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Secret Question:
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What is your first name?
How many cars do you have?
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First ANC Visit
Labour/Delivery
Follow-Up Visit
Child Follow-Up
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PMTCT Monthly Summary
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PMTCT
Child Follow-up
Child born outside this facility?
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Child List
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Mother/Caregiver Information
Mother taking treatment in this facility?
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Hospital Number:
Date Confirmed HIV:
Mother's Surname:
Mother's Other Names:
Date Started ARV/ART:
Mother's Address:
Mother's Phone No.:
Mother's Hospital Number
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Mother's Name: