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["MINISTERIO DE SALUD Y PROTECCIÓN SOCIAL\nPROGRAMA NACIONAL DE PREVENCIÓN Y CONTROL DE LA TUBERCULOSIS\nTARJETA DE REGISTRO INDIVIDUAL DE ADMINISTRACIÓN DEL TRATAMIENTO DIRECTAMENTE OBSERVADO  (TDO)\nTUBERCULOSIS FARMACORRESISTENTE \nVersión 002  12/01/2022"]
["1. DATOS SOCIODEMOGRÁFICOS (Marque con una X según corresponda) "]
["1.1 Departamento:",{"$nulls":24},"1.5 Régimen:",null,"Subsidiado _____   Contributivo______     No asegurado____   Excepción____ Especial_____",{"$nulls":12},"1.9. Pertenencia Étnica :",null,null,"Indigena: ________                  Afrodescendiente: ______              Rom/Gitano:  _______    Raizal:____________                                                 "]
["1.2 Municipio / Localidad o comuna:",{"$nulls":24},"1.6 EAPB:",{"$nulls":14},"1.10. Grupo poblacional:",null,null,"Habitante de calle: ____     Privado de la libertad: ____        Persona con discapacidad: ____     Trabajador de la Salud:_____.      Migrante:_____.       Gestante:_____.    Persona en centro psiquiátrico_____-                             \nLGBTIQ+_______    Otro ¿Cúal?__________. "]
["1.3 Tipo de identificación y número:",{"$nulls":24},"1.7 IPS de atención primaria: "]
["1.4 IPS de diagnóstico: ",{"$nulls":24},"1.8. IPS de supervisión al tratamiento: "]
["2. DATOS IDENTIFICACIÓN",{"$nulls":33},"4. CONDICIÓN DE INGRESO AL PROGRAMA DE TUBERCULOSIS "]
[{"$nulls":34},"4.1 TIPO DE PACIENTE - CONDICIÓN DE INGRESO"]
[{"$nulls":36},"Nuevo",{"$nulls":3},"Tras recaída",{"$nulls":4},"Reingreso  tras pérdida del seguimiento"]
["2.1 PRIMER APELLIDO",{"$nulls":9},"2.2 SEGUNDO APELLIDO",{"$nulls":9},"2.3 NOMBRES",{"$nulls":28},"IPS Y ET de donde fué remitido"]
["2.4  EDAD:",null,null,"UNIDAD DE MEDIDA DE LA EDAD:",{"$nulls":8},"2.5 SEXO:",{"$nulls":9}," 2.6 OCUPACIÓN:",{"$nulls":13},"Fracaso",{"$nulls":3},"Otro previamente tratado"]
[{"$nulls":5},"Años",{"$nulls":3},"Meses",{"$nulls":4},"Masculino",{"$nulls":4},"Femenino"]
[{"$nulls":43},"SI",null,"NO",null,"SD",null,"Cuáles?"]
["2.7 DIRECCIÓN DE LA VIVIENDA O COMUNIDAD DONDE HABITA",{"$nulls":17},"2.8 BARRIO / VEREDA",{"$nulls":8},"2.9 TELÉFONO:",{"$nulls":7},"¿Ha recibido medicamentos de 2a línea?"]
[]
[{"$nulls":34},"4.2 TIPO DE TUBERCULOSIS:",{"$nulls":14},"4.3 LOCALIZACIÓN EXTRAPULMONAR:"]
["2.10 NOMBRE DEL LUGAR DE TRABAJO Y DIRECCIÓN",{"$nulls":17},"2.11 BARRIO / VEREDA",{"$nulls":8},"2.12 TELÉFONO:",{"$nulls":8},"Pulmonar",{"$nulls":5},"Extrapulmonar"]
[]
[{"$nulls":34},"5. CONDICIONES ASOCIADAS A TENER EN CUENTA PARA EL MANEJO EN EL SEGUIMIENTO",{"$nulls":14},"6. MODALIDAD DE TRATAMIENTO DIRECTAMENTE OBSERVADO "]
["3. CONFIGURACIÓN DIAGNÓSTICA ",{"$nulls":55},"* La EAPB en los casos que se requiere debe garantizar el TDO hospitalario y  domiciliario según la pertinencia.                                                                    *Se debe concertar con el paciente el tipo de TDO a utilizar de acuerdo a la pertinencia.\n* Si el TDO es virtual debe contar con consentimiento informado. "]
["MARQUE CON X SI EL CRITERIO FUE POSITIVO, NEGATIVO \nO NO REALIZADO",{"$nulls":16},"3.3 RESULTADO BK SERIADO ",{"$nulls":7},"3.4 FECHA DE INICIO DE SINTOMAS",{"$nulls":10},"Desnutrición",{"$nulls":3},"EPOC",null,null,"Embarazo ",null,null,"Consumo SPA",{"$nulls":4},"6.1 TDO en IPS",null,null,"6.5 TDO virtual. "]
[{"$nulls":4},"3.1 CRITERIOS DIAGNÓSTICOS",{"$nulls":8},"+","-","NR",null,"1a BK",null,null,"2a BK",null,null,"3a BK"]
