Clinic ID	General ID	Fuchia ID	Register Year	Register Age	Register Age(Month)	Agey	Agem	Sex	KAP:	Mode of entry:	Date of TB screening:	Date of next visit:	HTC result:	HTC Date:	Sputum AFB result:	Sputum AFB date:	GeneXpert result:	GeneXpert date:	Place of CXR:	CXR date:	Lymphadenopathy:	Previous anti-TB history:	Fever (days):	Cough (days):	Night sweat (days):	LOW (days):	LOA (days):	Lymphadenopathy (days):	Lymphadenopathy(Describe)	Reason for CXR request:	Recheck after (days of antibiotics):	Months of anti-TB treatment:	MD's provisional diagnosis/action plan:	Antibiotics:	Suspicion on active TB:	Others:	Further consulting needed:	IF No, why:	Radiologist opinion:	MD's Management plan:	Need Tech team advice:	Teach Team advice(Describe)	MD's Name:	Case Noted: