07/07/06 08/06/06 09/05/06 TBC - TB Culture

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-14

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

De Castro, 07/07/05 02-06-0006 01/10/06

Rolando Tiu

Romeo Aquino

Brenda Dichoso

Remegio Caludo

W2-15

Lerma Guererro

59 02/06/47

Domingo, 07/12/05 02-06-0010 01/15/06

33 01/28/73

Junio, 07/12/05 02-06-0009 01/15/06

(8)

65 Tagaytay St, Grace Park, Caloocan City, NCR

44 Rosario St., Silang, Cavite, Region IVA

31 01/30/75

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Date done (mm/dd/yy) (9) 2,3,9

(10) (11) 7

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

1,2,8

10.1 3

R R S R R S

S S ND ND

12/04/05

12/11/05

01/10/06

R R S R R S

S S ND ND

06/09/06

06/16/06

07/09/05

R R R S R S

R R ND ND

12/06/05

12/13/05

01/12/06

R R R S R S

R R ND ND

06/11/06

06/18/06

01/07/06 35 M de la Fuente St., Sampaloc Manila, NCR

Loyola St., Hillside Subdivision, Lubao Pampanga, Region 3

Area E, Gate 11, Parola Compound, Tondo, Manila, NCR

1,2,8

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S R S

S S ND ND

12/07/05

12/14/05

R R S S R S

S S ND ND

06/12/06

06/19/06

07/12/05

R R S R R S

S S ND ND

12/09/05

12/16/05

01/15/06

R R S R R S

S S ND ND

06/14/06

06/21/06

07/12/05

R R S R R S

S S ND ND

12/09/05

12/16/05

01/15/06

R R S R R S

S S ND ND

06/14/06

06/21/06

01/10/06

1,2

10.2 2

01/10/06

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

07/10/05 01/13/06

01/08/06 6

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

07/07/05

01/05/06

01/25/84

Sablay, 07/10/05 02-06-0008 01/13/06

38 01/27/68

Palomar, 07/09/05 02-06-0007 01/12/06

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

4+ Mtb 2+ Mtb 01/10/06 2+ Mtb 0

Mtb

01/12/06 1+ Mtb 3+ Mtb 01/13/06 2+ Mtb 3+ Mtb 01/15/06 3+ Mtb 3+ Mtb 01/15/06

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

(19)

02/09/06 03/11/06 04/10/06 05/10/06 06/09/06 07/09/06 08/08/06 09/07/06

1+ Mtb 0 Mtb 1+ Mtb 0 Mtb 2+ Mtb 1+ Mtb 0

02/11/06 03/13/06 04/12/06 05/12/06 06/11/06 07/11/06 08/10/06 09/09/06

0 0

02/12/06 03/14/06 04/13/06 05/13/06 06/12/06 07/12/06 08/11/06 09/10/06

0 0

02/14/06 03/16/06 04/15/06 05/15/06 06/14/06 07/14/06 08/13/06 09/12/06

1+ Mtb 1+ 0

0 0

02/14/06 03/16/06 04/15/06 05/15/06 06/14/06 07/14/06 08/13/06 09/12/06 TBC - TB Culture

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-15

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Sanchez, 08/07/05 02-06-0011 02/10/06

Allan Santos

Levi Mariano

Anton Gana

Allyssa Aurelio

W2-16

Rodel Limbog

59 03/19/47

Regato, 08/25/05 02-06-0015 02/28/06

810 Pilar St., Caloocan City, NCR

31 03/15/75

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Date done (mm/dd/yy) (9) 1,2

