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Paper forms for the Kerry Town Ebola Treatment Centre run by Save the Children.

The "patient and work flow" file [pptx, pdf] gives an overview.  The other files are forms.  They are:

  1. Triage [word, pdf] (info collected by a medic with partial PPE behind plexiglass with a laptop)
  2. Assessment [word,pdf] (info collected by doctor and/or nurse in full PPE probably using tablet)
  3. Inpatient [word, pdf] (collected in wards with full PPE and tablet)
  4. Drug request form [word, pdf] (sent from wards or assessment using PPE+tablet)
  5. Lab request form [word, pdf] (sent from wards or assessment using PPE+tablet)
  6. Discharge/death form [word, pdf] (from wards using PPE+tablet)
  7. Exit form [word, pdf] (in exit tent, no PPE, laptop or tablet, probably not medical staff)
  8. Ward Assessment form [word, pdf]: A combination of 1+2 for transfer patients who enter with confirmed cases of Ebola, and with a CIF (case investigation form) filled out from the holding centre that transferred them.  For now, this is not being used because many patients arrive without CIFs.

Nov 5 update:  Forms have been recently updated, and now are starting to be used.  As we get feedback from clinicians, we expect further changes.

 

  File Modified
Microsoft Word Document SCI-KT-ETC_Drug_Request_Form_v1.0.docx 2014-10-26 by Aram Harrow
PDF File SCI-KT-ETC_Drug_Request_Form_v1.0.pdf 2014-10-26 by Aram Harrow
Microsoft Word Document SCI-KT_ETC_Discharge_Form_v2.0.docx 2014-11-05 by Aram Harrow
PDF File SCI-KT_ETC_Discharge_Form_v2.0.pdf 2014-11-05 by Aram Harrow
Microsoft Word Document SCI-KT_ETC_Exit_Form_v2.0.docx 2014-11-05 by Aram Harrow
PDF File SCI-KT_ETC_Exit_Form_v2.0.pdf 2014-11-05 by Aram Harrow
Microsoft Word Document SCI-KT-ETC_Inpatient_Form_v1.1.docx 2014-11-05 by Aram Harrow
PDF File SCI-KT-ETC_Inpatient_Form_v1.1.pdf 2014-11-05 by Aram Harrow
Microsoft Word Document SCI-KT-ETC_Triage_Form_v2.0.docx 2014-11-05 by Aram Harrow
PDF File SCI-KT-ETC_Triage_Form_v2.0.pdf 2014-11-05 by Aram Harrow
PDF File Patient_and_work_flow_KerryTown_2014_11_4.pdf 2014-11-05 by Aram Harrow
Microsoft Powerpoint Presentation Patient_and_work_flow_KerryTown_2014_11_4.pptx 2014-11-05 by Aram Harrow
Microsoft Word Document SCI-KT-ETC_Ward_Assessment_Form_v1.0.docx 2014-11-05 by Aram Harrow
PDF File SCI-KT-ETC_Ward_Assessment_Form_v1.0.pdf 2014-11-05 by Aram Harrow
Microsoft Word Document SCI-KT-ETC_Assessment_Form_v2.0.docx 2014-11-06 by Aram Harrow
PDF File SCI-KT-ETC_Assessment_Form_v2.0.pdf 2014-11-06 by Aram Harrow
Microsoft Word Document SCI-KT-ETC_Lab_Request_Form_v2.0.docx 2014-11-15 by Aram Harrow
PDF File SCI-KT-ETC_Lab_Request_Form_v2.0.pdf 2014-11-15 by Aram Harrow