1

NATION VICTOR BORNE DISEASE

CONTROL PROGRAMME,CUDDALORE

PRIMARY HEALTH CENTRE : KUNDIYAMALLUR

MONTHLY TECHNICAL REPORT ON LABORATORY ACTIVITES

FOR MONTH OF :
PASSIVE - NEW OP CASES -
ACTIVE - H . O W -
G.TOTAL -


2

DEPARTMENT OF PUBLIC HEALTH AND PREVENTIVE MEDICINE
DEPUTY DIRECTOR OF HEALTH SERVICES
CUDDALORE

From :-
GOVT. PRIMARY HEALTH CENTRE
KUNDIYMALLUR 607301
CUDDALORE
Madam,
Sub: Public Health and Preventive Medicine National Vector Borne Diseases Control Programme
Laboratory Services at primary Health Centre Monthly Technical Report for the Month of
Submitted Regarding

I am here with submitting technical Report of Laboratory Information of the PHC KUNDIYMALLUR
For the month of :




3

MALARIA MONTHLY TECHNICAL REPORT OF PHC HIGHLIGHTS
I
DEMOGRAPHY OF PHC
1
Population

2
No Of HSC

3
No Of Village Panchayat

4
No Of Town Panchayat

5
No Of Villages

II
A
MALARIA
PASSIVE SURVEILLANCE
1
New Op Cases

2
Total Fever Cases

3
No Of Fever Cases Screened

4
Other Related Cases Screened

5
BS Collected & Exam

6
Total Blood Smear Collect & Exam

7
Positive Cases Delected


Pv


Pf


Total


Treated


Refered


Referal Place



4

B ACTIVE SURVEILLANCE
1
Bs Collection


Health Inspectors


Village Health Nurse

2
Positive Cases Detected


Pv


Pf


Total


Treated

C REFFERAL CASES
1
No Of Cases


Insliution


Refered From


1 Places
Details
VI HIGHER OFFICIAL VISITED DETAILS
1
2





5


















1 Contact

BS


Positive


Species

2
Mass BS


Positive

Species
3
Follow Up BS No


Positive


Treated

II
STOCK OF ANTIMALARIALS & MATERIALS


4 AQ


8 AQ 2.5mg


7.5mg


slides

III
PILARISIS

1
No Of Provocative BS


Positive


Treated

2
Night Blood Slides


No examined


No positive


No Treated



6

IV OTHER LABORATORY ACTIVITIES

SAMPLES ABNORMAL / STATUS
1 Sputum
2 Grouping & Typing
3 Blood Serumfor Vbd
4 Widal
5 VDRL
6 Urine Analysis
7 Pregnancy Test
8 Brochemical Test
9 Slool Examination
10 Bile Salt
11 Bile Pigment
12 Bs Hb
13 Hb Sag
14 Hiv






7


PASSIVE SURVEILLANCE REPORT (FORM-1)
PHC: KUNDIYAMALLUR Month:
SL.
NO
Name of the Village
Village
code
OPD
New
Cases
15%
of
NOP
Cases
Total
Fever
Cases
Fever
Cases
Screened
Other
related
cases
screened
Total B.S
Collection
Examined Result
Details
of
positive
Treated
Short
fall
(Nos)
Short
fall %
1 Kundiyamallur
2 Kothavachery
3 Kallan kuppam
4 Ayyanthur
5 Adoor agaram
6 Periya kannadi
7 Paratham pattu
8 Manjampettai
9 Virupatchi
10 Pudukuppam
11 Pottaveli
12 M.mettukuppam
13 M.Pudupettai
14 Velavinayakar kuppam
15 Kuruvappanpettai
16 Varatharajanpettai
17 Boothampadi
18 Kalkunam
19 Rettipalayam
20 T .V.Nallur


8

TOTAL



ACTIVE SURVEILLANCE REPORT (FORM 2)
Month & Year : PHC : KUNDIYAMALLUR
Block PHC Code No : 605 A


Sl
NO
HSC
Code
No
Name of the
HSC/Village
Villag
e
code
Popula
tion
Name
Of the
HIV/VH
N
Blood sample Collection
Total Blood
Smears
Positive
Detecte
d
Positive
Treated

Staff Centers
Cod
e
Exa
m
HI VHN FTD Govt
Hospi
tal
PVt
Hospi
tal
Oth
ers
1 028 Kundiyamallur
2 Kothavacher
3 Kallankuppam
4 Ayyanthur

TOTAL
5 029 Adoor Agaram
6 Periyakannadi
7 Parathampattu
8 Manjapettai



9

TOTAL


ACTIVE SURVEILLANCE REPORT (FORM 3)
Month & Year PHC : KUNDIYAMALLUR
Block PHC Code No : 605 A
Sl
NO
HSC
Cod
e No
Name of the
HSC/Village
Villag
e
code
Popula
tion
Name
Of the
HIV/VH
N
Blood sample Collection
Total Blood
Smears
Positive
Detecte
d
Positive
Treated

