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Pregnancy tracking ToolPID 31
My Projects Project Home Project Setup Online Designer Data Dictionary Codebook

The Codebook is a human-readable, read-only version of the project's Data Dictionary and serves as a quick reference for viewing the attributes of any given field in the project without having to download and interpret the Data Dictionary. Note: Checkbox fields have their coded values displayed both in the format defined by users in the Online Designer/Data Dictionary as well as in the extended format seen in data imports and exports (i.e., field___code).

Data Dictionary Codebook 05/03/2026 6:53pm
Field finder: — When viewing this page, collapse:
Data Dictionary Codebook
Pregnancy tracking Tool (PID: 31)
05/03/2026 6:53pm
Instruments
Instrument Form Name
Registration Form 3rd month registration_form_3rd_month
Form 4th month form_4th_month
Form 5th month form_5th_month
Form 6th month form_6th_month
Form 7th Month form_7th_month
8th month st_followup_form_8th_month
form 9th month nd_followup_form_9th_month
After delivery form after_delivery_form
# Variable / Field Name Field Label
Field Note
 Field Attributes (Field Type, Validation, Choices, Calculations, etc.)
Instrument:Registration Form 3rd month(registration_form_3rd_month) Enabled as survey
1 [record_id] Record ID text
2 [name_of_interviwer_v2] Name of Interviwer text, Required
Field Annotation: @APPUSERNAME-APP
3 [date_of_survey_v2] Date of survey
text (date_dmy), Required
Field Annotation: @TODAY-UTC
4 [rch_id_v2] RCH id (to be given by ASHA)
 text (number), Required
5 [name_of_the_mother_v2] Name of pregnant women
text, Required
6 [name_of_spouse_v2] Name of spouse
 text, Required
7 [phone_number_pg_v2] Phone Number of pregnant women text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
8 [phone_number_2_v2] Phone number of the pregnant woman's husband
if second no is not available (9999999999)
 text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
9 [phone_number_of_the_pregna_v2] Phone number of the pregnant woman which can be used to contact her
(other than her husband's number)
not available then enter 9999999999
 text (number, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
10 [house_number] House number text, Required
11 [village_name] Village name text, Required
12 [nearest_health_and_wellnes] Nearest health and wellness center name text, Required
13 [name_of_block_from_where_t] Name of block from where the information get collected radio, Required
1Sangrur
2Sunam
3Bhawanigarh
4Dhuri
5Moonak
6Sherpur
7Longwal
8Kaurihan
14 [b_preferred_time_of_the_da_v2] B. Preferred time of the day to contact the woman. text, Required
15 [age_in_years_v2] Age (in years)
 text (number), Required
16 [lmp_v2] LMP
 text (date_dmy), Required
17 [edd_v2] EDD
 text (date_dmy), Required
18 [gestational_age_in_weeks_v2] Gestational age (in weeks)When ANC for your 7th month of pregnancy was received / due text (integer), Required
19 [gravida_v2] Gravida
 text (integer), Required
20 [parity_v2] Parity
 text (number), Required
21 [living_v2] No of children living text (integer), Required
22 [type_of_resident_v2] Type of resident radio, Required
1Permanent
2Migrant (long term - more than a year - from other state)
3Migrant (short term - less than 6 months - from other state)
23 [previous_pregnancy_history_v2] Previous Pregnancy History descriptive
24 [previous_history_of_stillb_v2] Previous history of stillbirth
 yesno, Required
1Yes
0No
25 [count_stillbirth_v2]
Show the field ONLY if:
[previous_history_of_stillb_v2] = '1'
specify the count text (integer), Required
26 [previous_history_of_neonat_v2] Previous history of Neonatal death
 yesno, Required
1Yes
0No
27 [count_neonatal_v2]
Show the field ONLY if:
[previous_history_of_neonat_v2] = '1'
Specify the count text (number), Required
28 [history_of_aborti_v2] Previous history of Abortions
 yesno, Required
1Yes
0No
29 [count_aborstion_v2]
Show the field ONLY if:
[history_of_aborti_v2]="1"
specify the count text (integer), Required
30 [previous_history_of_lscs_v2] Previous history of LSCS
 yesno, Required
1Yes
0No
31 [count_lscs_v2]
Show the field ONLY if:
[previous_history_of_lscs_v2] = '1'
specify the count text (number), Required
32 [history_of_any_illness_at_v2] History of any illness at any time during previous pregnancy
yesno, Required
1Yes
0No
33 [illness_v2]
Show the field ONLY if:
[history_of_any_illness_at_v2] = '1'
What was the illness? (Multiple responses are possible) checkbox, Required
1illness_v2___1Diabetes
2illness_v2___2Hypertension
3illness_v2___3Eclampsia/ Pre-eclampsia
4illness_v2___4Thyroid disease
5illness_v2___5pre-existing medical conditions such as heart disease, kidney disease, or epilepsy
6illness_v2___6Allergy
7illness_v2___7TB
8illness_v2___8HIV
9illness_v2___9Fever with rash
10illness_v2___10Severe Anemia / Hb less than 7 g/dl
11illness_v2___11Excessive bleeding (antepartum)
12illness_v2___12Others
34 [specify_illness_v2]
Show the field ONLY if:
[illness_v2(12)] = '1'
Specify text, Required
35 [anc_details_v2] ANC details descriptive
36 [registered_with_health_facili_v2] Have you registered with any health facility for ANC during this pregnancy?
