National Referral Hospital HMIS Monthly Report
I. Identification and Important Communications
A) Report Identification
1. Facility Name
5. Year
2. Countries – catchment area
6. Month
3. Province
7. Sector
4. District
8. Cell
C) Report Approvals/Processing
1. Name of In-charge
5. Date received
2. Qualification
6. Name
3. Date of sent
7. Signature
4. Signature
8. Date entered in DHIS
II. Outpatient Consultations
A) Summary statistics
New Cases
Old Cases
New Cases
1
General surgery
12
Pneumology
2
Neurosurgery
13
Hematology
3
Orthopedics
14
Rheumatology
4
Plastic surgery
15
Gastro-enterology
5
Cardiac surgery
16
Cardiology
6
Cardio-thoracic surgery
17
Nephrology
7
Transplants
18
Oncology
8
ENT
19
Dermatology
9
Ophtamology
20
Obstetrics and gynecology
10 Emergency
21
Pediatrics
11 Stomatology & oral surgery
22
Neonatology
B) Health insurance status of new cases
Total
C) Special causes of OPD visits
Old Cases
Total
1. Insured (Mutuelle or other insurance members)
1. Road traffic accidents
2. Non-Paying New cases (abandoned)
2. Natural or man-made disasters (epidemic,
earthquake, war, etc)
3. Number of Indigent new cases
D) Referrals out
1.Referred to other specialized hospital in Rwanda
2. Referred outside of the country
Total
E) Origin
1. Origin of OPD cases
(by residence)
Rwanda
East African
community – excl.
Rwanda
Other
HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
III. Chronic Diseases and Mental Health
Diagnosis
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Post-traumatic stress disorder
Schizophrenia and other psychoses
Neurological problems
Psychosomatic problems
Behavior disorders (not due to
alcohol/drugs)
Depression
Behavior disorders due to use of
alcohol/drugs
Other Psychological problems
Epilepsy
Diabetes
Hypertension
Congestive Cardiac Failure
Cardio vascular Disease Other
Leprosy (MB + PB)
Asthma
ICD-10
F43.1
F20.9
F29.8
F45.9
New cases
Under 20 years 20 years and above
M
F
M
F
Old cases
Under 20 years 20 years and above
M
F
M
F
F98.9
F32.9
F10-F19
FXX.9
G40.9
E10-E14
I10
I11.0
I51.6
A30.9
J45.9
IV. Hospitalizations
ENT
A) Summary statistics
Emergency
Internal
Medicine
Pediatrics Surgery
Gyn.
Obst.
Stoma- Intensive Other
tology
care
service
1 Number of beds (a)
2 Present at the beginning of the month
3 Admissions during the month of which:
3.1 Referred from the Health Centre
3.2 Non-referred patients
4 Discharges during the month (b) of which
4.1 Authorized/Cured
4.2 Abandoned
4.3 Deaths
4.4 Referred
4.5 Counter-referred
5 Present at the end of the month
6 Total hospitalization days for discharged patients (c)
7 Actual hospitalization days (d)
B) Payment for Hospitalization
Total
C) Special causes of admissions and deaths
1
Insured discharges (Mutuelle, etc.)
1. Road traffic accidents
2
Non-paying discharges
3
Non-Paying Indigents discharged
2. Natural or man-made disasters (epidemic, earthquake, war
victims, etc.)
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Admissions
Deaths
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HMIS
National Referral Hospital HMIS Monthly Report
D) Causes of Hospitalization and death at
discharge
Hospitalization
Under 5
years
M
1
Malaria, confirmed simple
B50-B53
2
Malaria, confirmed severe
B50-B53
3
Malaria presumptive
B54
4
Borreliosis
A69.2
5
Pneumonia
J12.9 +
J15.9
6
Pleurisy (non-Tuberculosis)
R09.1
7
Respiratory Infection Acute Others
J06.9 + J22
8
Asthma
J45.9
9
Diarrhoea bloody (Dysentery)
A09.0
10
Diarrhoea non-bloody with dehydration
A09.9
11
Diarrhoea non-bloody with NO
dehydration
A09.9
12
Diarrhoea Chronic opportunistic
infection
K52.9
13
Cholera
A00.9
14
Typhoid fever (salmonellosis)
A01.0
15
Meningitis
G03.9
16
Measles
B05.9
17
Diphtheria
A36.9
18
TB pulmonary Sputum positive
A15.0
19
TB extra pulmonary
A31.8
20
Fever Chronic (> 1 month)
B23.8
21
Pneumopathies
B20.6
22
Encephalitis
B22.0
23
Meningitis Cryptococal
G02.1+
B45.1
24
Skin infections opportunistic
L98.9
25
HIV Opportunistic Infections Other
B24
26
Trauma Head
S09.9
27
Ruptured spleen
S36.0
28
Fractures, open
T14.2.1
29
Fractures, internal
T14.2.0
30
Trauma Other
T79.9
31
Burns
T29.0
32
Cancer Uterine
C55
33
Cancer Breast
C50.9
34
Kaposi's sarcoma
C46.9
35
Cancer Liver
C22.9
36
Cancer Prostate
C61
37
Tumors Other malignant
C80.9
38
Tumors Other non malignant
D36.9
Version 1.5
12/4/2012
F
5 to 19
years
M
F
Deaths
20 years and
above
M
F
Under 5
years
M
F
5 to 19 years
M
F
20 years and
above
M
F
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HMIS
National Referral Hospital HMIS Monthly Report
D) Causes of Hospitalization and death at
discharge
Hospitalization
Under 5
years
M
39
Hepatitis
B19.9
40
Cirrhosis of the liver
K74.6
41
Digestive tract Hemorrhages
K92.2
42
Gastritis
K29.0
43
Ulcer gastro-duodenal
K27
44
Appendicitis
K35.8
45
Hernia
K46.9
46
Peritonitis (non-Tuberculosis)
K65.9
47
Intestinal occlusion
K56.6
48
Urinary tract infections
N39.0
49
Kidney infections
N15.9
50
Nephritic syndrome
N05
51
Glomerulonephritis
N05.9
52
Hypertension
I10
53
Cardiomyopathy
I42.9
54
Cerebro-vascular accident
55
Diabetes
I64
E10-E14
56
Bone infections (including
osteomyelitis)
M86.9
57
Bone and joint disease other
M80-M94
Malnutrition acute severe with
complications
Malnutrition acute moderate with
complications
Malnutrition acute severe without
complications
Malnutrition acute moderate without
complications
58
59
60
61
M
F
Deaths
20 years and
above
M
F
Under 5
years
M
F
5 to 19 years
M
F
20 years and
above
M
F
E4X.2
E4X.3
E4X.4
Malnutrition chronic severe
E4X.5
63
Malnutrition chronic moderate
E4X.6
64
Goitre
Vitamin A deficiency
(keratomalacia)
E04.9
Gynecological problems
N94.9
66
F
5 to 19
years
E4X.1
62
65
12/4/2012
E50.4
V. Surgery
1
Services
Type of surgical intervention
General surgery
1. Appendicectomy
Urgent interventions
Planned interventions
Post-surgical Infection Total
2. Laparotomy
3. Thyroidectomy
4. General surgery other
2 Gyneco Obstetrical
1. Cesarean
2. Hysterectomy
3. Laparotomy (EUP)
4. Other Laparotomies
5. Myomectomy
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HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
V. Surgery
Services
Type of surgical intervention
Urgent interventions
Planned interventions
Post-surgical Infection Total
6. Curettage
7. Gyneco-obstetrical surgery other
3 Orthopedic
1. Amputations
2. Osteosynthesis
3 Fracture without implant
4. Orthopedic surgery other
4 Ophthalmologic
1. Glaucoma
2. Trachoma
3. Cataract
4. Ophthalmological surgery other
5 Urology
1. Hernioraphy
2. Fistula Repair
3. Adenomectomy
4. Urology surgery other
6 Neurosurgery
1. Spinal cord injuries
2. Head injuries
3. Neurosurgery other
5 SURGICAL INTERVENTIONS TOTAL
Of which 1. Major surgery
2. Minor surgery
VI. Anesthesia
VII. VII. Physiotherapy Sessions
Number
Outpatients
1 General Anesthesia
1 Physical therapy
2 Regional Anesthesia
2 Audiology
3
3 Speech therapy
Local Anesthesia
Hospitalized
4 Other types of anesthesia
VIII. Gender Based Violence
Under 5 years
M
1
GBV victims with symptoms of sexual violence (new cases).
2
GBV victims with symptoms of physical violence (new cases).
3
GBV victims referred for care to higher level health facility
4
GBV victims referred to this facility by police
5
GBV victims referred to this facility by community health workers
6
GBV victims HIV+ seroconversion 3 months after exposure
7
GBV victims with irreversible disabilities due to GBV
8
GBV victim deaths
9
GBV victims pregnant 4 weeks after exposure
10
GBV victims received emergency contraception within 72 hours
11
GBV victims received post exposure HIV prophylaxis within 48 hours
Version 1.5
F
5-9 years
M
F
10-18 years
M
F
19 years and above
M
F
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HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
IX. Male Circumcision
< 30 days
1
30 days to 14 years
>=15 years
Male circumcisions performed in the facility
X. Obstetrical Complications
OPD NC
A. Cases and Deaths
ICD-10
O04.9
2
Abortions (symptoms suggesting induced
abortion)
Miscarriages (spontaneous abortions)
3
Ectopic pregnancy
O00.9
4
Threat of premature delivery
O47.9
5
Antepartum Hemorrhage (APH)
O46.9
6
Post-partum hemorrhage (PPH)
O72.1
7
Sepsis / Postpartum infection
O85
8
Prolonged or Obstructed labor
9
Eclampsia /Severe Pre Eclampsia
O66.9
O15.9
O14.1
1
Under 20 y.
