” Questionnaire for Clinic Xey Folder - Page 3
72.
Are there certain times when a patient cammoc get to the clfiaic because
of weather condircions?
( ]
( ]
Yes
Ne
73.
If yes, how many days per year?
74,
If yes, during whac months of the year?
75.
Deseribe the type of madical records kept, where they are kepe and the
accuracy and completeness of the medical records.
Type of record on each parient
Where record kept
Completeness of informacion
76.
Please check which of che following icams of information a
medical record:
boon tema Gene Geen hel feed) deel Que) femell
A
Accuracy
77.
are tabulations of number of clinic visits currently made?
{ ]
{ ]
78.
Reason for clinic visic
Medical dflagnosis
Type of treacment given
Medications prescribed
Name of partent
Age of patient
Sex of patiant
Past patient medical history
Other (please specify)
Yes
We
Tf yes, where are they sent?
kept on the