Staff Centers
Cod
e
Exa
m
HI VHN FTD Govt
Hospi
tal
PVt
Hospi
tal
Oth
ers
9 030 Virupatchi
10 Velavinayakar kuppam
11 Pudukuppam
12 Pottaveli
13 M.mettukuppam
14 M.Pudupettai

TOTAL
15 031 Kuruvappanpettai
16 Varatharajanpettai
17 Boothampadi
18 Kalkunam
19 Rettipalayam
20 T .V.Nallur



10

TOTAL






HEALTH INSPECTOR PERFOMANCE REPORTS (FORM VI)

Month & Year:
PHC : KUNDIYAMALLUR PHC Code No : 605 A
SL
NO
Name of the H I HSC Name
NO.Of
Villag
es
Population Target
BS Taken
N
o

o
f

v
i
l
l
a

g
e
s

c
o
v
e
r
e
d


NO Of Villages un
covered continuously




Remarks
D
u
r
i
n
g


t
h
e

m
o
n
t
h

S
h
o
r
t
f
a
l
l

d
u
r
i
n
g


t
h
e

m
o
n
t
h

U
p
t
o

t
h
e

m
o
n
t
h

2


m
o
n
t
h
s

3
-
6

m
o
n
t
h
s

7
-
1
2


m
o
n
t
h
s

1 Mr.Anbazhagan Kundiyamallur 4

2 Mr.Anbazhagan Adur agaram 4


Total 8
3 Mrs.Rajeswari Virupatchi 6

4
Mrs.Rajeswari Kuruvapanpet

TOTAL


11




GRAND TOTAL


STOCK REPORT (EQUIPMENTS) (FORM VII B)
BPHC :KUNDIYAMALLUR MONTH:
SI
NO
Items
OB Received
during
month
Issued
PHC Use
Issued to
Field Use
Total
Issued
Closing
Balance in
PHC
Closing
Balance In
Field
Total
Balance
Condition
Of The
Instruments
1 Microscope
2 Centifige
3 Calorimeter
4 Semiauto Analyser
5 Glucometer
6 ESR Tube
7 ESR Stand
8 Dc Counting Chamber
9 HB Meter
10 Capillary Tube
11 Hagedorn Needle
12 Landset
13 Micro Slide(New)
14 Micro Slide(Old)
15 Serum Vials


12

16 Pegion hole
17 Staining jar
18 Filter paper
19 Fogging machine(Pulse)
20 Fogging machine(Mini )


STOCK REPORT DRUGS AND CHEMICALS (FORM VII B)
BPHC :KUNDIYAMALLUR MONTH:
SI
NO
Drugs
OB Received
during
month
Issued
PHC Use
Issued to
Field Use
Total
Issued
Closing
Balance in
PHC
Closing
Balance In
Field
Total
Balance
Batch No Date Of
Expiry
1 Tab chloroquine
2 Tab primaquine 2.5mg
3 Tab primaquine 2.7mg
4 Artesunate
5 Sulfadoxine
pyremethamin

6 DEC
7 Albendozole
8 JSB I
9 Eosin powder
10 Liquid paraffin
11 Sprit
12 methonol
13 Buffer solution
14 Urine stick


13

15 Glucostick
16 Widal kit
17 VDRL Kit
18 Grouping kit
19 Technical malathion
20 Temephose
21 Pyrethrum


LABORATORY ACTIVITIES UNDER TAKEN (VII-B)
Name of the Lab Technician : R.AMUTHA PHC: KUNDIYAMALLUR Month :
SL
NO
Details of the activites
Samples
collected
/recived
Sampleles
analysed
Back log
Results
Test done
averge/day
Samples
analysed
upto the
monyth
Samples
analysedprevious
year
Remarks
Normal
Abnorma
l(specify
the
value/nat
ure
During
the
month
Up to
the
month
1 Malaria BS
2 Filarial BS
3 Sputum
4 Leprosy
5 Total count (TC)
6 Diffrential Count (DC)
7 Plated Count
8 Bleeding &clotting time
9 ESR


14






10 HB
11 Grouping &Typing
12 Blood serum for VBD
13 Widal
14 VDRL
15 Urine Albumin
16 U Sugar
17 Urine BS &BP
18 Urine Deposite
19 Pregnency Test
20 Sugar
21 Bilirubin
22 Cholesttrol
23 Creatinine
24 Stool Examination
25 Motion Sugar
26 Semen Analysis
27 H I V
28 HB Sag
29
30
31
32


15







LABORATORY ACTIVITIES UNDER TAKEN (VII-B)
Name of the Lab Technician : R.AMUTHA PHC : KUNDIYAMALLUR Month :
Total Working days
Days Worked

Days Attented
Works at lab
Days Attented
Works at
camps/field
Name of the other
PHC Visited /no of
days visited
Name of the other
PHC ,S Works
diverted
Remarks













16






TAMILNADU .M4 Monthly Report of Malaria Cases
Name of the PHC : KUNDIYAMALLUR Month & Year : PHC CODE : 605-A
S
.
N
O