20 y. and over
Hospitalized
Under 20 y.
20 y.and over
Deaths
Under 20 y.
20 y. and over
O03
10
Uterine rupture/tear
S37.6
11
Foetal Distress
O68.9
12
Perineal tear (3rd Degree)
13
Fistula (vesico vaginal or rectal)
O70.2
N82.0
K60.4
14
Anemia Severe (<7gm/dl)
O99.0
15
Malaria (confirmed) Treated
O98.6
16
HIV/Opportunistic Infections
O98.7
17
Obstetrical Complication Other
O75.4
B. Emergency Obstetric Care Interventions (Basic and Comprehensive):
1
Intravenus Antibiotics
2
Intravenus Anti-hypertensives
3
Intravenus Oxytocics
4
Manual removal of placenta
5
Manual vacuum aspiration (Post-Abortion Care)
6
Vacuum extraction
7
(Pre) eclamplsia cases receiving magnesium sulfate
8
Caesarean Section
9
Blood transfusion during delivery
Number
C. Women placed under observation for 72 hours or more
D. Women referred for emergency care to higher levels (or out of country)
XI. Deliveries and Births at Health facility
1
Deliveries, total
2
Deliveries, normal
3
Deliveries, abnormal (dystocic)
4
Deliveries 16 to 19 years
5
Deliveries 15 years and under
6
Multiple Pregnancies (twins, triplets)
7
Deliveries referred to elsewhere (e.g. international referral hospital)
8
Maternal deaths Total
9
Births, live
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HMIS
National Referral Hospital HMIS Monthly Report
10
Birth weight <2.5 kg (not premature)
11
Premature Birth weight <2.5 kg (alive, 22-37 weeks)
12
Still births macerated (>22 weeks or >500 grams)
13
Still births fresh (>22 weeks or >500 grams)
14
Deaths of live born babies
15
Newborns breastfed within 1 hour of delivery
16
Newborns who didn’t cry at birth
17
Newborns resuscitated
18
Newborns resuscitated successfully (cry within 5 minutes)
19
Newborns referred to higher level
12/4/2012
Death 0-7 days (excl. death at birth)
Death at birth
Death 8 to 28 days
XII. Neonatal causes of hospitalization and deaths
Hospitalized
Disease
ICD-10
0-7 days
M
1
Asphyxia
P21.9
2
Hypothermia
P80.9
3
Prematurity (22 to 37
weeks)
P07.3
4
Congenital malformation
Q89.9
5
Respiratory infection s
P28.8
6
Meningitis
P36.9
7
Skin infections
P39.4
8
Urinary tract infections
P39.3
9
Tetanus Neonatal
A33
10
Neonatal infections Other
P39.9
11
All other causes of
neonatal morbidity
Deaths
8- 28 days
F
M
0-7 days
F
M
8- 28 days
F
M
F
XIII. Family Planning
Methods
New
Acceptors
Stopped FP
Active users at
end of month
Quantity
distributed
Stock at end
of month
Days of stockout
1 Oral Contraceptives, projestative
2 Oral Contraceptives, combined
3 Injectables (Depo-Provera)
4 Injectables (Norristerat)
5 Implants
6 IUD
7 Male condoms
8 Female condoms
9 Other barrier methods (gel, diaphram)
10 Cycle beads
11 Auto-observation
12 Tubal ligations
13 Vasectomy
Tests taken
Positive
Negative (no spermatozoids)
14 Sperm control of vasectomy clients
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HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
XIV. Laboratory
Results
Exams
Positives
Total
Negatives
1. Blood Smears
1.1. Plasmodium
1.2. Micro-filaria
1.3. Borellia
1.4. Trypanosoma
2. Rapid Diagnostic Tests for Malaria
3. Stools…..Samples TOTAL
Of
which
3.1. Entamoeba histolytica
3.2. Entamoeba coli
3.3. Giardia
3.4. Ascariasis
3.5. Ankylostomiasis (hookworms)
3.6. Schistosoma
3.7. Trichuris
3.8. Taenia
3.9. Other parasites in stools
4. Urine
Of
which
4.1. Sugar
4.2. Albumin
4.3. Pregnancy test
5. Sputum (Number of Patients)
Of
which
5.1. Diagnosis of TB by microscopy
5.2. Control of TB positive patients
6. Bacteriology
6.1.Vaginal
swab
Fresh
Gram
Of which diplococcus gram (-)
6.2. Urethral
swab
Fresh
Gram
Of which diploccocus gram (-)
7. Blood
7.1. Hemoglobin
7.2. RPR
7.3. HIV final result
7.4. ESR/VS
7.5. Full Blood Count (FBC/NFS)
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HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
XIV. Laboratory
Results
Exams
Positives
Total
Negatives
7.6. ALAT(GPT)
7.7. Creatinine
7.8. Blood glucose
7.9. Amylase
7.10. CD4
7.11. Widal
7.12. Pregnancy test
8. Other liquids
8.1. Cerebro Spinal fluid
9. Genetic tests
10. Anatomo-pathologic tests (cancer)
11. Cultures (hemoculture, pyoculture, coproculture,
etc…)
12. Other Lab tests
TOTAL tests conducted in the laboratory
XV. Blood Bank Security
Internal
Medicine
a. Transfusions
Pediatrics
Surgery
Gyn. Obst.
