Case Study 2
Gender , Age _________ years, Month.
Learning Process 1: Accepting Clients Registration and Provider Information
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: Health Assessment and measure child development
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 3: Summary of Child Health and Development Assessment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Appointment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 5: Summary of Activities
____________________________________________________________________ _______________________
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 47 | p a g e
PH 15.3
Part 7 Health Promotion
Learning Activity 7.3 Health promotion activities for children aged 6-12 years in schools or
in hospitals. (2 case studies)
Objective
To provide students with skills to assess the health of children aged 6-12 years.
Case Study 1
Gender , Age _________ years, Month.
Learning Process 1: Checking Information
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: Coordination and Appointment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 3: Prepare Materials and Forms
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Conducting a School-age Health Assessment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 5: Summary of Health Assessment Results
_________________________________________________________________ __________________________
___________________________________________________________________________________________
Learning Process 6: Summary of Activities
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 48 | p a g e
Case Study 2
Gender , Age _________ years, Month.
Learning Process 1: Checking Information
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: Coordination and Appointment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 3: Prepare Materials and Forms
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Conducting a School-age Health Assessment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 5: Summary of Health Assessment Results
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 6: Summary of Activities
___________________________________________________________________________________________
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 49 | p a g e
PH 15.4
Part 7 Health Promotion
Learning Activity 7.4 Health promotion activities for the elderly (1 case study)
Objective
To enable students to learn the process and have skills to promote the health of the elderly
General information for the elderly
Name Mr/Mrs/Miss Age years Date of Birth
Address congenital disease
Treatment at Reference Person Name Mr/Mrs/Miss
Relationship Phone Number
Participation in activities of organizations/clubs/groups Not participating Participating (Specify)
Barthel Activities of Daily Living: ADL
1. Eat food when it's ready in front of you. Can't do it (0) can do it myself, but I need someone to help. can do it
For example, I use a spoon to scoop it up (1) myself (2)
2. Wash your face, comb your hair, brush your need help (0) can do it myself (1)
teeth, and shave in the past 1 - 2 days. ( Including what you can do yourself if
you have the equipment provided)
3. Sit up from the bed. or from bed to chair. Can not (0) Needs a lot of help, for Need some help, can do it
( Always sit and example, it takes one such as telling them to myself (3)
fall) / Requires 2 strong or skilled person or follow or giving a little
people to help two normal people to support or need
lift it up support or push up to sit someone to take care
(1) of it for safety (2)
4. Using the bathroom, toilet Can't help I can do it myself (at help yourself well (can sit up and
myself (0) least I can clean myself down from the toilet by himself)
after finishing my errands), Cleaned up after the errands were
but I need some help (1) finished. can take off the clothes) (2)
5. Mobility in a room or house Immobile (0) You must use a Ground or moving Walking
wheelchair to help you with help, such as or moving
move on your own. (No supporting or telling to on its own
need to be pushed by follow or need to pay (3)
someone) and must be attention to take care of
able to go in and out of safety (2)
the corner of the
room/door (1)
6. Wearing clothes Someone has to wear it 50% self-help, the Help yourself well (including
little or little help yourself rest need help (1) buttoning, zipping, or using
(0) adapted clothing) (2)
7. Going up and down a flight of stairs Impossible (0) Need help (1) Can go up and down by himself (if you
need to use a walking aid such as a walker,
you must take it up and down as well) (2)
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8. Taking a shower Someone must help or make it (0) Can take a shower by himself (1)
9 . Inhibition of defecation during the past 1 Can't hold Can't hold back sometimes (less Able to hold back
week. back (0) than 1 time/week) (1) normally (2)
10. Urinary incontinence in the past 1 week Can't hold Can't hold back sometimes (less Able to hold back
back (0) than once a day) (1) normally (2)
Total score………………………………..Points Elderly social group Elderly at home group Elderly bedridden
from 12 points or more Score 5 – 11 points groups Score 0 – 4
Severe 5 – 8 points points
Moderate 9 – 11 points
Screening for major problems and common diseases
Filter and detectable values Interpret results
1. Hypertension: (must be below 140/90 mmHg)
systolic pressure (SBP) ............mmHg Normal Abnormal and refer to staff
diastolic pressure (DBP) ............mmHg (must be below 140/90 mmHg) Be patient
2. Diabetes : (Measurement of FPG while fasting must not exceed 125
mg/dl.)
Abstain from food for more than 8 hours before the examination ( Measurement pierced fingertip fasting, the value is not
more than 100 mg/dl. Not fasting, the value is not more
Did not skip food before the examination than 100 mg/dl.)
Normal Abnormal and refer to staff
FPG Sugar level………… mg/dl. Be patient
fingertip fasting Sugar level………... mg/dl.
Manual of Public Health Internship (Filed training 1) 3.2021 51 | p a g e
Learning Process 1: Learn the relevant report record system.
___________________________________________________________________________________________
Learning Process 2: Identifying Public Health Problems Among the Elderly
___________________________________________________________________________________________
Learning Process 3: Prepare information and knowledge for health promotion activities.
____________________________________________________________________________ _______________
Learning Process 4: Learn the process of making appointments and accepting seniors.
___________________________________________________________________________________________
Learning Process 5: Studying Health Promotion Activities for the Elderly
___________________________________________________________________________________________
Learning Process 6: Summary of Activities
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 52 | p a g e
PH 15.4
Part 7 Health Promotion
Learning Activity 7.5 Health Promotion Activities for Persons with Disabilities (1 case study)
Objective
To enable students to learn the process and have skills to promote health for people with
disabilities.
General information for people with disabilities
Name Mr./Mrs./Ms................................................................................................... age.................. Year Date of birth .....................................
House number.............Moo...........Sub-district...................................district..............Province..................Congenital disease....................
Person with disabilities card number .......................................... Card issuance date......../........../........Expiration date....... /......./.......
Weight................................ kg Height.........................Centimeters Temperature.................degrees Pulse ......................times/minute
Respiration rate.....................times/min Blood pressure................................mmHg
Disability type
□ Visual impairment (01) □ Hearing and interpretive impairment (02)
□ Physical or Mobility Disability (03) □ Mental and Behavioral Disability (04)
□ Intellectual disability (05) □ learning disability (06)
□ Autistic disabilities (07) □ Behavioral or emotional disabilities (08)
□ Redundant disabilities(09)
ADL Assessment Score………………………………………………………………….........................................................................................………………………
Date of First appraisal...............................................................................................................................................................................................
Illness history..............................................................................................................................................................................................................
Getting help/welfare
Disability payment □ Received □ Not received Amount............... baht / month / year from the organization...........................
Equipment/aids that have been received
1. …………………………………..………...................................…….From................................................................................... Amount....………… pcs
1. …………………………………..………...................................…….From................................................................................... Amount....………… pcs
Assessing condition/Assessing problems/cause of home visit (Problem list)/Rehabilitation care
Problem list Care cure and Rehabilitation
............................................................................................................. ...............................................................................................................
............................................................................................................. ..............................................................................................................
............................................................................................................. ..............................................................................................................
............................................................................................................. ..............................................................................................................
............................................................................................................. ..............................................................................................................
............................................................................................................. ..............................................................................................................
Residential information
Characteristics of the house □ one floor □ two floors, disabled people stay on the floor.............
Bathroom style, handrails □ Yes □ No □ flush toilet □ Cesspool Latrine □ Diaper □ Others............................
Plans for the next visit.............................................................................................................................................................................................
Reason for..................................................................................................................................................................................................................
□ Physiotherapist comes to recover. □ Assessment of disability to issue a disability certificate □ Other..................................
Manual of Public Health Internship (Filed training 1) 3.2021 53 | p a g e
Learning Process 1: Learn the relevant report record system.
___________________________________________________________________________________________
Learning Process 2: Identify public health problems among people with disabilities
___________________________________________________________________________________________
Learning Process 3: Prepare information and knowledge for health promotion activities.
___________________________________________________________________________________________
Learning Process 4: Learn the process of making an appointment at a hospital or visiting a disabled
person's home.
___________________________________________________________________________________________
Learning Process 5: Study health promotion activities for people with disabilities.
___________________________________________________________________________________________
Learning Process 6: Summary of Activities
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 54 | p a g e
PH 16
Part 8 Immunization
Objective
To enable students to learn the process and have skills for immunization in children and
pregnant women.
