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HPV vaccination planning/recording/monitoring forms
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FormsUsersReported to DeadlinePresentation
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Form 1AList of eligible school girlsNodal teacher or school printipalHealth centre6 weeks before the vaccination day and HC submit this form with the Microplan to the District levelSoft copy (DHO will print and distribute)
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Form 1BList of eligible out-of-school girlsVillage headHealth centre6 weeks before the vaccination day and HC submit this form with the Microplan to the District levelSoft copy (DHO will print and distribute)
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Form 2Activity plan (date and location)Health centreSchool and VillageProvide this plan to the school and village during the form 1A & 1B collection and submit this form with the microplan to the DistrictSoft copy (DHO will print and distribute)
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Form 3AMicroplanning tool for health centreHealth centreDistrict Health Office6 weeks before the vaccination dayExcel file
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Form 3BMicroplanning tool for district health officeDistrict Health OfficeProvincial Health Office5 weeks before the vaccination dayExcel file
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Form 3CMicroplanning tool for provincial health officeProvincial Health OfficeNIP4 weeks before the vaccination dayExcel file
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Form 3DMicroplanning tool for national immunisation programmeNIP3 weeks before the vaccination dayExcel file
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Form 4Tally sheetVaccination team (health centre/district hospital)Health centreVaccination daySoft copy (DHO will print and distribute)
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Form 5List of missed girlsVaccination team (health centre/district hospital)School and VillageVaccination daySoft copy (DHO will print and distribute)
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Form 6Reporting formHealth centreDistrict Health OfficeEvery month Excel file
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Check ListCheck ListHealth centreDistrict Health Office6 weeks before the vaccination daySoft copy (DHO will print and distribute)
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HPV Register!
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*** DHO should ensure that every health centre has the forms above by 8 weeks before the vaccination day.
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