Tag Archives: Data collection forms
General National Information
OffThe information to be collected for this form covers a variety of topics. However, it is anticipated that much of it can be obtained from existing publications available at a Ministry of Health, Census Office, Ministry of Finance/Economy and so forth. All sources of information should be completely referenced. Whenever possible, a sample document should […]
Information System Assessment Form
OffThe information for this form will be obtained primarily from interviews conducted with public, private or parastatal companies. All sources of information must be completely referenced.
Ministry of Health Form
OffThis data collection form focuses on drug policy, selection and information issues within the Ministry of Health. Various departments or divisions within the MOH may provide the required information. Drug procurement information will be obtained from the relevant medical stores/procurement office (use medical stores survey form). Note all sources of information and obtain copies of […]
Regional Medical Store Form
OffThis form is to be used for Regional Medical Stores. The questionnaire is followed by a review of inventory levels of tracer items, a price comparison form, and cost analysis form.
Private Clinic/Hospital Survey
OffThis survey is to be conducted at private for profit clinics and hospitals (outpatient department only) with dispensaries. Ask to speak to the person in charge. Present the letter signed by the Director General of the Ministry of Health. Explain the purpose of the study and the amount of time required to complete the questionnaire. […]
Price Comparison Form B
OffThis form is to be used to collect data on the prices paid by public stores and facilities or other organizations conducting procurements for essential health commodities. To collect data on prices charged to patients use Price Comparison Form A.
Prescribing & Dispensing Analysis
OffUse this form to review 30 patient records in public health centers and hospitals, NGO/Mission clinics and hospitals, and Private clinics and hospitals
Price Comparison Form A
OffThis form is to be used to collect information about prices charged to patients and customers in all facilities. Use Price Comparison Form B to collect data on prices paid by facilities to obtain products.
SEAM DCF – Log of Drug Samples
OffLog of Drug Samples for _____________ Region, __________(Country)