A variety of alternative medical record schemes have been successfully implemented throughout the developing world to meet the needs of patients. These schemes respond to problems such as language barriers, high illiteracy rates, transient populations, rapid turnover of health care providers, lack of formal identification papers, as well as to time and monetary constraints. This section provides a brief overview of patient-retained, facility-retained and combined system alternatives. Patient -Retained Records These are often in the form of a card or small notebook (sometimes called a medical "carnet," pronounced "car- NAY"), which is kept at home and brought by the patient on each visit. It can be protected from deterioration by placement in a plastic bag or envelope. Ideally it contains a summary of the patient's history and problems and is then updated on each visit. This system works best if the record is somewhat durable and if patients remember to bring them. Their proper use can be encouraged by having the patients pay a nominal fee for their purchase and by imposing mild penalties for loss or failure to bring to visits. For example, a "discount" on the price of a clinic visit can be offered to patients bringing their carnets. These notebooks can be cheaply produced locally and can be tailored for adults or children. Children's versions may contain a growth chart and immunization schedule as well as sections for entry of parental information printed on the cover. It is often worthwhile to document the patient's village of origin on the front of the card or carnet. This further bit of information is helpful in distinguishing patients with similar names who do not know, for example, their own date of birth. Patient-retained records have several advantages: They make registration for visits easier by providing a source of identification They are readily available on home visits They provide crucial information if a patient visits another provider or clinic, thereby improving continuity of care. They speed clinic visits by avoiding record retrieval (which can be very difficult when spelling / pronunciation of names is difficult) They can facilitate community surveys They can serve as the vehicle to communicate with pharmacists in place of a prescription pad They require no form of facility based storage and retrieval Facility- Retained Records Records retained by facilities require the expense and labor of a system of storage and retrieval. In areas where the population does not carry formal written means of identification the retrieval process can be difficult. But facility retained records can have certain advantages: They can provide data about health care needs of the community which can be analyzed for future planning. They can be used to track patients who need return visits and follow-up, particularly high risk groups who may require home visits if they fail to show for important follow-up. They may be the only practical means where patient cooperation with self-retained records is low. Combined Records Systems A combination of patient retained and facility retained records often proves most valuable. It allows for minimal records to be kept at the facility, but provides for data collection and tracking of high risk patients. Assigning a number common to both records facilitates retrieval of the facility record when the patient presents. Facilities which have international personnel should develop multilingual record forms to ease the language burden on workers whose native tongue is not the principal one in use. This suggestion applies to history and physical sheets, progress note forms, order sheets and test request forms.