Learning Process 1: Logging in Records and Reports
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: The Acceptance Process
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________ _________________
Learning Process 3: Vaccination Recording Process
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Vaccinating the Target Audience (Record it in the Vaccination Practice Recording Form)
4.1 BCG vaccine in newborns (Case study of 2 cases, by observation)
4.2 DTP-HBV vaccine (case study, 2 cases)
4.3 OPV vaccine (case study of 5 cases)
4.4 MMR vaccine (1 case study)
4.5 DTP Vaccine (Case Study 2 cases)
4.6 LAJE Vaccine (1 case study)
4.7 dT vaccine in pregnant women or patients who have been in an accident (case study of 2 cases)
Manual of Public Health Internship (Filed training 1) 3.2021 55 | p a g e
4.1 BCG vaccine in newborns (Case study of 2 cases, by observation)
BCG Vaccination Practice Record Form for Newborns
Case Study 1
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard 0-2 years old)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนักมากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 56 | p a g e
BCG Vaccination Practice Record Form for Newborns
Case Study 2
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard 0-2 years old)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ น้าหนกั มากกว่าเกินเกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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4.2 DTP-HBV vaccine (case study, 2 cases)
DTP-HBV Vaccination Practice Record Form
Case Study 1
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ น้าหนกั มากกวา่ เกินเกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 58 | p a g e
DTP-HBV Vaccination Practice Record Form
Case Study 2
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ น้าหนักมากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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4.3 OPV vaccine (case study of 5 cases)
OPV Vaccination Practice Record Form
Case Study 1
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 60 | p a g e
OPV Vaccination Practice Record Form
Case Study 2
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 61 | p a g e
OPV Vaccination Practice Record Form
Case Study 3
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 62 | p a g e
OPV Vaccination Practice Record Form
Case Study 4
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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OPV Vaccination Practice Record Form
Case Study 5
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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4.4 MMR vaccine (1 case study)
MMR Vaccination Practice Record Form
Case Study 1
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนกั มากกว่าเกินเกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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4.5 DTP Vaccine (Case Study 2 cases)
DTP Vaccination Practice Record Form
Case Study 1
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ น้าหนักมากกวา่ เกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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DTP Vaccination Practice Record Form
Case Study 2
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ นา้ หนักมากกว่าเกนิ เกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
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4.6 LAJE Vaccine (1 case study)
LAJE Vaccination Practice Record Form
Case Study 2
Child's name-surname HN EPI No.
Sex Male Female Date of Birth / / Age Years Month
Address
1. Child Growth
Head Teeth
circumference
Age d/m/y Weight Height (No. Teeth)
examination (kg) (cm) (cm)
growing decayed
teeth
.....Years ....Month ..../....../..... ............. ............. ........................... ............... ................
2. Nutrition status (Child Growth Standard)
Length for age □ Short stature □ relatively short
□ Standard Length □ quite high □ high
Weight for age □ less than Standard □ relatively little □ Standard weight
□ Quite heavy weight □ น้าหนักมากกวา่ เกินเกณฑ์
Weight for Length □ thin □ rather thin □ Normal
□ Chubby □ Overweight □ Obese
3. History of illness
5.1 Congenital disease □ No □ Yes (Identify)
5.2 Drug and food allergy
4. Immunization
□ complete □ not specifying the reason
Vaccination Age Method of d/m/y vaccinated Appointment
vaccination 1st 2nd 3rd d/m/y vaccine
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 68 | p a g e
4.7 dT vaccine in pregnant women or patients who have been in an accident (case study of 2 cases)
Recording form for dT vaccination practice in pregnant women
Case study No......
pregnant woman
name-surname
Gender Male Female Date of birth / / Address
Congenital disease □ No □ Yes (Identify)
Drug and food allergy
Immunization
Age Gestational age d/m/y vaccinated Appointment
d/m/y
dT 1 dT 2 dT 3
.....Years ....Month ......weeks.......days ....../....../...... ....../....../...... ....../....../..... ....../....../.......
.....Years ....Month ......weeks.......days ....../....../...... ....../....../...... ....../....../..... ....../....../.......
