{{-- @dd($cal_resultes); --}}
@csrf
Select State/Region Name:

National Tuberculosis Programme
Quarterly Report on TB Case Registration (TB - 07)
Name of townships/code no Patients registered during Date of Completion of this form:
Region/State:
Name of Township TB coordinator
Area population _________________________
CNR (Bacteriologically confirmed)=
(Per 100000 pop.) 		Block (1), Row (1) x 100,000
Population
CNR (All TB cases) =
(Per 100,000 pop.) 		Block (1), Row (1+2+3) x 100,000
Population
Block 1: All TB cases registered during the quarter except Transfer in patients
Type of patient
/Type of Disease		 New Re-treatment Cases (choose one) Total Grand Total
Relapse Previously treated (excluding relapse) Unknown previous treatment history
M F M F M F M F M F
Pulmonary, bacteriologically confirmed {{$cal_resultes["b1_pbc_new_male"]}} {{$cal_resultes["b1_pbc_new_female"]}} {{$cal_resultes["b1_pbc_relapse_male"]}} {{$cal_resultes["b1_pbc_relapse_female"]}} {{$cal_resultes["b1_pbc_Ptreat_male"]}} {{$cal_resultes["b1_pbc_Ptreat_female"]}} {{$cal_resultes["b1_pbc_UPtreat_male"]}} {{$cal_resultes["b1_pbc_UPtreat_female"]}} {{$cal_resultes["b1_pbc_total_male"]}} {{$cal_resultes["b1_pbc_total_female"]}} {{$cal_resultes["b1_pbc_Gtotal"]}}
Pulmonary, clinically diagnosed {{$cal_resultes["b1_pcd_new_male"]}} {{$cal_resultes["b1_pcd_new_female"]}} {{$cal_resultes["b1_pcd_relapse_male"]}} {{$cal_resultes["b1_pcd_relapse_female"]}} {{$cal_resultes["b1_pcd_Ptreat_male"]}} {{$cal_resultes["b1_pcd_Ptreat_female"]}} {{$cal_resultes["b1_pcd_UPtreat_male"]}} {{$cal_resultes["b1_pcd_UPtreat_female"]}} {{$cal_resultes["b1_pcd_total_male"]}} {{$cal_resultes["b1_pcd_total_female"]}} {{$cal_resultes["b1_pcd_Gtotal"]}}
Extra pulmonary, bacteriologically confirmed {{$cal_resultes["b1_epbc_new_male"]}} {{$cal_resultes["b1_epbc_new_female"]}} {{$cal_resultes["b1_epbc_relapse_male"]}} {{$cal_resultes["b1_epbc_relapse_female"]}} {{$cal_resultes["b1_epbc_Ptreat_male"]}} {{$cal_resultes["b1_epbc_Ptreat_female"]}} {{$cal_resultes["b1_epbc_UPtreat_male"]}} {{$cal_resultes["b1_epbc_UPtreat_female"]}} {{$cal_resultes["b1_epbc_total_male"]}} {{$cal_resultes["b1_epbc_total_female"]}} {{$cal_resultes["b1_epbc_Gtotal"]}}
Extra pulmonary, clinically diagnosed {{$cal_resultes["b1_epcd_new_male"]}} {{$cal_resultes["b1_epcd_new_female"]}} {{$cal_resultes["b1_epcd_relapse_male"]}} {{$cal_resultes["b1_epcd_relapse_female"]}} {{$cal_resultes["b1_epcd_Ptreat_male"]}} {{$cal_resultes["b1_epcd_Ptreat_female"]}} {{$cal_resultes["b1_epcd_UPtreat_male"]}} {{$cal_resultes["b1_epcd_UPtreat_female"]}} {{$cal_resultes["b1_epcd_total_male"]}} {{$cal_resultes["b1_epcd_total_female"]}} {{$cal_resultes["b1_epcd_Gtotal"]}}
Total TB Case {{$cal_resultes["b1_total_tb_new_male"]}} {{$cal_resultes["b1_total_tb_new_female" ]}} {{$cal_resultes["b1_total_tb_relapse_male"]}} {{$cal_resultes["b1_total_tb_relapse_female"]}} {{$cal_resultes["b1_total_tb_Ptreat_male"]}} {{$cal_resultes["b1_total_tb_Ptreat_female"]}} {{$cal_resultes["b1_total_tb_UPtreat_male"]}} {{$cal_resultes["b1_total_tb_UPtreat_female"]}} {{$cal_resultes["b1_total_tb_total_male"]}} {{$cal_resultes["b1_total_tb_total_female"]}} {{$cal_resultes[ "b1_total_tb_Gtotal"]}}
