LOG FORM FOR MEDICAL VISITORS TO CAMPS/SHELTERS

ALL VISITING MEDICAL SERVICE PROVIDERS NOT COORDINATED BY THE BATTICALOA DISASTER HEALTH RESPONSE TEAM, PLEASE CONTACT THE TEAM OFFICE ON 065-2222931 AT THE DPDHS OFFICE, BATTICALOA TOWN. ALL MEDICAL TEAMS PLEASE FILL OUT DETAILS BELOW (AND LEAVE THEM AT THE CAMP) TO ENABLE BETTER COORDINATION OF SERVICES TO THIS LOCATION. THANK YOU.

CAMP/SHELTER NAME:
LOCATION:
G.S. NAME:

Date of Visit:

Visiting Medical Team Contact Details (Institution, Address, Telephone, Contact Person):

Activities Conducted (Provide Specific Details):

Key Health Issues for Follow-up: