National TB Elimination Program Date Printed: 12-05-2025

Treatment Card Copy

Patient Information Episode ID: 79310057

Name : Bimala Bhil Address : C/O Jaipur Pincode : 325001

Age : 28 Ward/Village : - Landmark : -

Sex : Female Taluka/Mandal : Bundi Mobile No : 7733077844

Occupation : Unknown Town/City : - Aadhar No : -

Economic Status : Unknown State : Rajasthan Area : Urban Slum

Contact Person

Name : - Address : - Mobile No : -

Treatment Supporter Home visit details

Name : - Initial Home Visit by : -

Designation : - Home Visit Date : -

Mobile No : - No. of visits before diagnosis of current episode : -

Treatment Details

Date of onset of first symptom : -

Investigations Lab Lab No Sample sent Test DST
Disease Classification : Pulmonary (ZN / FM / CBNAAT to CDST Result Result
/ Liquid C / Solid C) (date)
Type of Patient : -
Pre-treatment
Basis Of Diagnosis : CBNAAT
End of Intensive Phase
History Of Previous ATT : No
End of Treatment
Source Of Treatment : Public

Previous Regimen : -

Comorbidity

HIV Status : Non-Reactive Diabetes Status : Non-diabetic Other Comorbidity : -

CPT Delivered On : - RBS : 96

Initiated On ART : - Initiated On ADT : -

Date & ART No : - - Date & ADT No : -

Contact Tracing

No of household contacts

0 4 4
No Screened
0 4 4

0 0 0
No With Symptoms

0 0 0

No Evaluated
0 0 0

0 0 0
No Diagnosed
0 4 4

0 4 4
No Put on treatment
Addiction Related Information Treatment Phase

Current Tobacco User : Negative Date of initiation of Intensive Phase : 27-07-2024

Tobacco Type : - Date of initiation of Continuation Phase : -

Linked for cessation : - Dosage frequency : -

Status of Tobacco use at end of treatment : - Drug formulations : -

H/o Alcohol intake : No Drug packaging : -

Linked for deaddiction : - Dosages FDC/Combipack : -

Height : 165

Adherence

Type of Adherence : None

Month/year 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Jul - 2024

Aug - 2024

Sep - 2024

Oct - 2024

Nov - 2024

Digitally Confirmed Dose Missed Dose Manually Confirmed Missed Dose Manually Confirmed Dose

Retrieval Actions for Missed Doses Details of adverse events

Date By whom Whom contacted Reason for Outcome of Date of adverse Details of Action Taken Duration for management Outcome of
missed doses retrieval action event symptomps of adverse event adverse event

Post treatment follow up clinical & sputum

Follow up Clinical Sputum CXR Impression Findings :

Nutrition support :
6 months of Rx
(if any, give details)

12 months of Rx

18 months of Rx

24 months of Rx

Treatment outcome : CURED

Treatment outcome date : 11-01-2025

Remarks :

This is print out generated from Ni-kshay Signature of the MO with date:__________________