Block 2: All new and relapse cases (bacteriologically confirmed or clinically diagnosed) registered during the quarter by age group and
sex
Age/
Type of Patients		 0-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 >= 65 Total Grand Total
M F M F M F M F M F M F M F M F M F M F
New {{$cal_resultes["b2_new_male_0_4"]}} {{$cal_resultes["b2_new_female_0_4"]}} {{$cal_resultes["b2_new_male_5_9"]}} {{$cal_resultes["b2_new_female_5_9"]}} {{$cal_resultes["b2_new_male_10_14"]}} {{$cal_resultes["b2_new_female_10_14"]}} {{$cal_resultes["b2_new_male_15_24"]}} {{$cal_resultes["b2_new_female_15_24"]}} {{$cal_resultes["b2_new_male_25_34"]}} {{$cal_resultes["b2_new_female_25_34"]}} {{$cal_resultes["b2_new_male_35_44"]}} {{$cal_resultes["b2_new_female_35_44"]}} {{$cal_resultes["b2_new_male_45_54"]}} {{$cal_resultes["b2_new_female_45_54"]}} {{$cal_resultes["b2_new_male_55_64"]}} {{$cal_resultes["b2_new_female_55_64"]}} {{$cal_resultes["b2_new_male_65"]}} {{$cal_resultes["b2_new_female_65"]}} {{$cal_resultes["b2_age_new_total_male"]}} {{$cal_resultes["b2_age_new_total_female"]}} {{$cal_resultes["b2_age_new_total_Gtotal"]}}
Relapse {{$cal_resultes["b2_relapse_male_0_4"]}} {{$cal_resultes["b2_relapse_female_0_4"]}} {{$cal_resultes["b2_relapse_male_5_9"]}} {{$cal_resultes["b2_relapse_female_5_9"]}} {{$cal_resultes["b2_relapse_male_10_14"]}} {{$cal_resultes["b2_relapse_female_10_14"]}} {{$cal_resultes["b2_relapse_male_15_24"]}} {{$cal_resultes["b2_relapse_female_15_24"]}} {{$cal_resultes["b2_relapse_male_25_34"]}} {{$cal_resultes["b2_relapse_female_25_34"]}} {{$cal_resultes["b2_relapse_male_35_44"]}} {{$cal_resultes["b2_relapse_female_35_44"]}} {{$cal_resultes["b2_relapse_male_45_54"]}} {{$cal_resultes["b2_relapse_female_45_54"]}} {{$cal_resultes["b2_relapse_male_55_64"]}} {{$cal_resultes["b2_relapse_female_55_64"]}} {{$cal_resultes["b2_relapse_male_65"]}} {{$cal_resultes["b2_relapse_female_65"]}} {{$cal_resultes["b2_age_relapse_total_male"]}} {{$cal_resultes["b2_age_relapse_total_female"]}} {{$cal_resultes["b2_age_relapse_total_Gtotal"]}}
Total {{$cal_resultes["b2_new_male_0_4"]+$cal_resultes["b2_relapse_male_0_4"]}} {{$cal_resultes["b2_new_female_0_4"]+$cal_resultes["b2_relapse_female_0_4"]}} {{$cal_resultes["b2_new_male_5_9"]+$cal_resultes["b2_relapse_male_5_9"]}} {{$cal_resultes["b2_new_female_5_9"]+$cal_resultes["b2_relapse_female_5_9"]}} {{$cal_resultes["b2_new_male_10_14"]+$cal_resultes["b2_relapse_male_10_14"]}} {{$cal_resultes["b2_new_female_10_14"]+$cal_resultes["b2_relapse_female_10_14"]}} {{$cal_resultes["b2_new_male_15_24"]+$cal_resultes["b2_relapse_male_15_24"]}} {{$cal_resultes["b2_new_female_15_24"]+$cal_resultes["b2_relapse_female_15_24"]}} {{$cal_resultes["b2_new_male_25_34"]+$cal_resultes["b2_relapse_male_25_34"]}} {{$cal_resultes["b2_new_female_25_34"]+$cal_resultes["b2_relapse_female_25_34"]}} {{$cal_resultes["b2_new_male_35_44"]+$cal_resultes["b2_relapse_male_35_44"]}} {{$cal_resultes["b2_new_female_35_44"]+$cal_resultes["b2_relapse_female_35_44"]}} {{$cal_resultes["b2_new_male_45_54"]+$cal_resultes["b2_relapse_male_45_54"]}} {{$cal_resultes["b2_new_female_45_54"]+$cal_resultes["b2_relapse_female_45_54"]}} {{$cal_resultes["b2_new_male_55_64"]+$cal_resultes["b2_relapse_male_55_64"]}} {{$cal_resultes["b2_new_female_55_64"]+$cal_resultes["b2_relapse_female_55_64"]}} {{$cal_resultes["b2_new_male_65"]+$cal_resultes["b2_relapse_male_65"]}} {{$cal_resultes["b2_new_female_65"]+$cal_resultes["b2_relapse_female_65"]}} {{$cal_resultes["b2_age_new_total_male"]+$cal_resultes["b2_age_relapse_total_male"]}} {{$cal_resultes["b2_age_new_total_female"]+$cal_resultes["b2_age_relapse_total_female"]}} {{$cal_resultes["b2_age_new_total_Gtotal"]+$cal_resultes["b2_age_relapse_total_Gtotal"]}}
Childhood TB Meningitis by Age group and Sex
0 – 4 5 – 9 10 – 14 Total Grand Total
M F M F M F M F
{{$cal_resultes["child_0_4_male"]}} {{$cal_resultes["child_0_4_female"]}} {{$cal_resultes["child_5_9_male"]}} {{$cal_resultes["child_5_9_female"]}} {{$cal_resultes["child_10_14_male"]}} {{$cal_resultes["child_10_14_female"]}} {{$cal_resultes["child_total_male"]}} {{$cal_resultes["child_total_female"]}} {{$cal_resultes["child_total_male"]+$cal_resultes["child_total_female"]}}
Block 3: Laboratory diagnostic and follow-up activity
Smear Xpert Test
(a) Patients with presumptive TB for Diagnosis (Dx)
(b) Number of Patients with positive bacteriological results out of Diagnosis (Dx)
(c) Number of patients examined for follow-up
(d) Number of positive patients out of follow-up
Block 4: TB/HIV activities (all TB cases registered during the quarter)
Number of patients tested for HIV or/and known HIV status
(Pos / Neg) at the time of Diagnosis registered in the Township
TB register 		No. of HIV-positive TB
patients 		HIV-positive TB patients
Start CPT and ongoing CPT 		No. of HIV + TB patients Start ART
and ongoing ART
{{$cal_resultes["b4_HIV_know"]}} {{$cal_resultes["b4_HIV_Positvie"]}} {{$cal_resultes["b4_HIV_Positvie_S_CPT"]}} {{$cal_resultes["b4_HIV_Positvie_S_ART"]}}
a No. of treated TB Patients with DM {{$cal_resultes["TB_DM"]}} (Base on the DM Status of TB07 column "N")
b Total smokers Current {{$cal_resultes["smoke_current"]}} Past {{$cal_resultes["smoke_past"]}} Never {{$cal_resultes["smoke_never"]}} Unknown {{$cal_resultes["smoke_unkown"]}}
c Nationality - National {{$cal_resultes["national"]}} Non-national {{$cal_resultes["nannational"]}}
IR {{$cal_resultes["IR"]}} Case RR {{$cal_resultes["RR"]}} Case CR {{$cal_resultes["CR"]}} Case MR {{$cal_resultes["MR"]}} Total {{$cal_resultes["IR"]+$cal_resultes["RR"]+$cal_resultes["CR"]+$cal_resultes["MR"]}} Case
Transfer In: Male {{$cal_resultes["transfer_male"]}} Female {{$cal_resultes["transfer_female"]}} ; Total {{$cal_resultes["transfer_male"]+$cal_resultes["transfer_female"]}}
d Total No. of relapse patients who were tested Gene Xpert {{$cal_resultes["relapse_Gen_xpert"]}}
e Total No. of relapse patients who were diagnosis RR+ {{$cal_resultes["relapse_Gen_xpert_RR"]}}
f DST Coverage among register TB Cases {{$cal_resultes["DSTD_case"]}} 100%
Remark-
Countersigned by
Signature: Signature:
Name: Name:
Designation: Designation:
@if ($cal_resultes["report_type"]=="Report_view") {{--
--}} @endif {{--
Select State/Region Name:
Quarterly report on the ouotcome of TB patient registered 12-15 months earlier (TB - 08)
Name of township Patient registered during
