AYFT Data Management Information System
Action for Youth Foundation Trust
TB Management Information System
Action for Youth Foundation Trust TB Screening & Referral Tracking Tool
First Name
Last Name
Date of Birth
Gender
-Select-
Male
Female
Others
Option 4
District
Harare South Western District
Harare West South West District
Harare Western District
Health Facility
Budiriro Polyclinic
Budiriro Satellite Clinic
Glen Norah Satellite Clinic
Glen View Satellite Clinic
Glen View Polyclinic
Rutsanana Polyclinic
Highfields Polyclinic
Mufakose Polyclinic
Warren Park Polyclinic
Kuwadzana Polyclinic
Kuwadzana Satellite Clinic
Western Triangle Satellite Clinic
Sally Mugabe Hospital
Kambuzuma Polyclinic
TB Symptoms
Current Cough
Night Sweats
Weight Loss
Fever
No Symptoms
TPT History
Been on TPT for the past 3 years
Recently Completed TPT
Currently on TPT
Never Been on TPT
TB History
Been on TB Treatment
Never Been on TB Treatment
TB Treatment Defaulter (If so, refer to CATS for TB reinstation)
Post TB Screening Action Taken
Referred for TPT by CATS
Referred for further TB Investigations by CATS
Name of the CATS
Form Captured By
Officer's Designation
- Select -
Program Coordinator
Program Assistant
Program Graduate Trainee
Program Intern
SIE Officer
SIE Assistant
SIE Intern
Executive Director
Complete TB Data Entry
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