Multidrug-Resistant Tuberculosis Alert
Patient Information
Name
Date of Birth
Gender
Male
Female
Other
Patient ID
Contact Number
Address
Clinical & Laboratory Details
Date of Diagnosis
Drug Resistance Status
MDR-TB
XDR-TB
Specimen Type
Lab Confirmation
Test Date
Resistance To Drugs
Treatment Information
Treatment Start Date
Current Regimen
Healthcare Provider
Notes / Additional Information