 yesno, Required
1Yes
0No
37 [no_of_anc_visits_done_v2]
Show the field ONLY if:
[registered_with_health_facili_v2] = '1'
No. of ANC visits done till now
text (integer), Required
38 [type_of_facility_v2]
Show the field ONLY if:
[registered_with_health_facili_v2] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
39 [other_health_facility_v2]
Show the field ONLY if:
[type_of_facility_v2] = '4'
Other text, Required
40 [month_preg_in_anc_done_v2]
Show the field ONLY if:
[registered_with_health_facili_v2] = '1'
In which month of your pregnancy did you have the first ANC visit (for your current pregnancy)?
text (integer), Required
41 [most_recent_anc_v2] When was your most recent ANC visit?




 radio, Required
1Less than 1 week ago
2Between 2-4 weeks ago
3More than 1 month ago
4Never had an ANC visit
5Others specify
42 [other_recent_anc_v2]
Show the field ONLY if:
[most_recent_anc_v2] = '5'
Other text, Required
43 [clinical_tests_conducted_i_v2] Clinical Tests Conducted in the ANC visit descriptive
44 [height_checked_v2] Height checked yesno, Required
1Yes
0No
45 [were_you_informed_about_th_v2]
Show the field ONLY if:
[height_checked_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
46 [value_of_height_in_cm_v2]
Show the field ONLY if:
[were_you_informed_about_th_v2] = '1'
Value of height in cm
text (number), Required
47 [any_hrp_complication_ht_v2]
Show the field ONLY if:
[height_checked_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
48 [medicines_treatment_provid_ht_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
49 [referred_hrp_ht_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2] = '1'
Referred
 yesno, Required
1Yes
0No
50 [weight_checked_v2] Weight Checked yesno, Required
1Yes
0No
51 [informed_about_wt_v2]
Show the field ONLY if:
[weight_checked_v2] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
52 [value_wt_v2]
Show the field ONLY if:
[informed_about_wt_v2] = '1'
Value in Kg text (integer), Required
53 [was_any_hrp_complication_i_v2]
Show the field ONLY if:
[weight_checked_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
54 [medicines_treatment_provid_wt_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
55 [referred_wt_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2] = '1'
Referred
yesno, Required
1Yes
0No
56 [blood_pressure_v2] Blood Pressure checked yesno, Required
1Yes
0No
57 [were_you_informed_about_bp_v2]
Show the field ONLY if:
[blood_pressure_v2] = '1'
Were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
58 [value_bp_v2]
Show the field ONLY if:
[were_you_informed_about_bp_v2] = '1'
Value
text, Required
59 [hrp_complication_bp_v2]
Show the field ONLY if:
[blood_pressure_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
60 [medicines_treatment_provid_bp_v2]
Show the field ONLY if:
[hrp_complication_bp_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
61 [referred_bp_v2]
Show the field ONLY if:
[hrp_complication_bp_v2] = '1'
Referred
yesno, Required
1Yes
0No
62 [abdominal_check_up_v2] Abdominal check up
yesno, Required
1Yes
0No
63 [were_you_informed_abdomin_v2]
Show the field ONLY if:
[abdominal_check_up_v2] = '1'
were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
64 [value_v2]
Show the field ONLY if:
[were_you_informed_abdomin_v2] = '1'
Value text, Required
65 [hrp_complication_abdomin_v2]
Show the field ONLY if:
[abdominal_check_up_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
66 [medicines_treatment_abdomin_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
67 [referred_abdomin_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2] = '1'
Referred
 yesno, Required
1Yes
0No
68 [investigation_done_in_the_v2] Investigation done in the ANC visit descriptive
69 [hemoglobin_v2] Hemoglobin
 yesno, Required
1Yes
0No
70 [were_you_informed_about_hb_v2]
Show the field ONLY if:
[hemoglobin_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
71 [value_hb_v2]
Show the field ONLY if:
[were_you_informed_about_hb_v2] = '1'
Value text (number), Required
72 [hrp_complication_hb_v2]
Show the field ONLY if:
[hemoglobin_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
73 [medicines_hb_v2]
Show the field ONLY if:
[hrp_complication_hb_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
74 [referred_hb_v2]
Show the field ONLY if:
[hrp_complication_hb_v2] = '1'
Referred yesno, Required
1Yes
0No
75 [blood_glucose_sugar_rbs_or_v2] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
76 [informed_rbs_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
77 [value_rbs_v2]
Show the field ONLY if:
[informed_rbs_v2] = '1'
Value
text (integer), Required
78 [hrp_complication_rbs_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
79 [medicines_treatment_rbs_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
80 [referred_rbs_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2] = '1'
Referred
yesno, Required
1Yes
0No
81 [urine_test_v2] Urine Test
 yesno, Required
1Yes
0No
