” Questionnaire for Clinic Xay Holder ~ Page 8
72.
Are there certain times when a patient cannot ger to the clinic because
of weather conditions?
( ]
{]
Yes
Yeo
73.
If yes, how many days per year?
74,
If yes, during whac months of the year?
75.
Describe the type of medical records kept, where they are kepe and the
accuracy and completeness of the medical records.
Type of record on each patienc
Where record keot
Completeness of information
Please check which of the following icams of information are kepe on the
medical record:
-
tabulations of number of clinic visits currently made?
{]
[ ]
78.
Reason for clinic visit
Medical diagnosis
Type of treatment given
Medications prescribed
Nama of patient
Age of patient
Sex of patient
. Past parctenc medical history
Other (please specify)
5
77.
Bd bed eee med feed Gerd feed Band tad
76,
rare rs rears rae ee
VA
Accuracy
Yas
Wo
If yes, where are they sent?