Assessment Of Public Facilities For Readiness To Deliver Antiretroviral Therapy Page 3

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Decision on readiness
………………………………………………….Hospital/Health centre has qualified as
stand alone ART delivery site.
Assessment performed by:
Name…………………………………………..Signature………………………………
Name…………………………………………..Signature………………………………
Name…………………………………………..Signature………………………………
Name…………………………………………..Signature……………………………....
District Health Officer:
Name…………………………………………..Signature………………………………..
** If no on any of the question the clinic does not qualify automatically
If no on other sections the clinic can qualify after remedial action is discussed and agreed
upon
Version 1 11/06/09

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