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 69 | p a g e
Recording form for dT vaccination practice in Accidental Patients
Case study No......
Accidental Patients
name-surname
Gender Male Female Date of birth / / Address
Congenital disease □ No □ Yes (Identify)
Drug and food allergy
Vaccination history
No history/Unknown/Not sure
have history
Type of vaccination Vaccination history
DTP/DTP-HB 1-3 DTP 4-5 Completely vaccinated
when under 5 years old Incomplete received......needles
dT Grade 6 vaccinated No
dT wound No
vaccinated ...... times
the last time when......./........./.........
dT
dT
บนั ทึกการไดร้ ับวคั ซีน dT
Age Accident Type of d/m/y Appointment
received vaccine vaccinated d/m/y
.....Years ....Month .............................. ........................ ....../....../...... ....../....../......
.....Years ....Month .............................. ........................ ....../....../...... ....../....../......
Recommendations specific to vaccines received today
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 70 | p a g e
Learning process 5: Summary of important health education for each vaccine type in No. 4.1 to No.4.6.
___________________________________________________________________________________________
___________________________________________________________________________________ ________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 6: Summarize the key principles of each vaccine target group appointment in No. 4.1 to
No.4.6.
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 7: Summary of Activities
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 71 | p a g e
PH 17
Part 9 Family Planning
Objective
To have knowledge Understanding and skill in family planning, injecting or oral medication, or
ring insertion or condom use (2 case studies)
Case Study No. 1
Learning Process 1: Study the relevant records/reports.
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: The Process of Accepting Customers
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 3: Family Planning and Health Education Services
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Appointment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 5: Summary of Activities
___________________________________________________________________________________________
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 72 | p a g e
Case Study No. 2
Learning Process 1: Study the relevant records/reports.
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 2: The Process of Accepting Customers
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 3: Family Planning and Health Education Services
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 4: Appointment
___________________________________________________________________________________________
___________________________________________________________________________________________
Learning Process 5: Summary of Activities
___________________________________________________________________________________________
___________________________________________________________________________________________
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 73 | p a g e
PH 18
Part 10 Preliminary Medical Care
Objective
To enable students to learn the process and have first aid and basic therapeutic skills (10 cases
per person).
Case Study No. ....
Age............years Gender.................................
Address..................................................................................................................................................................................
Recorder’s name-surname..............................................................Date................................Time...........................
Illness history
Chief Complaint
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Present Illness
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Past History Illness
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Personal History and behaviors
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Family History
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Manual of Public Health Internship (Filed training 1) 3.2021 74 | p a g e
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Menstrual history in female patients
.............................................................................................................................................................................................
............................................................................................................................................................................................
History in children under 6 years old
• Parturition Normal Abnormal (specify) ……………………...........………
Accoucheur................................................................................................................
• Growth Normal
Abnormal (specify) …………………................................................…...........………
• Feeding Breast feeding
Powdered milk
Condensed milk (brand).........................
supplement (brand).................
• Immunization BCG when (Date)................................................................
Hepatitis B virus when (Date)................................................................
DTP when (Date)................................................................
OPV when (Date)................................................................
MMR when (Date)................................................................
LAJE when (Date)................................................................
dT when (Date)................................................................
Others when (Date)................................................................
Physical examination
1. Body Weight................Kg. Height ...................Cm. BMI…………………
2. VITAL SIGNS
Body Temperature = ………………C๐
Pulse = ............................................................. times/minute
Respiration Rate = ...................................... times/minute
Blood Pressure =…………………………… mm/hg
3. General Appearance
Conscious ( ) Good ( ) Seem ( ) Noisy ( ) Unconscious ( ) Others.............
Physical appearance ( ) Strong ( ) Tired ( ) Others......................................
Shape ( ) Normal ( ) Obese ( ) Thin ( ) Other......................
4. Head ( ) Normal ( ) Abnormal (specify)...........................................................
Head circumference (≤ 2-year-old)........................................cm.
Hair ( ) Normal ( ) Dry and crisp ( ) Hair loss ( ) Lice ( ) Other.....................
Manual of Public Health Internship (Filed training 1) 3.2021 75 | p a g e
Scalp ( ) Normal ( ) Wound ( ) Blister ( ) Dandruff ( ) Other....................
fontanelle ( ) Normal ( ) dented ( ) bulging ( ) other.............................