82 [were_you_informed_urne_v2]
Show the field ONLY if:
[urine_test_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
83 [hrp_complication_urn_v2]
Show the field ONLY if:
[urine_test_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
84 [medicines_treatment_urne_v2]
Show the field ONLY if:
[hrp_complication_urn_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
85 [referred_urn_v2]
Show the field ONLY if:
[hrp_complication_urn_v2] = '1'
Referred
yesno, Required
1Yes
0No
86 [usg_v2] USG
 yesno, Required
1Yes
0No
87 [informed_about_usg_v2]
Show the field ONLY if:
[usg_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
88 [hrp_complication_usg_v2]
Show the field ONLY if:
[usg_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
89 [medicines_treatment_usg_v2]
Show the field ONLY if:
[hrp_complication_usg_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
90 [referred_usg_v2]
Show the field ONLY if:
[hrp_complication_usg_v2] = '1'
Referred
yesno, Required
1Yes
0No
91 [danger_signs_v2] Danger Signs descriptive
92 [did_you_experience_any_of_v2] "Did you experience any of the following danger signs during anytime of the pregnancy? checkbox, Required
1did_you_experience_any_of_v2___1Vaginal Bleeding
2did_you_experience_any_of_v2___2Severe Headaches
3did_you_experience_any_of_v2___3Blurred Vision
4did_you_experience_any_of_v2___4Reduced fetal movements
5did_you_experience_any_of_v2___5Excessive swelling in face or hands or feet
6did_you_experience_any_of_v2___6Convulsions
7did_you_experience_any_of_v2___7Fever
8did_you_experience_any_of_v2___8Severe Abdominal Pain
9did_you_experience_any_of_v2___9Dizziness and Lightheadedness
10did_you_experience_any_of_v2___10Fatigue and Weakness
11did_you_experience_any_of_v2___11Fast or difficult Breathing/shortness of breath
12did_you_experience_any_of_v2___12No
13did_you_experience_any_of_v2___13Any other
93 [specify_dangersign_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2(13)] = '1'
Specify text, Required
94 [if_experienced_any_danger_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2(1)] = '1' OR [did_you_experience_any_of_v2(2)] = '1' OR [did_you_experience_any_of_v2(3)] = '1' OR [did_you_experience_any_of_v2(4)] = '1' OR [did_you_experience_any_of_v2(5)] = '1' OR [did_you_experience_any_of_v2(6)] = '1' OR [did_you_experience_any_of_v2(7)] = '1' OR [did_you_experience_any_of_v2(8)] = '1' OR [did_you_experience_any_of_v2(9)] = '1' OR [did_you_experience_any_of_v2(10)] = '1' OR [did_you_experience_any_of_v2(11)] = '1' or [did_you_experience_any_of_v2(13)] = '1'
If experienced any danger sign, how did you manage it? radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 95 [registration_form_3rd_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:Form 4th month(form_4th_month) Enabled as survey
96 [name_of_interviwer_v2_v2] Name of Interviwer text, Required
Field Annotation: @APPUSERNAME-APP
97 [date_of_survey_v2_v2] Date of survey
text (date_dmy), Required
Field Annotation: @TODAY-UTC
98 [rch_id_v2_v2] RCH id (to be given by ASHA)
 text (number), Required
99 [name_of_the_mother_v2_v2] Name of pregnant women
text, Required
100 [name_of_spouse_v2_v2] Name of spouse
 text, Required
101 [phone_number_pg_v2_v2] Phone Number of pregnant women text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
102 [phone_number_2_v2_v2] Phone number of the pregnant woman's husband
if second no is not available (9999999999)
 text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
103 [phone_number_of_the_pregna_v2_v2] Phone number of the pregnant woman which can be used to contact her
(other than her husband's number)
not available then enter 9999999999
 text (number, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
104 [b_preferred_time_of_the_da_v2_v2] B. Preferred time of the day to contact the woman. text, Required
105 [age_in_years_v2_v2] Age (in years)
 text (number), Required
106 [lmp_v2_v2] LMP
 text (date_dmy), Required
107 [edd_v2_v2] EDD
 text (date_dmy), Required
108 [gestational_age_in_weeks_v2_v2] Gestational age (in weeks)When ANC for your 7th month of pregnancy was received / due text (integer), Required
109 [gravida_v2_v2] Gravida
 text (integer), Required
110 [parity_v2_v2] Parity
 text (number), Required
111 [living_v2_v2] No of children living text (integer), Required
112 [type_of_resident_v2_v2] Type of resident radio, Required
1Permanent
2Migrant (long term - more than a year - from other state)
3Migrant (short term - less than 6 months - from other state)
113 [previous_pregnancy_history_v2_v2] Previous Pregnancy History descriptive
114 [previous_history_of_stillb_v2_v2] Previous history of stillbirth
 yesno, Required
1Yes
0No
115 [count_stillbirth_v2_v2]
Show the field ONLY if:
[previous_history_of_stillb_v2_v2] = '1'
specify the count text (integer), Required
116 [previous_history_of_neonat_v2_v2] Previous history of Neonatal death
 yesno, Required
1Yes
0No
117 [count_neonatal_v2_v2]
Show the field ONLY if:
[previous_history_of_neonat_v2_v2] = '1'
Specify the count text (number), Required
118 [history_of_aborti_v2_v2] Previous history of Abortions
 yesno, Required
1Yes
0No
119 [count_aborstion_v2_v2]
Show the field ONLY if:
[history_of_aborti_v2_v2]="1"
specify the count text (integer), Required
120 [previous_history_of_lscs_v2_v2] Previous history of LSCS
 yesno, Required
1Yes
0No
121 [count_lscs_v2_v2]
Show the field ONLY if:
[previous_history_of_lscs_v2_v2] = '1'
specify the count text (number), Required
122 [history_of_any_illness_at_v2_v2] History of any illness at any time during previous pregnancy
yesno, Required
1Yes
0No
123 [illness_v2_v2]
Show the field ONLY if:
[history_of_any_illness_at_v2_v2] = '1'
What was the illness? (Multiple responses are possible) checkbox, Required
1illness_v2_v2___1Diabetes
2illness_v2_v2___2Hypertension
3illness_v2_v2___3Eclampsia/ Pre-eclampsia
4illness_v2_v2___4Thyroid disease
5illness_v2_v2___5pre-existing medical conditions such as heart disease, kidney disease, or epilepsy
6illness_v2_v2___6Allergy
7illness_v2_v2___7TB
8illness_v2_v2___8HIV
9illness_v2_v2___9Fever with rash
10illness_v2_v2___10Severe Anemia / Hb less than 7 g/dl
11illness_v2_v2___11Excessive bleeding (antepartum)
12illness_v2_v2___12Others
124 [specify_illness_v2_v2]
Show the field ONLY if:
[illness_v2_v2(12)] = '1'
Specify text, Required
125 [anc_details_v2_v2] ANC details descriptive
126 [registered_with_health_facili_v2_v2] Have you registered with any health facility for ANC during this pregnancy?
 yesno, Required
1Yes
0No
127 [no_of_anc_visits_done_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2] = '1'
No. of ANC visits done till now
text (integer), Required
128 [type_of_facility_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
129 [other_health_facility_v2_v2]
Show the field ONLY if:
[type_of_facility_v2_v2] = '4'
Other text, Required
130 [month_preg_in_anc_done_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2] = '1'
In which month of your pregnancy did you have the first ANC visit (for your current pregnancy)?
text (integer), Required
131 [most_recent_anc_v2_v2] When was your most recent ANC visit?




 radio, Required
1Less than 1 week ago
2Between 2-4 weeks ago
3More than 1 month ago
4Never had an ANC visit
5Others specify
132 [other_recent_anc_v2_v2]
Show the field ONLY if:
[most_recent_anc_v2_v2] = '5'
Other text, Required
133 [clinical_tests_conducted_i_v2_v2] Clinical Tests Conducted in the ANC visit descriptive
134 [height_checked_v2_v2] Height checked yesno, Required
1Yes
0No
135 [were_you_informed_about_th_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
136 [value_of_height_in_cm_v2_v2]
Show the field ONLY if:
[were_you_informed_about_th_v2_v2] = '1'
Value of height in cm
text (number), Required
137 [any_hrp_complication_ht_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
138 [medicines_treatment_provid_ht_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
139 [referred_hrp_ht_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
140 [weight_checked_v2_v2] Weight Checked yesno, Required
1Yes
0No
141 [informed_about_wt_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
142 [value_wt_v2_v2]
Show the field ONLY if:
[informed_about_wt_v2_v2] = '1'
Value in Kg text (integer), Required
143 [was_any_hrp_complication_i_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
144 [medicines_treatment_provid_wt_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
145 [referred_wt_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
146 [blood_pressure_v2_v2] Blood Pressure checked yesno, Required
1Yes
0No
147 [were_you_informed_about_bp_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2] = '1'
Were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
148 [value_bp_v2_v2]
Show the field ONLY if:
[were_you_informed_about_bp_v2_v2] = '1'
Value
text, Required
149 [hrp_complication_bp_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
150 [medicines_treatment_provid_bp_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
151 [referred_bp_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
152 [abdominal_check_up_v2_v2] Abdominal check up
yesno, Required
1Yes
0No
153 [were_you_informed_abdomin_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2] = '1'
were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
154 [value_v2_v2]
Show the field ONLY if:
[were_you_informed_abdomin_v2_v2] = '1'
Value text, Required
155 [hrp_complication_abdomin_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
156 [medicines_treatment_abdomin_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
157 [referred_abdomin_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
158 [investigation_done_in_the_v2_v2] Investigation done in the ANC visit descriptive
159 [hemoglobin_v2_v2] Hemoglobin
 yesno, Required
1Yes
0No
160 [were_you_informed_about_hb_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
161 [value_hb_v2_v2]
Show the field ONLY if:
[were_you_informed_about_hb_v2_v2] = '1'
Value text (number), Required
162 [hrp_complication_hb_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
163 [medicines_hb_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
164 [referred_hb_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2] = '1'
Referred yesno, Required
1Yes
0No
165 [blood_glucose_sugar_rbs_or_v2_v2] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
166 [informed_rbs_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
167 [value_rbs_v2_v2]
Show the field ONLY if:
[informed_rbs_v2_v2] = '1'
Value
text (integer), Required
168 [hrp_complication_rbs_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
169 [medicines_treatment_rbs_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
170 [referred_rbs_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
171 [urine_test_v2_v2] Urine Test
 yesno, Required
1Yes
0No
172 [were_you_informed_urne_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
173 [hrp_complication_urn_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
174 [medicines_treatment_urne_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
175 [referred_urn_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
176 [usg_v2_v2] USG
 yesno, Required
1Yes
0No
177 [informed_about_usg_v2_v2]
Show the field ONLY if:
[usg_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
178 [hrp_complication_usg_v2_v2]
Show the field ONLY if:
[usg_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
179 [medicines_treatment_usg_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
180 [referred_usg_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
181 [danger_signs_v2_v2] Danger Signs descriptive
182 [did_you_experience_any_of_v2_v2] "Did you experience any of the following danger signs during anytime of the pregnancy? checkbox, Required
1did_you_experience_any_of_v2_v2___1Vaginal Bleeding
2did_you_experience_any_of_v2_v2___2Severe Headaches
3did_you_experience_any_of_v2_v2___3Blurred Vision
4did_you_experience_any_of_v2_v2___4Reduced fetal movements
5did_you_experience_any_of_v2_v2___5Excessive swelling in face or hands or feet
6did_you_experience_any_of_v2_v2___6Convulsions
7did_you_experience_any_of_v2_v2___7Fever
8did_you_experience_any_of_v2_v2___8Severe Abdominal Pain
9did_you_experience_any_of_v2_v2___9Dizziness and Lightheadedness
10did_you_experience_any_of_v2_v2___10Fatigue and Weakness
11did_you_experience_any_of_v2_v2___11Fast or difficult Breathing/shortness of breath
12did_you_experience_any_of_v2_v2___12No
13did_you_experience_any_of_v2_v2___13Any other
183 [specify_dangersign_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2(13)] = '1'
Specify text, Required
184 [if_experienced_any_danger_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2(1)] = '1' OR [did_you_experience_any_of_v2_v2(2)] = '1' OR [did_you_experience_any_of_v2_v2(3)] = '1' OR [did_you_experience_any_of_v2_v2(4)] = '1' OR [did_you_experience_any_of_v2_v2(5)] = '1' OR [did_you_experience_any_of_v2_v2(6)] = '1' OR [did_you_experience_any_of_v2_v2(7)] = '1' OR [did_you_experience_any_of_v2_v2(8)] = '1' OR [did_you_experience_any_of_v2_v2(9)] = '1' OR [did_you_experience_any_of_v2_v2(10)] = '1' OR [did_you_experience_any_of_v2_v2(11)] = '1' or [did_you_experience_any_of_v2_v2(13)] = '1'
If experienced any danger sign, how did you manage it? radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 185 [form_4th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:Form 5th month(form_5th_month) Enabled as survey
186 [name_of_interviwer_v2_v2_v2] Name of Interviwer text, Required
Field Annotation: @APPUSERNAME-APP
187 [date_of_survey_v2_v2_v2] Date of survey
text (date_dmy), Required
Field Annotation: @TODAY-UTC
188 [rch_id_v2_v2_v2] RCH id (to be given by ASHA)
 text (number), Required
189 [name_of_the_mother_v2_v2_v2] Name of pregnant women
text, Required
190 [name_of_spouse_v2_v2_v2] Name of spouse
 text, Required
191 [phone_number_pg_v2_v2_v2] Phone Number of pregnant women text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
192 [phone_number_2_v2_v2_v2] Phone number of the pregnant woman's husband
if second no is not available (9999999999)
 text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
193 [phone_number_of_the_pregna_v2_v2_v2] Phone number of the pregnant woman which can be used to contact her
(other than her husband's number)
not available then enter 9999999999
 text (number, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
194 [b_preferred_time_of_the_da_v2_v2_v2] B. Preferred time of the day to contact the woman. text, Required
195 [age_in_years_v2_v2_v2] Age (in years)
 text (number), Required
196 [lmp_v2_v2_v2] LMP
 text (date_dmy), Required
197 [edd_v2_v2_v2] EDD
 text (date_dmy), Required
198 [gestational_age_in_weeks_v2_v2_v2] Gestational age (in weeks)When ANC for your 7th month of pregnancy was received / due text (integer), Required
