Date: Location:
Impressions & Diagnoses
Record any Adverse Drug Reactions since the last visit
Date of onset Reaction Grading Causative agent

Current Diagnoses Noted Today

WHO Staging:
Adult
Child
Cotrimoxazole
Adherence
Dispensed
Decision Points
Decision Points
Clinical Notes:
Return Visit Date:
At Risk Population
Is the client a member of at-risk population?



PwP Services
Has the client been given condoms this visit?
Has the Client disclosed HIV status to their sexually active partner?
Has the client's partner received on-site HIV testing?
Has the client been screened for STI (in this visit)?