5. Skin
Color ( ) Normal ( ) Pale ( ) Jaundice
Rash, blister, or purpura ( ) None ( ) Yes, found at................................................
Wound or abscess ( ) None ( ) Yes Found at ................................................
Skin withered ( ) No ( ) Yes
others....................................................................................................................................................
6. Face
Color ( ) Normal ( ) Pale ( ) Yellow ( ) Red
Edema ( ) None ( ) Yes, found at................................................
Crooked Mouth ( ) None ( ) Yes, Found At................................................
Others....................................................................................................................................................
7. Eyes
Eyelids ( ) Normal ( ) Abnormal on the side................................................
Conjunctiva ( ) Normal ( ) Pale ( ) Red
Sclera ( ) Normal ( ) Pale ( ) Yellow ( ) Red
Cornea ( ) Clear ( ) Cloudy ( ) Ulcerative ( ) Found on the side.............
Pupil Right pupil……mm. Reactive to light ( ) Normal ( ) Slow ( ) No reaction to light
Left side......mm. Reactive to light ( ) Normal ( ) Slow ( ) No reaction to light
Eyelid ( ) None ( ) Found on the side ................................................
Stye ( ) None ( ) Found on the side ................................................
others....................................................................................................................................................
8. Ears
Tinnitus ( ) None ( ) Found on the side ................................................
Deaf ( ) None ( ) Found on the side ................................................
Hearing ( ) Normal ( ) Decreased, found on the side ................................................
others....................................................................................................................................................
9. Nose
Nasal ( ) None ( ) Clear ( ) Thick in color.................................
Nosebleed ( ) None ( ) Found on the side ................................................
Nasal mucosa ( ) normal ( ) pale swelling ( ) red swelling
Ala Nasi Movement ( ) No ( ) Yes
others....................................................................................................................................................
Manual of Public Health Internship (Filed training 1) 3.2021 76 | p a g e
10. Mouth
Lips ( ) Normal
( ) Abnormal ( ) Pale ( ) Red ( ) Cracked ( ) Swollen ( ) Wound
Tooth ( ) Normal ( ) Decay ( ) Which tooth is painful
Gum ( ) Normal ( ) Inflamed ( ) Ulcerated
Tongue ( ) Normal ( ) Thick ( ) Greasy
Oral mucosa with red spot or Kolpik’s Spot ( ) No ( ) Yes, found at................................
Root Of the Mouth ( ) Normal ( ) with white spots
Pharynx ( ) Normal ( ) Red ( ) Purulent
Tonsils ( ) Normal ( ) Abnormal
Jaws ( ) Not Hard ( ) Clenched Jaw
Chin ( ) Normal ( ) Abnormal................................
Others....................................................................................................................................................
11. Neck
Stiff Neck ( ) No ( ) Yes
Thyroid Gland ( ) Normal ( ) Enlarged Size................................
Veins In the Neck ( ) Normal ( ) Bulging
Lymph Nodes ( ) Normal ( ) Abnormal, Found At ..........................
Trachea ( ) Normal ( ) Abnormal, Found At .........................
Others....................................................................................................................................................
12. Axilla
Lymph nodes ( ) Not enlarged ( ) Enlarged, found on the side.................................
Others....................................................................................................................................................
13. Chest
Chest characteristics ( ) Normal ( ) Abnormal ................................................
Movement ( ) Normal ( ) Abnormal ................................................
Breast ( ) Normal ( ) Abnormal ................................................
( ) There is a lump size............. on the side................
Nipple ( ) Normal ( ) Abnormal side .....................................
Others....................................................................................................................................................
14. Lung
Look panting ( ) Yes ( ) No
Listen Sound ( ) Normal ( ) Sound is slowly found at..................................
( ) Rhonchi sound found at........................................................
( ) Wheezing sound found at.......................................................
Manual of Public Health Internship (Filed training 1) 3.2021 77 | p a g e
( ) Crepitation sounds found at................................................
Palpation Movement ( ) Normal ( ) Abnormal
Percussion Sound ( ) Normal ( ) Solid ( ) Transparent
Others....................................................................................................................................................