199 [gravida_v2_v2_v2] Gravida
 text (integer), Required
200 [parity_v2_v2_v2] Parity
 text (number), Required
201 [living_v2_v2_v2] No of children living text (integer), Required
202 [type_of_resident_v2_v2_v2] Type of resident radio, Required
1Permanent
2Migrant (long term - more than a year - from other state)
3Migrant (short term - less than 6 months - from other state)
203 [previous_pregnancy_history_v2_v2_v2] Previous Pregnancy History descriptive
204 [previous_history_of_stillb_v2_v2_v2] Previous history of stillbirth
 yesno, Required
1Yes
0No
205 [count_stillbirth_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_stillb_v2_v2_v2] = '1'
specify the count text (integer), Required
206 [previous_history_of_neonat_v2_v2_v2] Previous history of Neonatal death
 yesno, Required
1Yes
0No
207 [count_neonatal_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_neonat_v2_v2_v2] = '1'
Specify the count text (number), Required
208 [history_of_aborti_v2_v2_v2] Previous history of Abortions
 yesno, Required
1Yes
0No
209 [count_aborstion_v2_v2_v2]
Show the field ONLY if:
[history_of_aborti_v2_v2_v2]="1"
specify the count text (integer), Required
210 [previous_history_of_lscs_v2_v2_v2] Previous history of LSCS
 yesno, Required
1Yes
0No
211 [count_lscs_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_lscs_v2_v2_v2] = '1'
specify the count text (number), Required
212 [history_of_any_illness_at_v2_v2_v2] History of any illness at any time during previous pregnancy
yesno, Required
1Yes
0No
213 [illness_v2_v2_v2]
Show the field ONLY if:
[history_of_any_illness_at_v2_v2_v2] = '1'
What was the illness? (Multiple responses are possible) checkbox, Required
1illness_v2_v2_v2___1Diabetes
2illness_v2_v2_v2___2Hypertension
3illness_v2_v2_v2___3Eclampsia/ Pre-eclampsia
4illness_v2_v2_v2___4Thyroid disease
5illness_v2_v2_v2___5pre-existing medical conditions such as heart disease, kidney disease, or epilepsy
6illness_v2_v2_v2___6Allergy
7illness_v2_v2_v2___7TB
8illness_v2_v2_v2___8HIV
9illness_v2_v2_v2___9Fever with rash
10illness_v2_v2_v2___10Severe Anemia / Hb less than 7 g/dl
11illness_v2_v2_v2___11Excessive bleeding (antepartum)
12illness_v2_v2_v2___12Others
214 [specify_illness_v2_v2_v2]
Show the field ONLY if:
[illness_v2_v2_v2(12)] = '1'
Specify text, Required
215 [anc_details_v2_v2_v2] ANC details descriptive
216 [registered_with_health_facili_v2_v2_v2] Have you registered with any health facility for ANC during this pregnancy?
 yesno, Required
1Yes
0No
217 [no_of_anc_visits_done_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2] = '1'
No. of ANC visits done till now
text (integer), Required
218 [type_of_facility_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
219 [other_health_facility_v2_v2_v2]
Show the field ONLY if:
[type_of_facility_v2_v2_v2] = '4'
Other text, Required
220 [month_preg_in_anc_done_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2] = '1'
In which month of your pregnancy did you have the first ANC visit (for your current pregnancy)?
text (integer), Required
221 [most_recent_anc_v2_v2_v2] When was your most recent ANC visit?




 radio, Required
1Less than 1 week ago
2Between 2-4 weeks ago
3More than 1 month ago
4Never had an ANC visit
5Others specify
222 [other_recent_anc_v2_v2_v2]
Show the field ONLY if:
[most_recent_anc_v2_v2_v2] = '5'
Other text, Required
223 [clinical_tests_conducted_i_v2_v2_v2] Clinical Tests Conducted in the ANC visit descriptive
224 [height_checked_v2_v2_v2] Height checked yesno, Required
1Yes
0No
225 [were_you_informed_about_th_v2_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
226 [value_of_height_in_cm_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_th_v2_v2_v2] = '1'
Value of height in cm
text (number), Required
227 [any_hrp_complication_ht_v2_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
228 [medicines_treatment_provid_ht_v2_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
229 [referred_hrp_ht_v2_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
230 [weight_checked_v2_v2_v2] Weight Checked yesno, Required
1Yes
0No
231 [informed_about_wt_v2_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2_v2] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
232 [value_wt_v2_v2_v2]
Show the field ONLY if:
[informed_about_wt_v2_v2_v2] = '1'
Value in Kg text (integer), Required
233 [was_any_hrp_complication_i_v2_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
234 [medicines_treatment_provid_wt_v2_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
235 [referred_wt_v2_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
236 [blood_pressure_v2_v2_v2] Blood Pressure checked yesno, Required
1Yes
0No
237 [were_you_informed_about_bp_v2_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2_v2] = '1'
Were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
238 [value_bp_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_bp_v2_v2_v2] = '1'
