2. Buruli Ulcer Recording Forms
These are forms used to
obtain/collect/capture information about a
patient, the disease and intervention (s)
provided
1. Buruli ulcer client/treatment card(BU01)
2. Register of Buruli ulcer cases in a health
facility (BU02)
3. A laboratory request form (BU04)
3. Buruli Ulcer Treatment Card (BU01)
A BU treatment card is filled in for every new patient
diagnosed with BU with any lesion and categorized
(e.g. new and either category I, II or III).
• The BU treatment card includes information on the
patient (e.g., name, address, sex, age) as well as
pertinent information on the prescribed treatment
and drug dosages and treatment outcome.
• Great care should be taken to ensure that the
information on the BU treatment card is accurate,
since it is crucial to notification of cases and
evaluation of treatment outcomes and is the basis of
the facility BU register.