Township code no. of Date of completion of this form:
Name of Township TB coordinator Signature
TB patient type No. of cases registered Treatment outcomes
Cured Treatment completed Failed Died Lost to follow-up Not evaluated Moved to second-line drug
Block 1(A). All TB cases registered during the quarter of the previous year
1. Bacteriologically confirmed new case
2. Bacteriologically confirmed relapse cases
3. Clinically diagnosed, new and relapse
4. Retreatment (excluding relapse)
All TB Cases
Block 1(B). All HIV positive TB cases registered during the quarter of the previous year
1. Bacteriologically confirmed new case
2. Bacteriologically confirmed relapse cases
3. Clinically diagnosed, new and relapse
4. Retreatment (excluding relapse)
All HIV Positive TB Cases
Block 1(C). All childhood cases registered during the quarter of the previous year
1. Bacteriologically confirmed new case
2. Bacteriologically confirmed relapse cases
3. Clinically diagnosed, new and relapse
4. Retreatment (excluding relapse)
All TB Cases
Block 2: TB/HIV activities (all TB cases registered during the quarter of the previous year)
HIV-positive
TB patients		 HIV-positive
TB patients on CPT		 HIV-positive
TB patients on ART
Countersigned by:
Signature:
Name:
Designation:
Select State/Region Name:
Quarterly Report for TB/HIV collaborative activity
AIDS/STD team / HIV Clinic Quarter
TB Team Year
Township/District
Block A: Reporting for AIDS/STD team / HIV Clinic Newly enrolled 1st visit for calender year Head count in current quarter
0 - 14 >= 15 0 - 14 >= 15 0 - 14 >= 15
Male Female Male Female Male Female Male Female Male Female Male Female
Number of PLHIV attended HIV care during the reporting period
Number of PLHIV screened for TB during reporting period
Number of PLHIV referred for TB diagnostic evaluation
Number of PLHIV diagnosed with active TB diasease and registered for TB treatment
Number of PLHIV received IPT evaluation
Number of PLHIV who were eligible for IPT
Number of PLHIV who were givening IP in reporting period
___
IPT outcome reporting for patient
registered in IPT during the same
quarter, one year earlier 		Total number registered during
same quarter, one year earlier 		Completed
>= 6 months 		Incomplete (Discontinue due
to side effects, lost to follow up) 		TB disease while on IPT
Patients registered during:
Quarter of
Year
_____
Block B: Reporting for TB Team Number Data Source
0-4 >=5-14 >=15
Male Female Male Female Male Female
Number of New + Relaplse TB patients registered during
the reporting period
Number of New + Relapse TB patients registered during the
reporting period who had an HIV test result recorded in the
TB register
Number of New + Relapse TB patients registered over the
reporting period with documented HIV-positive status
Number of New + Relapse HIV positive TB patients,
registered during the reporting period, starting or continuing
CPT treatment during their TB treatment
Number of New + Relapse HIV positive TB patients,
registered during the reporting period, who are started on or
continue previously initiated ART during TB treatment
____
Signature Signature
Name Name
Disignation Disignation
Programme Programme
--}}