Value
text, Required
239 [hrp_complication_bp_v2_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
240 [medicines_treatment_provid_bp_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
241 [referred_bp_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
242 [abdominal_check_up_v2_v2_v2] Abdominal check up
yesno, Required
1Yes
0No
243 [were_you_informed_abdomin_v2_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2_v2] = '1'
were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
244 [value_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_abdomin_v2_v2_v2] = '1'
Value text, Required
245 [hrp_complication_abdomin_v2_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
246 [medicines_treatment_abdomin_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
247 [referred_abdomin_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
248 [investigation_done_in_the_v2_v2_v2] Investigation done in the ANC visit descriptive
249 [hemoglobin_v2_v2_v2] Hemoglobin
 yesno, Required
1Yes
0No
250 [were_you_informed_about_hb_v2_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
251 [value_hb_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_hb_v2_v2_v2] = '1'
Value text (number), Required
252 [hrp_complication_hb_v2_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
253 [medicines_hb_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
254 [referred_hb_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2_v2] = '1'
Referred yesno, Required
1Yes
0No
255 [blood_glucose_sugar_rbs_or_v2_v2_v2] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
256 [informed_rbs_v2_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
257 [value_rbs_v2_v2_v2]
Show the field ONLY if:
[informed_rbs_v2_v2_v2] = '1'
Value
text (integer), Required
258 [hrp_complication_rbs_v2_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
259 [medicines_treatment_rbs_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
260 [referred_rbs_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
261 [urine_test_v2_v2_v2] Urine Test
 yesno, Required
1Yes
0No
262 [were_you_informed_urne_v2_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
263 [hrp_complication_urn_v2_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
264 [medicines_treatment_urne_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
265 [referred_urn_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
266 [usg_v2_v2_v2] USG
 yesno, Required
1Yes
0No
267 [informed_about_usg_v2_v2_v2]
Show the field ONLY if:
[usg_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
268 [hrp_complication_usg_v2_v2_v2]
Show the field ONLY if:
[usg_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
269 [medicines_treatment_usg_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
270 [referred_usg_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
271 [danger_signs_v2_v2_v2] Danger Signs descriptive
272 [did_you_experience_any_of_v2_v2_v2] "Did you experience any of the following danger signs during anytime of the pregnancy? checkbox, Required
1did_you_experience_any_of_v2_v2_v2___1Vaginal Bleeding
2did_you_experience_any_of_v2_v2_v2___2Severe Headaches
3did_you_experience_any_of_v2_v2_v2___3Blurred Vision
4did_you_experience_any_of_v2_v2_v2___4Reduced fetal movements
5did_you_experience_any_of_v2_v2_v2___5Excessive swelling in face or hands or feet
6did_you_experience_any_of_v2_v2_v2___6Convulsions
7did_you_experience_any_of_v2_v2_v2___7Fever
8did_you_experience_any_of_v2_v2_v2___8Severe Abdominal Pain
9did_you_experience_any_of_v2_v2_v2___9Dizziness and Lightheadedness
10did_you_experience_any_of_v2_v2_v2___10Fatigue and Weakness
11did_you_experience_any_of_v2_v2_v2___11Fast or difficult Breathing/shortness of breath
12did_you_experience_any_of_v2_v2_v2___12No
13did_you_experience_any_of_v2_v2_v2___13Any other
273 [specify_dangersign_v2_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2_v2(13)] = '1'
Specify text, Required
274 [if_experienced_any_danger_v2_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2_v2(1)] = '1' OR [did_you_experience_any_of_v2_v2_v2(2)] = '1' OR [did_you_experience_any_of_v2_v2_v2(3)] = '1' OR [did_you_experience_any_of_v2_v2_v2(4)] = '1' OR [did_you_experience_any_of_v2_v2_v2(5)] = '1' OR [did_you_experience_any_of_v2_v2_v2(6)] = '1' OR [did_you_experience_any_of_v2_v2_v2(7)] = '1' OR [did_you_experience_any_of_v2_v2_v2(8)] = '1' OR [did_you_experience_any_of_v2_v2_v2(9)] = '1' OR [did_you_experience_any_of_v2_v2_v2(10)] = '1' OR [did_you_experience_any_of_v2_v2_v2(11)] = '1' or [did_you_experience_any_of_v2_v2_v2(13)] = '1'
If experienced any danger sign, how did you manage it? radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 275 [form_5th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:Form 6th month(form_6th_month) Enabled as survey
276 [name_of_interviwer_v2_v2_v2_v2] Name of Interviwer text, Required
Field Annotation: @APPUSERNAME-APP