15. Heart
Look Apex Beat ( ) See ( ) Don't see location............................................
Listen Sound ( ) Normal ( ) Abnormal
( ) Light ( ) Strong
Rhythm of the dance ( ) evenly.................................. times/minute
( ) Irregular................................times/minute
Palpation Apex Beat ( ) Normal ( ) Abnormal
Thrill ( ) No ( ) Yes
Percussion The size of the heart ( ) normal ( ) is not normal at................................
others....................................................................................................................................................
16. Abdomen
Look Appearance ( ) Normal ( ) Swelling
Aneurysm ( ) No ( ) Yes
Surgical scar ( ) No ( ) Yes
Striped belly in women (Strias) ( ) No ( ) Yes
Ascites ( ) No ( ) Yes
Listen Bowel Sound ( ) Normal...............times/minute
Percussion Sound ( ) Abnormal.............times/minute
( ) Normal ( ) Abnormal found at................................
( ) Solid, found at................................................ .
Palpation Guarding ( ) No ( ) Yes
( ) Yes found at .................................
Tenderness ( ) No
Liver ( ) not found ( ) found size ................................
Spleen
( ) tenderness ( ) dent ( ) hard
( ) not found ( ) found size
Mass ( ) No ( ) found at .................................
( ) tenderness ( ) does not hurt
Others....................................................................................................................................................
17. Genitals ( ) Normal ( ) Abnormal .....................................................................
18. Arms ( ) None ( ) Found...........................................................
Disability
Manual of Public Health Internship (Filed training 1) 3.2021 78 | p a g e
Swelling ( ) None ( ) Found...........................................................
Feel numb ( ) None ( ) Found next to ................................................
Paralysis ( ) None ( ) Found on the side....................................................
Shoulder ( ) Normal ( ) Swollen side pain................................................
Elbow ( ) Normal ( ) Swelling, pain in the side..................................
19. Legs
Disability ( ) None ( ) Found...........................................................
Swelling ( ) None ( ) Found...........................................................
Feel numb ( ) None ( ) Found next to ................................................
Paralysis ( ) None ( ) Found on the side....................................................
Inguinal lymph nodes ( ) normal ( ) enlarged, found on the side.........................................
Knee joint ( ) Normal ( ) Swollen side pain .......................................................
Knee reflex ( ) Normal ( ) Abnormal
Shin ( ) normal ( ) Abnormal ................................................
Ankle ( ) Normal ( ) Abnormal .................................................
Ankle reflex ( ) Normal ( ) Abnormal .................................................
Others....................................................................................................................................................
Laboratory examination deemed appropriate to send for examination
( ) sputum examination …………………………………………………………………………………
( ) Fecal examination ……………………………………………………………………………………
( ) Urine, check ………………………………………………….................................................
( ) Blood test ………………………..………………………………………………………………………
( ) Others, check ……………………………………………………………………………………………
Laboratory results
( ) Sputum……………………………………………………………………………………………………
( ) Stool……………………………………………………………....……………………………………….
( ) Urine.....................................................................................................................
( ) Blood……………………………………………………………………………………………………….
( ) Others ………………………………………………………………………………………………………………………...............
Summary of symptoms and Findings
Symptoms
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
Manual of Public Health Internship (Filed training 1) 3.2021 79 | p a g e
Signs
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
Differential Diagnosis
1....................................................................................................................................................................................................
2....................................................................................................................................................................................................
3....................................................................................................................................................................................................
Final diagnosis
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
ICD10...........................................................................................................................................................................................
Treatment
.......................................................................................................................................................................................................
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Manual of Public Health Internship (Filed training 1) 3.2021 80 | p a g e
Health education
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
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.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
Signature ________________________________
(_______________________________)
Student
Date ________________________________
Signature ________________________________
(_______________________________)
Supervisor
Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 81 | p a g e
PH 14
Part 11 First Aid and Primary Therapeutic Activities
at the Emergency Room
Objective
To enable students to learn the process and have first aid and basic therapeutic skills.