[{"$nulls":25},"dd",null,"mm",null,"aa",{"$nulls":6},"VIH/SIDA ",{"$nulls":3},"Enfermedad Renal Crónica",null,null,"Hipertensión ",null,null,"Cáncer ",{"$nulls":4},"6.2 TDO Domiciliario "]
[{"$nulls":4},1,"Baciloscopia"]
[{"$nulls":17},"FECHA ",{"$nulls":18},"COVID-19",{"$nulls":3},"Enfermedad hepática",null,null,"Tabaquismo ",null,null,"Alcoholismo",{"$nulls":4},"6.3 TDO Comunitario "]
[{"$nulls":4},2,"Cultivo líquido",{"$nulls":11},"3.5 FECHA RESULTADO CULTIVO",{"$nulls":7},"3.6 FECHA DE DIAGNÓSTICO TB FR"]
[{"$nulls":17},"dd",null,"mm",null,"aa",{"$nulls":3},"dd",null,"mm",null,"aa",{"$nulls":6},"Diabetes Mellitus",{"$nulls":3},"Tratamiento inmunosupresor",null,null,"Silicosis",null,null,"Otra:__________",{"$nulls":4},"6.4 TDO Hospitalario "]
[{"$nulls":4},3,"Pruebas moleculares"]
[{"$nulls":17},"3.7 COINFECCIÓN\nTB/VIH",null,null,"3.7.1  SE REALIZA PRUEBA DE VIH",{"$nulls":8},"3.7.2 FECHA DE DIAGNÓSTICO PREVIO DEL VIH ",{"$nulls":8},"3.7.4 RESULTADO Y FECHA DE PRUEBA CONFIRMATORIA DE VIH "]
[{"$nulls":4},4,"Histopatología",{"$nulls":33},"POS",{"$nulls":3},"NEG",{"$nulls":3},"dd",null,null,"mm",null,"aaaa"]
[{"$nulls":21},"SI",{"$nulls":3},"NO",{"$nulls":3},"dd",null,"mm",null,"aaaa"]
[{"$nulls":4},5,"Cuadro Clínico"]
[{"$nulls":20},"3.7.3 RESULTADO Y FECHA DE PRUEBA PRESUNTIVA DEL VIH ",{"$nulls":18},"3.7.5 RECIBE TRATAMIENTO ANTIRETROVIRAL ",{"$nulls":5},"3.7.6 FECHA DE INICIO ANTIRRETROVIRALES",{"$nulls":9},"3.7.7 RECIBE TRIMETOPRIM SULFAMETOXAZOL"]
[{"$nulls":4},6,"Epidemiológico",{"$nulls":15},"POS",{"$nulls":3},"NEG",{"$nulls":3},"PACIENTE NO ACEPTA",{"$nulls":15},"dd",null,"mm",null,null,"aaaa"]
[{"$nulls":21},"dd",null,"mm",null,"aa",{"$nulls":12},"SI",null,"NO",null,"SD",{"$nulls":12},"SI",null,"NO",null,"SD"]
[{"$nulls":4},7,"Radiológico"]
[{"$nulls":17},"8. ESQUEMA DE TRATAMIENTO INSTAURADO Y AJUSTES"]
[{"$nulls":4},8,"Tuberculínico",{"$nulls":11},"8.1 PESO INICIAL",{"$nulls":6},"8.2 FASE INTENSIVA",{"$nulls":11},"8.3 FASE DE CONTINUACIÓN"]
[{"$nulls":17},"_________kg",{"$nulls":6},"8.2.1. Dosis inicial",{"$nulls":3},"8.2.2. Ajuste de dosis",{"$nulls":3},"8.2.3. Ajuste de dosis",{"$nulls":3},"8.3.1, Dosis inicial",{"$nulls":3},"8.3.2. Ajuste de dosis",{"$nulls":3},"8.3.3. Ajuste de dosis",{"$nulls":4},"8.3.4. Ajuste de dosis",{"$nulls":3},"8.3.5. Ajuste de dosis",{"$nulls":3},"8.3.6. Ajuste de dosis"]
[{"$nulls":4},"3.2 OTRAS AYUDAS DIAGNOSTICAS",{"$nulls":19},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":4},"dd/mm/aa",{"$nulls":3},"dd/mm/aa",{"$nulls":3},"dd/mm/aa"]
[{"$nulls":4},9,"ADA"]
[{"$nulls":17},"MEDICAMENTO",{"$nulls":6},"Dosis a recibir en mg según peso ",{"$nulls":3},"Dosis mg",{"$nulls":3},"Dosis mg",{"$nulls":3},"Dosis mg",{"$nulls":3},"Dosis mg",{"$nulls":3},"Dosis mg",{"$nulls":4},"Dosis mg",{"$nulls":3},"Dosis mg",{"$nulls":3},"Dosis mg"]
[{"$nulls":4},10,"Test en Orina (Lipoarabinomanano)",{"$nulls":11},"Bedaquilina 100mg (Bdq)"]
["7. CLASIFICACIÓN DE LA RESISTENCIA A FÁRMACOS \n(marque con una X la casilla de clasificación del tipo de resistencia. Acontinuación, registre el perfil de resistencia de cada medicamento R resistente, S sensible, NR no reportado acorde a los resultados de las pruebas de sensibilidad)",{"$nulls":16},"Clofazimine 100mg (Cfz)"]
[{"$nulls":17},"Linezolid 600mg (Lzd)"]
["7.1","Monorresistencia",{"$nulls":4},"FÁRMACOS DE PRIMERA LÍNEA",{"$nulls":10},"Levofloxacino 250mg (Lfx) "]
[{"$nulls":6},"R",null,"H",null,"Z",null,"E",null,"S",null,null,"Moxifloxacino 400mg (Mfx) "]
["7.2","Polirresistente",{"$nulls":15},"Pirazinamida 400mg (Z) "]