(10) (11) 3

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

P. Burgos St., Majayjay, Laguna, Region IVA

112 E Santos St, San Juna, M. Mla, NCR

1,8

10.1 3

R R S R R S

S S ND ND

01/04/06

01/11/06

02/10/06

R R S R R S

S S ND ND

07/10/06

07/17/06

08/12/05

R R R R R S

S S ND ND

01/09/06

01/16/06

02/15/06

R R R R R S

S S ND ND

07/15/06

07/22/06

02/10/06

1,2,9

08/15/05

R R R R R S

S S ND ND

01/12/06

01/19/06

02/18/06

R R R R R S

S S ND ND

07/18/06

07/25/06

08/22/05

R R R R R S

S S ND ND

01/19/06

01/26/06

02/25/06

R R R R R S

S S ND ND

07/25/06

08/01/06

02/13/06 Brgy. San Andres, san Juan, Batangas, Reg. IVA

723 Apitong St., marikina Heights, Marikina City, NCR

02/20/06

1,8,2

10.2 2

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

08/25/05

R R S S S S

S S ND ND

01/22/06

01/29/06

02/28/06

R R S S S S

S S ND ND

07/28/06

08/04/06

02/23/06

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0

mm/dd/yy

08/07/05

02/05/06

03/05/73

Alvarez, 08/22/05 02-06-0014 02/25/06

22 02/28/84

Fagar, 08/15/05 02-06-0013 02/18/06

(8)

02/28/63

Bordador, 08/12/05 02-06-0012 02/15/06

Street No. and name Brgy. City, Region

Chest x-ray result

TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

2+ Mtb 0

Mtb

02/10/06 2+

02/15/06 1+ Mtb 3+ Mtb 02/18/06 2+

02/25/06 2+ Mtb 0

Mtb

02/28/06 (11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

0 0

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

TBC

0 0

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

(19)

03/12/06 04/11/06 05/11/06 06/10/06 07/10/06 08/09/06 09/08/06 10/08/06

1+ 0

0 0

03/17/06 04/16/06 05/16/06 06/15/06 07/15/06 08/14/06 09/13/06 10/13/06

0 0

03/20/06 04/19/06 05/19/06 06/18/06 07/18/06 08/17/06 09/16/06 10/16/06

0 0

0 0 2+ Mtb 0 0

0 0

0 Mtb 0

03/27/06 04/26/06 05/26/06 06/25/06 07/25/06 08/24/06 09/23/06 10/23/06

1+ Mtb 1+ 0

0 0

03/30/06 04/29/06 05/29/06 06/28/06 07/28/06 08/27/06 09/26/06 10/26/06 TBC - TB Culture

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-16

REP U

S NE PI

Programmatic Management of Drug - Resistant TB (PMDT)

F THE PHI LIP IC O BL

(5) Date of birth (mm / dd / yy) (6)

Cardinal, 11/19/05 02-06-0071 03/03/06

Sylvia Villa

Rhea Martha

Virgilio Nakpil

Tina Sabal

W2-17

Luisa Gil

35 04/02/71

Capinpin, 10/24/05 03-06-0068 03/18/06

26 03/19/80

Mabuti, 11/21/05 02-06-0074 03/17/06

49 03/23/57

Bueno, 11/01/05 02-06-0073 03/06/06

(8)

85 Pulang Lupa, Quiapo, Manila, NCR

03/21/60

Macandile, 11/23/05 02-06-0072 03/04/06

Street No. and name Brgy. City, Region

23 03/31/83

(5) Sex

(9) Chest x-ray result

1- Male 2- Female

0– Normal 1– Cavitary 2– Infiltrate 3– Nodule 4– Miliary TB 5– Intrathoracic lymphadenopathy 6– Endobronchial spread 7– Fibrosis

Chest x-ray result Date done (mm/dd/yy) (9) 3

(10) (11) 10.1 2

Drug Susceptibility Testing (DST)

Date DST specimen collected (mm/dd/yy)

S - Susceptible R - Resistant ND - Not Done

(12)

H R Z E S Km Ofx Cfx Lfx Other Other

(13)

Date DST released (mm/dd/yy)

Date received by Tx center (mm/dd/yy)

(14)