Learning Process 1: Recording in Records and Reports
___________________________________________________________________________________________
Learning Process 2: Service Acceptance Process
________________________________________________________________________ ___________________
Learning Process 3: History Recording Process Initial physical examination
___________________________________________________________________________________________
Learning Process 4: First Aid and Initial Therapy at the Emergency Room
4.1 Wet dressing (5 people)
4.2 Dry dressing ( 5 persons)
4.3 Simple suture/other procedures (1 person)
4.4 Intramuscular injection (5 patients)
4.5 History taking, disease screening (2 cases)
4.6 Physical examination (2 cases)
Manual of Public Health Internship (Filed training 1) 3.2021 82 | p a g e
Wet dressing procedure training data recording form
Case Study No. 1
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อ่ืนๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 83 | p a g e
Wet dressing procedure training data recording form
Case Study No. 2
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อ่ืนๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 84 | p a g e
Wet dressing procedure training data recording form
Case Study No. 3
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อน่ื ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 85 | p a g e
Wet dressing procedure training data recording form
Case Study No. 4
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อ่นื ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 86 | p a g e
Wet dressing procedure training data recording form
Case Study No. 5
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อ่นื ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 87 | p a g e
4.2 Dry dressing ( 5 persons)
Dry dressing procedure training data recording form
Case Study No. 1
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อนื่ ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 88 | p a g e
Dry dressing procedure training data recording form
Case Study No. 2
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อื่นๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 89 | p a g e
Dry dressing procedure training data recording form
Case Study No. 3
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อืน่ ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 90 | p a g e
Dry dressing procedure training data recording form
Case Study No. 4
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อืน่ ๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 91 | p a g e
Dry dressing procedure training data recording form
Case Study No. 5
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Wound Images
Type of wound Incision wound Lacerated wound
Abrasion wound Contusion wound
Others...............................................................................................
Characteristics of the wound width................cm. Length.............cm. Depth....................cm.
Methods for washing wounds and dressing wounds…………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….
Wound dressing method Wet dressing Dry dressing Others (อื่นๆ)..............
Next appointment.............................................. Reason for the appointment......................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 92 | p a g e
4.3 Simple suture/other procedures (1 person)
Simple suture/other procedures training data recording form
Case Study No. ......
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Simple suture (pictures of wounds before and after stitches)
Suture Simple suture Continuous suture Others (อ่นื ๆ).................
Number of stitches.................. Needles Next appointment date............./…………./……………
Reason for the appointment.......................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Precautions for caring for wounds
............................................................................................................................................................................
............................................................................................................................................................................
Advising
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 93 | p a g e
Simple suture/other procedures training data recording form
Case Study No. ......
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
In the case of silk cutting (pictures of the wound before and after silk cutting)
Characteristics of the wound before silk cutting
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Characteristics of the wound after silk cutting
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Advice after cutting
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
General advice
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 94 | p a g e
4.4 Intramuscular injection (5 patients)
Intramuscular injection procedures training data recording form
Case Study No. 1
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Name of injecting drug.........................................................................................................................................
Injection type ampule VIAL
Method of injection intramuscular injection subcutaneous injection
intradermal injection intravenous injection
Position of injection……………………………………………………………………………………………………………………..........
Method of preparation of the drug…………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Caution
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Advice
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Next appointment Date ……………/……………/……………
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 95 | p a g e
Intramuscular injection procedures training data recording form
Case Study No. 2
Patient No. ..........................
Age........years..........month Gender.......................... Vital Signs.......................................................................
Weight..................kg. Height...................cm. BMI = ...........................Date of birth........................................
Chief Complaint....................................................................................................................................................
..................................................................................................................................................................................
Present Illness …………………………………………………………………………………………………………………….....................
…………....................……………………………………………………………………………………………………………………………………..
Name of injecting drug.........................................................................................................................................
Injection type ampule VIAL
Method of injection intramuscular injection subcutaneous injection
intradermal injection intravenous injection
Position of injection……………………………………………………………………………………………………………………..........
Method of preparation of the drug…………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Caution
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Advice
………………………………………………………………………………………………………………………………………………………....……
………………………………………………………………………………………………………………………………………………………....……
Next appointment Date ……………/……………/……………
Signature ________________________________ Signature________________________________
(_______________________________) (_______________________________)
Student Supervisor
Date ________________________________ Date ________________________________
Manual of Public Health Internship (Filed training 1) 3.2021 96 | p a g e
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