Patients will be triaged according to the following:

1. When then arrive
2. Urgency of need
3. Quick screening of the triage personnel
4. Concern for local customs/culture

Each patient will be given a Gospel tract to read while they wait. Please be careful throughout the clinic process, so that no one ever thinks that their spiritual response to us will determine their level of care. We are not trying to get “clinic Christians,” and every care will be given to avoid pressuring nationals to make decisions because it is the “polite” response to receiving free medical care.  

Those patients who will be seen will first be given a registration form. This form will follow them throughout the clinic process, from pre-registration to the pharmacy.

No one will be seen without a form, and ONLY one person will be seen for each form (i.e., it’s not one form per family, but one form per patient).

Patients will be registered in order of his/her place in line. Exceptions can be made in case of emergency, of course.   The number of patients to be registered each day or half-day will be determined in advance, and then we’ll adjust as needed each day or half-day. Generally we see fewer on the first day, then more on each subsequent day as we all learn our tasks.  

At registration, patient’s name, village, and age will be recorded. 

At triage a patient will be asked appropriate medical questions, using a translator if needed. You may use the screening questions (handout) as a guide. Based on the questions and responses, vital signs will be taken as indicated, based on the initial interview. (Vital signs will be done on everyone, and we will need to be flexible.)

Use appropriate personnel (nurses, nurses aids, etc.) to obtain and record vital signs when needed. 

Remember that we are looking for one primary complaint, so you should not do a complete review of systems.  We aim for discerning the ONE most important problem a patient has, although we may need to briefly address more than one.

Jot down only pertinent facts that will help the examiner.

Once a patient has been triaged, they will then wait to see an examining RN/MD, according to his/her place in line.

It’s wise if someone will help keep the patient flow moving towards the examiners, helping to see which patient is next to be called.

When a patient is seen, record only brief notes as on the registration form.  Record only pertinent physical findings in an abbreviated format, diagnosis(es), and at the bottom of the form record what Rx’s the patient needs from the pharmacy. Labs can be recorded on the back, provided an arrow is drawn to point the examiner towards them.

1. Try to minimize the number of meds for each patient, so as to avoid confusion.
2. Antibiotic resistance is not such a problem here, so treatment duration can be shorter. Pediatric doses can be on the lower end of the acceptable treatment range.
3. In prescribing, keep in mind the available formulary, including the approximate amounts of each medicine in the pharmacy.

The 6 primary areas of the clinic will be as follows: 1) registration, 2) triage area, 3) examination area, 4) wound care and lab, 5) pharmacy and 6)counseling area. Each of these areas need waiting areas and translators, which will be determined once we see the layout of the clinic area.

1. We will need team members and translators at each of these areas..
2. How spiritual ministry is done will be determined by the missionaries/national believers, but always take every available opportunity to point patients toward their spiritual needs. This should be done in such a way that patients know that their care is not dependent on their response.
3. Examinations will be focused and problem-oriented, and in many cases, diagnoses will be determined based on history and labs. But each patient should know that we care very much about him/her as a person.  

Once a patient has been seen by the examiner, they will then go to the counseling area, unless wound care or lab work is needed.   After lab, the patient will then wait for the examiner to determine any appropriate treatment. Even if the lab is negative, the examiner should be shown the results.

Blood-borne pathogen protocols will ALWAYS be followed, but especially in wound care. No one who has not received Hepatitis B vaccine should be handling any kind of body fluids or wounds.

To go to counseling, lab, or wound care, the patient always carries his/her registration form. This form will be our record of each patient’s care.

At the pharmacy, patients will wait while medicines are prepared per the written pharmacy guidelines. In the event of questions regarding medications the examiner may be asked questions, but it is best to do this while he/she is in between patient examinations (if at all possible).

1. The pharmacy may be the longest wait for the patient, but it is important that we are very careful in filling Rx’s, and that each patient fully understands how to properly take his/her Rx’s.
2. No medicines will be dispensed without a patient registration form.

After a patient has received his/her Rx’s, the registration form will be left in the pharmacy.  The only reason a patient is to leave the clinic with his/her registration form, is for follow up by the examiner later that week (i.e., blood pressure recheck, blood sugar recheck, etc).  This form that has return instructions written and highlighted will allow that patient to enter the clinc.  Otherwise, they will be turned away! Registration forms will be carefully filed by date, then by last name alphabetically.

As registration forms are returned to the pharmacy, they will be filed according to the date, for numbering, and  then give to the missionary for follow up. At the end of each day, registration personnel should tally up the following for each day:

1. Number of patients seen
2. Number of children (0-12 yrs)
3. Number of adults (13+ yrs)

These results should be recorded each day and given to the clinic director.