VIRAL LOAD SAMPLE COLLECTION DAILY DATA REPORTING TOOL

Site: ___ CHUY Date of Report :__13/4/2020____________________

Type of Breastfeeding Last VL Result: Nature of

collection mother (1), (1)Suppressed Sample Sent(1); Observations Date
Sex M/F Destination Sample Plasma Date of
Date de sample Lab Patient Stored at site(2) Date sample is (sample sample Reference
SN ART Code Age (yrs) (1=Targeted or Pregnant Woman (2) (Reference (1) Total Blood return to Results
collection Number 2= Routine) (2), Others (3). Unsuppressed sent (2) accepted / was Lab Notes
Lab) site
rejected) analyzed
M F 1 2 1 2 3 1 2 1 2 1 2

1 4/13/2020 457 CE/06/06/13/188 X 61 X X X X 4/14/2020 CIRCB X

2 4/13/2020 458 CE/06/09/10/097 X 54 X X X X 4/14/2020 CIRCB X

3 4/13/2020 459 CE/06/06/08/067 X 40 X X X X 4/14/2020 CIRCB X

4 4/13/2020 460 CE/06/06/07/058 X 46 X X X X 4/14/2020 CIRCB X

5 4/13/2020 461 CE/06/07/13/177 X 49 X X X X 4/14/2020 CIRCB X

6 4/13/2020 462 CE/06/06/07/109 X 42 X X X X 4/14/2020 CIRCB X

7 4/13/2020 463 1296/17 X 37 X X X X 4/14/2020 CIRCB X

8 4/13/2020 464 CE/06/10/18/027 X 33 X X X X 4/14/2020 CIRCB X

9 4/13/2020 465 CE/06/06/05/102 X 46 X X X X 4/14/2020 CIRCB X

10 4/13/2020 466 CE/06/01/19/002 X 12 X X X X 4/14/2020 CIRCB X

11 4/13/2020 467 CE/06/07/16/041 X 40 X X X X 4/14/2020 CIRCB X

12 4/13/2020 468 CE/06/06/03/038 X 16 X X X X 4/14/2020 CIRCB X

13 4/13/2020 469 CE/35/04/12/001 X 68 X X X X 4/14/2020 CIRCB X

13 4/13/2020 469 CE/35/04/12/001 X 68 X X X X 4/14/2020 CIRCB X

14 4/13/2020 470 CE/06/06/14/078 X 39 X X X X 4/14/2020 CIRCB X

15 4/13/2020 471 CE/06/05/18/015 X 25 X X X X 4/14/2020 CIRCB X

16 4/13/2020 472 CE/06/06/02/022 X 45 X X X X 4/14/2020 CIRCB X

17 4/13/2020 473 CE/06/06/09/104 X 62 X X X X 4/14/2020 CIRCB X

18 4/13/2020 474 CE/06/08/17/007 X 31 X X X X 4/14/2020 CIRCB X

19 4/13/2020 475 CE/06/06/13/129 X 34 X X X X 4/14/2020 CIRCB X

20 4/13/2020 476 CE/06/06/05/090 X 56 X X X X 4/14/2020 CIRCB X

 VIRAL LOAD SAMPLE COLLECTION WEEKLY DATA REPORTING TOOL
Formation Sanitaire: CHUY Date de rapport :___
__17/4/2020____________________

Type de Femme allaitante Nombre d'echantilons envoyés le meme Nombre

prelevement (1), Femme jour-(0); Apres 24 heures-(1); Apres 48 h- d'échantillons
Nombre de Patients Eligibles Prélevés Sexe M/F
Date de (1=Ciblé ou enceinte (2), (2); Apres 72 h-(3); Apres 4 jours-(4); Au- Plasma (1)
JOUR 2=routine) Autres (3). dela de 4 jours-(5) Sang total (2) Observations
prélevement

10- 15- 20- 25- 30- 35- 40- 45-

< 1an 1-4ans 5-9ans 14ans 19ans 24ans 29ans 34ans 39ans 44ans 49ans 50ans+ M F 1 2 1 2 3 0 1 2 3 4 5 1 2

1 4/13/2020 0 0 0 1 1 0 1 3 2 3 4 5 4 16 3 17 1 0 19 0 20 0 0 0 0 20 0

2 4/14/2020 0 0 0 0 1 0 1 1 1 4 3 5 3 13 1 15 0 0 16 0 16 0 0 0 0 16 0

TOTAL 0 0 0 1 2 0 2 4 3 7 7 10 7 29 4 32 1 0 35 0 36 0 0 0 36 0