Patient information | Name |
---|---|
 | Age |
 | Sex |
 | Address |
 | Outpatient/inpatient |
 | Date of prescription Pharmacy code Hospital code |
Practitioner's information | Qualification |
 | Duration in practice |
Information on Diarrhoeal episode | Duration of diarrhoea |
 | Presence of blood |
 | Presence of fever |
 | Presence of vomiting |
 | Presence of pain in stomach |
Prescription given | ORS |
 | Zinc |
 | Antibiotics |
 | Probiotics |
 | Racecadotril |
 | Miscellaneous drugs (including antiemetic) |