[{"$nulls":6},"FÁRMACOS DE SEGUNDA LÍNEA",{"$nulls":10},"Cicloserina 250mg (Cs)"]
["7.3","MDR",{"$nulls":4},"           Bdq",null,"     Cfz",null,"      Lzd",null,"     Mfx",null,"       Lfx",null,null,"Rifampicina 150mg (R) "]
[{"$nulls":17},"Isoniacida 75mg (H)"]
["7.4","PREXDR",{"$nulls":4},"          Amk",null,"      Cs",null,"      Eto",null,"      Dlm",{"$nulls":4},"Etambutol 275mg (E)"]
[{"$nulls":17},"Delamanid 50mg (Dld)"]
["7.5.","XDR",{"$nulls":5},"Otro. Cuál?",{"$nulls":9},"Pretomanid 200mg (Pto)"]
[{"$nulls":17},"Número de tabletas de RHZE en caso Monorresistencia a H "]
["* Si el paciente tiene resistencia a medicamento de primera línea (H y/o R), se deben realizar pruebas de sensibilidad a farmacos de segunda línea como quinolonas, Bdq, Lzd, Cfz. "]
[]
["9. ESTUDIO DE CONTACTOS ",{"$nulls":16},"9.1 NOMBRE Y APELLIDOS ",{"$nulls":14},"9.2 PARENTESCO ",{"$nulls":3},"9.3 EDAD ",null,"9.4 DOCUMENTO DE IDENTIFICACIÓN",{"$nulls":3},"9.5 EAPB",null,null,"9.6 ¿Es Sintomático Respiratorio- SR ?",null,null,"9.7 ¿Se deriva a atención en salud?",null,null,"9.8.El contacto fue evaluado clínicamente?",null,null,"9.8 Si es SR ¿se tomó muestra para prueba molecular y sensibilidad a fármacos",null,null,"9.9 OBSERVACIONES"]
{"$rows_empty":11}
["10. ADMINISTRACIÒN DEL TRATAMIENTO DIRECTAMENTE OBSERVADO ","10.1 FASE INTENSIVA: \n Escribir el número consecutivo de dosis iniciando con el dia que inicia el tratamiento por ejemplo: el 01/03/2022 registra dosis 1,  el 02/03/2022 dosis 2 , etc. El dia que no se administra se registra (NR)",{"$nulls":3},"MES/AÑO               DÍA",{"$nulls":4},1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,"PESO en Kg",null,"11. CONTROLES BACTERIOLÓGICOS \n\nFase intensiva: BK y Cultivo Mensual \nFase de continuación: BK y Cultivo Bimestral hasta finalizar el tratamiento. \n\n\n\n* Conversión bacteriológica: se considera cuando hay 2 cultivos consecutivos negativos con un mes de diferencia. \n\n* Reversión bacteriológica: se considera cuando el caso vuelve a tener 2 resultados de cultivos positivos, posteriores a la conversión bacteriológica.  ",{"$nulls":4},"Nº Mes","11.1. Resultado de Baciloscopia de control al tratamiento  ",null,null,"(dd/mm/aa)","mm","aaaa","11.2. Resultado Cultivo Líquido ",null,null,"(dd/mm/aa) ","mm","aaaa"]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},1]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},2]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},3]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},4]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},5]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},6]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},7]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},8]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},9]
[null,"10.2 FASE DE CONTINUACIÓN: \n Escribir el número consecutivo de dosis iniciando con el dia que inicia el tratamiento por ejemplo: el 01/03/2022 registra dosis 1,  el 02/03/2022 dosis 2 , etc. El dia que no se administra se registra (NR)",{"$nulls":3},"MES/AÑO                  DÍA",{"$nulls":4},1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,"PESO en Kg",{"$nulls":6},10]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},11]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},12]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},13]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},14]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},15]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},16]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},17]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},18]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},19]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},20]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},21]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},22]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},23]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},24]