Name of the HSC
H
S
C


C
o
d
e


p
o
p

Total
fever
cases
recorded
during
Number of
Blood slides
collected &
Examined
N
u
m
b
e
r

o
f

s
l
i
d
e
s

r
e
p
o
r
t
e
d

w
i
t
h
i
n

2
4

h
o
u
r
s

o
f


s
l
i
d
e
s

c
o
l
l
e
c
t
i
o
n

Positives Distribution of total malaria cases
P
f

C
a
s
e
s

T
r
e
a
t
e
d

w
i
t
h


A
C
T

S
e
v
e
r
e

c
a
s
e
s

t
r
e
a
t
e
d

w
i
t
h

l
n
j

a
r
t
e
e
t
h
e
r

O
u
t
b
r
e
a
k
s

r
e
p
o
r
t
e
d

(
Y
/
N
)



S
t
o
c
k

o
u
t

o
f

a
n
t
i
m
a
l
a
r
i
a
l
s

R
D
T
S

s


N
o

o
f

m
a
l
a
r
i
a

c
a
s
e
s

r
e
f
e
r
r
e
d

N
o

o
f

d
e
a
t
h
s

N
a
m
e

/

A
g
e

/

S
e
x

o
f

D
e
a
t
h

C
a
s
e
s

I

F
.
N

I
I

F
.
N

T
o
t
a
l

A
c
t
i
v
e

P
a
s
s
i
v
e

M
a
s
s

&
c
o
n
t
a
c
t

T
o
t
a
l

P
V

p
f

M
i
x
e
d

T
o
t
a
l

0-4 5-14
15&ab
ove
P
a
s
s
i
v
e

c
a
s
e
s

S
C
S
T
P
r
e
g
n
a
n
t

w
o
m
e
n

R
D
T

p
r
e
s
e
n
t

(
y
/
n
)

A
C
T

P
R
E
S
E
N
T

(
y
/
n
)

M F M F M F
KUNDIYAMALLYR





ADOOR AGARAM

VIRUPATCHI

KURUVAPPANPETTAI



17

TOTAL
MPW M :
MPWM :
MPW F :
SC Subtotal :
PHC (DIST TOTAL) :
TOTAL :
TAMILNADU .M4 Monthly Report of Malaria Cases
Name of the PHC : KUNDIYAMALLUR Month & Year :
STOCK POSITION
Stock position
R
D
T

C
o
m
b
i
b
l
i
s
t
e
r

p
a
c
k

C
Q

A
C
T

p
a
c
k
s

A
S

t
a
b
l
e
t
s

S
P

t
a
b
l
e
t
s

I
n
j

A
r
t
e
e
t
h
e
r

a
t

P
H
C

P
Q

s
m
a
l
l

P
Q

L
a
r
g
e

S
l
i
d
e
s

L
a
n
c
e
t
s

Opening Balance



Received during the
month

Total of above

Utilization

Balance



18









NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEM
Name of the PHC : KUNDIYAMALLUR Month & Year :
FORTNIGHT -I
SL.
NO
Name of the HSC
Total
Blood
Smear
Cool.&
Exam
RDT Performed
Passive
Blood
Smear
Slide Reported
Within 24 Hr of
Slide collection
Positive Case Age wise
Malaria
Reffered
Case
Pf ACT
Treated
Death
due to
malaria
RDT
BS
Exam
RDT
Pv
RDT
Pf
Total
Bs
Coll&
Exam
Pv Pf
0 to 4 5 to 14 15 & Above
Male Female Male
Female

Male
Female


ADOOR AGARAM






KUNDIYAMALLUR






19


KURUVAPPANPETTAI





VIRUPATCHI






TOTAL



NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEM
Name of the PHC : KUNDIYAMALLUR Month & Year :
FORTNIGHT -II
SL.
NO
Name of the HSC
Total
Blood
Smear
Cool.&
Exam
RDT Performed
Passive
Blood
Smear
Slide Reported
Within 24 Hr of
Slide collection
Positive Case Age wise
Malaria
Reffered
Case
Pf ACT
Treated
Death
due to
malaria
RDT
BS
Exam
RDT
Pv
RDT
Pf
Total
Bs
Coll&
Exam
Pv Pf
0 to 4 5 to 14 15 & Above
Male Female Male
Female

Male
Female


ADOOR AGARAM





KUNDIYAMALLUR




20




KURUVAPPANPETTAI





VIRUPATCHI






TOTAL



NATIONAL ANTI MALARIA MANAGEMENT INFORMATION SYSTEM HO CUDDALORE (FORM-III)
Name of the PHC : KUNDIYAMALLUR Month & Year :
SL
NO
Name of the HSC
Active passive
Total
Active Passive
Total
I-II FN Grand
Total I FN

I FN II FN II FN
BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve BS +Ve
1 ADOOR AGARAM
2 KUNDIYAMALLUR
3 KURUVAPPANPETTAI
4 VIRUPATCHI
5
6
7


21

8
9
10
11
12
TOTAL