CBHI Form No.

3-A

 

 

 

 

 

 

 

 

 

 

 

 

Monthly

 

 

MONTHLY REPORT ON CASES AND DEATHS DUE TO NON-COMMUNICABLE  DISEASES IN THE STATE / UT

 

 

 

 

 

 Name of the State/UT:

 

 

Reporting Month & Year:

 

 

 

 

 

 

Total No. of Govt. Secondary, Tertiary & Super Speciality Medical  Care Institutions in the State/UT:

 

 

No. of Medical Care Institutions Reported During the Month:

 

 

 

 

 

 

Sl.

 No.

 

 

 

Nature/ Group of Non Communicable Diseases

New* Patients Reported/Treated During the Month

Total Deaths During the Reporting Month

 

 

Out-Patient

In-Patient(IPD) Cases Referred Amongst Out-Patients(OPD)

IPD Cases Reported

Direct

Total Cases

 

(OPD)

 

Cases

 

M

F

M

F

M

F

M

F

Total

M

F

Total

 

1

2

3

4

5

6

7

8

9

(3+7)

10

(4+8)

11

(9+10)

12

13

14

 

1

Cardio Vascular Diseases

 

 

 

1.1

 Hypertension

 

 

 

 

 

 

 

 

 

 

 

 

 

1.2

 Ischemic Heart  Diseases

 

 

 

 

 

 

 

 

 

 

 

 

 

2

Neurological Disorders

 

 

 

2.1

 Cerebro Vascular Accident

 

 

 

 

 

 

 

 

 

 

 

 

 

2.2

 Other Neurological Disorders **

 

 

 

 

 

 

 

 

 

 

 

 

 

3

Diabetes Mellitus

 

 

3.1

 Type 1 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.2

 Type 2

 

 

 

 

 

 

 

 

 

 

 

 

 

4

Lungs Disease

 

 

4.1

 Bronchitis

 

 

 

 

 

 

 

 

 

 

 

 

 

4.2

 Emphysemas

 

 

 

 

 

 

 

 

 

 

 

 

 

4.3

 Asthma

 

 

 

 

 

 

 

 

 

 

 

 

 

5

Psychiatric Disorder

 

 

5.1

 Common Mental Disorders

 

 

 

 

 

 

 

 

 

 

 

 

 

5.2

 Severe Mental Disorders

 

 

 

 

 

 

 

 

 

 

 

 

 

6

Accidental Injuries

 

 

 

 

 

 

 

 

 

 

 

 

 

7

Cancer

 

 

 

 

 

 

 

 

 

 

 

 

 

8

Snake Bite

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

M - Male,  F - Female,  T - Total

 ** - Other Neurological disorders like Epilepsy, Parkisons Diseases,  Dementia.

 

 

* - New Registrations are to be considered as New Patients.

 

 

 

 

 

 

 

Secondary Medical / Health Care Institutions: Taluka /CHC/District Hospitals

 

 

 

 

 

 

Tertiary Medical / Health Care Institutions: Speciality & Super Speciality Hospitals at Regional/State Level including  attached to Medical Colleges.

 

 

 

 

 

 

This Monthly Report should be communicated Online http://www.cbhidghs.nic.in/   to CBHI positively by 20th of the succeeding            

month. In case it is not at all possible for Online data transmission, then send through e-mail- javascript:main.compose('new','t=dircbhi@nb.nic.in')  OR Fax 011 –23061529/

23063175  to CBHI by 20th of succeeding month, positively. 

 

 

 

To :

Signature

 

 

 

 

 

The Director,

Central Bureau of Health Intelligence (CBHI

Name & Designation

 

 

 

 

 

Dte.GHS/GOI, Room No. 401 - A Wing,
Nirman Bhavan, New Delhi – 110108.

Address with telephone / e-mail

 

 

 

 

 

Website/Online http://www.cbhidghs.nic.in/
E-Mail: javascript:main.compose('new','t=dircbhi@nb.nic.in')
Tel/ Fax: 91-011-23061529 / 23063175

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To  :

The Director,

Central Bureau of Health Intelligence (CBHI)

Dte.GHS/GOI, Room No. 401 - A Wing,
Nirman Bhavan, New Delhi – 110108.

Website/Online http://www.cbhidghs.nic.in/
E-Mail: javascript:main.compose('new','t=dircbhi@nb.nic.in')
Tel/ Fax: 91-011-23061529 / 23063175