[{"$nulls":5},"Mes_______Año",{"$nulls":42},25]
["12. REGISTRO DE  CONTROLES AL SEGUIMIENTO EN EL TRATAMIENTO  (Diligencie SI, NO o SD)",{"$nulls":40},"13. REACCIONES ADVERSAS (Diligencie SI, NO o SD)",{"$nulls":10},"15. OBSERVACIONES EN EL SEGUIMIENTO AL TRATAMIENTO"]
["MES","                                             12.1 Médico general\n",null,null,"12.2 Profesional enfermería",null,null,"12.3 Médico especialista",null,null,"12.4 Radiografía PA y lateral",null,null,"12.5 Psicología y Test Psicológico ",null,null,"12.6 Nutrición ",null,null,"12.7 Trabajo Social ",null,null,"12.8 Audiometría ",null,null,"12.9 Electrocardiografìa",null,null,"12.10 Recibe Antirretroviral si tiene VIH",null,"12.11 Recibe TMSX si tiene VIH",null,"12.12 Pruebas de función hepática ",null,null,"12.13 Pruebas de función renal",null,null,"12.14 Hemograma y electrólitos ",null,null,"MES","13.1 Ictericia","13.2 Prolongación segmento QT en el ECG","13.3 Prurito","13.4 Rash cutáneo","13.5 Hipoacusia","13.6 Dispepsia ","13.7 Neuritis periférica","13.8 Aleración neurológica","13.9 Falla hepática","13.10 Falla renal"]
[0]
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16,{"$nulls":51},"15.1. CERCET:  Comité CERCET al que fue presentado el paciente:____________________ Fecha: _________________"]
[17]
[18]
[19,{"$nulls":51},"* Cuando el caso sea transferido a otra Entidad Territorial, se debe enviar (Ficha de notificación SIVIGILA, Copia de historia clinica, Formula médica, tarjeta de tratamiento diligenciada, reporte de documentación pendiente).                                                            * Cuando el caso sea transferido a otro pais debe enviarse al Centro Nacional de Enlace, con la misma documentación mencionada anteriormete y entregar 30 días de tratamiento), previa firma del compromiso para supervisión virtual. "]
[20]
[21]
[22]
[23]
["14. CONDICIÓN DE EGRESO"]
[1,"14.1. CURADO",null,null,2,"14.2. TRATAMIENTO TERMINADO",{"$nulls":6},3,"14.3. FRACASO",null,null,4,"14.4 PÉRDIDA DE SEGUIMIENTO",{"$nulls":6},"Causa:",{"$nulls":9},5,"14.5. FALLECIDO",null,"Causa:",{"$nulls":9},6,"14.6. NO EVALUADO",null,"Causa:",{"$nulls":3},7,"14.7. DESCARTADO ",null,"Causa: "]
[]
[{"$nulls":4},"dd",null,"mm",null,"aaaa"]
["14.8. Fecha de egreso",{"$nulls":9},"14.9.","IPS de egreso. ",{"$nulls":11},"14.10.","Nombre del profesional que certifica egreso:",{"$nulls":17},"14.11.","Teléfono:",{"$nulls":6},"14.12.","Correo electrónico: "]
[]
["Versión 002 Ministerio de Salud y Protección Social 20/12/2021"]
[]
[]
[{"$nulls":6},"SI",{"$nulls":43},"(1 a 9 colonias)"]
[{"$nulls":6},"NO",{"$nulls":43},"(+)"]
[{"$nulls":6},"SD",{"$nulls":43},"(++)"]
[{"$nulls":50},"(+++)"]
[{"$nulls":50},"Negativo"]
[{"$nulls":50},"Sin dato "]
[{"$nulls":50},"No realizado"]
[]
[]
[]
[]
[{"$nulls":11},"NR",null,"M.TB Positivo"]
[{"$nulls":11},1,null,"M.TB Negativo"]
[{"$nulls":11},2,null,"Contaminado"]
[{"$nulls":11},3,null,"M. no tuberculosa "]
[{"$nulls":11},4,null,"No realizado "]
[{"$nulls":11},5]
[{"$nulls":11},6]
[{"$nulls":11},7]
[{"$nulls":11},8]
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