(15)

mm/dd/yy

11/19/05

R R S S S S

S S ND ND

04/18/06

04/25/06

03/03/06

R R S S S S

S S ND ND

07/31/06

08/07/06

02/26/06 39 Champaca St., Navotas, Metro Manila, NCR

San Pascual Ibaba, Sta Barbara, Pampanga, Region 3

56 Balderama St. Brgy Pampanga, Davao City Region 12

33 San Rafael St., Antipolo, Rizal, Region 3

10.1 3

Fibrothorax Bullae Pleural effusion Pneumothorax Bronchiectasis Atelectasis Consolidation Mass Others, specify _______________

R R S S R S

R R ND ND

04/22/06

04/29/06

R R S S R S

R R ND ND

08/01/06

08/08/06

11/01/05

R R S R R S

S S ND ND

03/31/06

04/07/06

03/06/06

R R S R R S

S S ND ND

08/03/06

08/10/06

03/01/06

11/21/05

R R S S S S

S S ND ND

04/20/06

04/27/06

03/17/06

R R S S S S

S S ND ND

08/14/06

08/21/06

10/24/05

R R S R R R

S S ND ND

03/23/06

03/30/06

03/18/06

R R S R R R

S S ND ND

08/15/06

08/22/06

03/12/06

03/13/06

(10) Registration group 8– 9– 10– 11– 12– 13– 14– 15– 16–

11/23/05 03/04/06

02/27/06 5

1-New 2-After Cat I failure 3-After Cat II failure 4-After Cat IV failure 5-After default 6-Cat I relapse 7-Cat II relapse 8-Cat IV relapse 9-Transfer-in

10-Other patient w/ 10.1 Non-DOTS 10.2 Other (+) 10.3 Other (–)

mo 0 TBC

Last name, First and Middle name

Sex

Site of disease ( P / EP )

Address (7)

DSSM

(4)

Age (completed yrs)

03/03/06 2+ Mtb 1+ Mtb 03/04/06 1+ Mtb 0

Mtb

03/06/06 1+ Mtb 3+ Mtb 03/17/06 2+ Mtb 3+ Mtb 03/18/06

(11) Previous TB treatment

(13) Drug Susceptability Testing (DST)

1- New 2- First line drugs only 3- First and second-line drugs

Category IV Register/ Page 1 of 2

(2)

Name

Previous TB treatment

Category IV Date Treatment Registration screened start date No. (mm/dd/yy) (mm/dd/yy) (TC-YY-NNNN) (1) (3)

Registration group

Category IV Register

REP U

Category IV REGISTER | page 2 of 2

S NE PI

F THE PHI LIP IC O BL

Programmatic Management of Drug - Resistant TB (PMDT)

HIV status

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

TBC

DSSM

Follow-up DSSM and culture monitoring during treatment (16)

(19)

2+ Mtb 2+ Mtb 1+ Mtb 0 Mtb 0 0

0 0

04/03/06 05/03/06 06/02/06 07/02/06 08/01/06 08/31/06 09/30/06 10/30/06

0 0

04/05/06 05/05/06 06/04/06 07/04/06 08/03/06 09/02/06 10/02/06 11/01/06

0 0

04/16/06 05/16/06 06/15/06 07/15/06 08/14/06 09/13/06 10/13/06 11/12/06

1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+ Mtb 1+

04/17/06 05/17/06 06/16/06 07/16/06 08/15/06 09/14/06 10/14/06 11/13/06 TBC - TB Culture

Excluded 1. Extrapulmonary 2. Trans-in

2 0 1 1 0 0 0

0 1

(18) Post-treatment follow-up

(19) HIV status

0-Negative 1-Positive 2-Unknown

W2-17

MANAGEMENT OF DRUG-RESISTANT TUBERCULOSIS TRAINING FOR HEALTH FACILITY STAFF IN THE PHILIPPINES

REF

ISSN 2012-2675

Department of Health Government of Philippines

Tropical Disease Foundation, Inc. Makati, Metro Manila, Philippines

World Health Organization

Office of the Representative in the Philippines

9 772012 267009 PRINTED IN THE PHILIPPINES