Intensive care
Neonatology
1. Number of patients transfused
2. Number of packs of blood
b. Blood pack stock
management
Number received (donated
and from other blood banks)
Number Used
Number Destroyed or
damaged
Remaining in Stock
1. Type A
2. Type B
3. Type AB
4. Type O
XVI. Medical Imagery
Type of imagery
Number
Type of medical imagery
1. X-Ray Lung
8. Mammography
2. X-Ray Bones
9. Ultrasound (Echography)
3. X-Ray Abdomen without preparation
10. ECG
4. X-Ray Abdomen with dye
11. CT scan
5. X-ray other
12. Colonoscopy
6. Gastroscopy
13 Other medical imagery
Number
7. MRI
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HMIS
National Referral Hospital HMIS Monthly Report
12/4/2012
XVII. Finances
A) Receipts (from all sources including Insurance)
Description
B) Expenditures
Total Amount
Description
Total amount
1. Preventive care
1. Purchase of medicines, medical materials
2. Curative care (including hospitalization)
2. Salaries, social security, professional taxes, personnel
payments
3. Deliveries
3. Employee bonuses
4. Laboratory
4. Travel expenses
5. Sale of medicines/ supplies
5. Office supplies / printed materials / medical records
6. Surgery
6. Maintenance and repair of medical equipment
7. Issue of Medical-Legal Documents
7. Maintenance and repair of non-medical equipment
8. Sale of patient records/forms
8. Maintenance and repair of transport
9. Transport of patients
9. Maintenance and repair of infrastructure
10. Performance Based Financing
10. Maintenance/cleaning supplies
11. Other State Subsidies
11. Fuel and motor oil
12. Contributions from other donors
12. Water and Electricity
13. Bank interest
13. Communication (Telephone, Internet…)
14. Other receipts
14. Training
Total Receipts (A)
15. Costs associated with indigents
16. Purchase medical equipment
17. Purchase non-medical equipment
18. Purchase transport
19. Other expenses
Total Expenses (B)
Total Amount
C. Mutuelle receipts
D. Other health insurance receipts (RAMA / MMI /
FARG/ Private insurers)
14.1 Co-payments
15.1 Co-payments
14.2 Payment for care
15.2 Payment for care
14.3 Payment for medication
16.3 Payment for medication
E) Credits
Total Amount
F) Debts
Description
Amount
Description
Amount
1. Credits at the beginning of the month (e)
1. Debts at the beginning of the month (i)
2. (+) Additional credits during the month (f)
2. (+) Total debts this month (j)
3. (-) Reimbursements during the month (g)
3. (-) Reimbursements this month (k)
4. Total credits at the end of the month (H) = (e+f)-(g)
4. Debt at the end of the month (L) = (i+ j) -(k)
Total credits: all parties who owe the FOSA money, goods (e.g. medicines) or services (ex. consultations) provided.
Total debts: all parties who whom the FOSA owes money, goods (e.g. medicines) or services (ex. consultations) provided.
G) Financial Statement
Description
Amount
Description
Amount
1. General bank account (m)
6. Total available at the beginning of the month (r)
2. (+) Pharmacy bank account (n)
7. (+) balance of receipts and expenses (s) = (A-B)
3. (+) General cash on hand (o)
4. (+) Pharmacy cash on hand (p)
5. Total available at the end of month (Q) = m+n+o+p
H) Receipts in hand
I) Pending Receipts
1. From the population (C)
2. Indigents (u)
3. Other nonpaying clients* (v)
Q=T
8. Total available at the end of the month (T) = r + s
4. Credits for goods and services
during the month** (w)
* Other non-paying clients: patients other than indigents for whom was not paid for by the patient nor any other
organization.
** All credits in goods (e.g. medicines) or services (ex. consultations) – financial credits are not counted.
Version 1.5
5. Total receipts not received
(X) = u+v+w
J) Total pending
receipts
(Y)= (C) + (X)
I) Ratio of pending
receipts/receipts in hand
(Z) =(X) X100/ (Y)
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