277 [date_of_survey_v2_v2_v2_v2] Date of survey
text (date_dmy), Required
Field Annotation: @TODAY-UTC
278 [rch_id_v2_v2_v2_v2] RCH id (to be given by ASHA)
 text (number), Required
279 [name_of_the_mother_v2_v2_v2_v2] Name of pregnant women
text, Required
280 [name_of_spouse_v2_v2_v2_v2] Name of spouse
 text, Required
281 [phone_number_pg_v2_v2_v2_v2] Phone Number of pregnant women text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
282 [phone_number_2_v2_v2_v2_v2] Phone number of the pregnant woman's husband
if second no is not available (9999999999)
 text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
283 [phone_number_of_the_pregna_v2_v2_v2_v2] Phone number of the pregnant woman which can be used to contact her
(other than her husband's number)
not available then enter 9999999999
 text (number, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
284 [b_preferred_time_of_the_da_v2_v2_v2_v2] B. Preferred time of the day to contact the woman. text, Required
285 [age_in_years_v2_v2_v2_v2] Age (in years)
 text (number), Required
286 [lmp_v2_v2_v2_v2] LMP
 text (date_dmy), Required
287 [edd_v2_v2_v2_v2] EDD
 text (date_dmy), Required
288 [gestational_age_in_weeks_v2_v2_v2_v2] Gestational age (in weeks)When ANC for your 7th month of pregnancy was received / due text (integer), Required
289 [gravida_v2_v2_v2_v2] Gravida
 text (integer), Required
290 [parity_v2_v2_v2_v2] Parity
 text (number), Required
291 [living_v2_v2_v2_v2] No of children living text (integer), Required
292 [type_of_resident_v2_v2_v2_v2] Type of resident radio, Required
1Permanent
2Migrant (long term - more than a year - from other state)
3Migrant (short term - less than 6 months - from other state)
293 [previous_pregnancy_history_v2_v2_v2_v2] Previous Pregnancy History descriptive
294 [previous_history_of_stillb_v2_v2_v2_v2] Previous history of stillbirth
 yesno, Required
1Yes
0No
295 [count_stillbirth_v2_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_stillb_v2_v2_v2_v2] = '1'
specify the count text (integer), Required
296 [previous_history_of_neonat_v2_v2_v2_v2] Previous history of Neonatal death
 yesno, Required
1Yes
0No
297 [count_neonatal_v2_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_neonat_v2_v2_v2_v2] = '1'
Specify the count text (number), Required
298 [history_of_aborti_v2_v2_v2_v2] Previous history of Abortions
 yesno, Required
1Yes
0No
299 [count_aborstion_v2_v2_v2_v2]
Show the field ONLY if:
[history_of_aborti_v2_v2_v2_v2]="1"
specify the count text (integer), Required
300 [previous_history_of_lscs_v2_v2_v2_v2] Previous history of LSCS
 yesno, Required
1Yes
0No
301 [count_lscs_v2_v2_v2_v2]
Show the field ONLY if:
[previous_history_of_lscs_v2_v2_v2_v2] = '1'
specify the count text (number), Required
302 [history_of_any_illness_at_v2_v2_v2_v2] History of any illness at any time during previous pregnancy
yesno, Required
1Yes
0No
303 [illness_v2_v2_v2_v2]
Show the field ONLY if:
[history_of_any_illness_at_v2_v2_v2_v2] = '1'
What was the illness? (Multiple responses are possible) checkbox, Required
1illness_v2_v2_v2_v2___1Diabetes
2illness_v2_v2_v2_v2___2Hypertension
3illness_v2_v2_v2_v2___3Eclampsia/ Pre-eclampsia
4illness_v2_v2_v2_v2___4Thyroid disease
5illness_v2_v2_v2_v2___5pre-existing medical conditions such as heart disease, kidney disease, or epilepsy
6illness_v2_v2_v2_v2___6Allergy
7illness_v2_v2_v2_v2___7TB
8illness_v2_v2_v2_v2___8HIV
9illness_v2_v2_v2_v2___9Fever with rash
10illness_v2_v2_v2_v2___10Severe Anemia / Hb less than 7 g/dl
11illness_v2_v2_v2_v2___11Excessive bleeding (antepartum)
12illness_v2_v2_v2_v2___12Others
304 [specify_illness_v2_v2_v2_v2]
Show the field ONLY if:
[illness_v2_v2_v2_v2(12)] = '1'
Specify text, Required
305 [anc_details_v2_v2_v2_v2] ANC details descriptive
306 [registered_with_health_facili_v2_v2_v2_v2] Have you registered with any health facility for ANC during this pregnancy?
 yesno, Required
1Yes
0No
307 [no_of_anc_visits_done_v2_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2_v2] = '1'
No. of ANC visits done till now
text (integer), Required
308 [type_of_facility_v2_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2_v2] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
309 [other_health_facility_v2_v2_v2_v2]
Show the field ONLY if:
[type_of_facility_v2_v2_v2_v2] = '4'
Other text, Required
310 [month_preg_in_anc_done_v2_v2_v2_v2]
Show the field ONLY if:
[registered_with_health_facili_v2_v2_v2_v2] = '1'
In which month of your pregnancy did you have the first ANC visit (for your current pregnancy)?
text (integer), Required
311 [most_recent_anc_v2_v2_v2_v2] When was your most recent ANC visit?




 radio, Required
1Less than 1 week ago
2Between 2-4 weeks ago
3More than 1 month ago
4Never had an ANC visit
5Others specify
312 [other_recent_anc_v2_v2_v2_v2]
Show the field ONLY if:
[most_recent_anc_v2_v2_v2_v2] = '5'
Other text, Required
313 [clinical_tests_conducted_i_v2_v2_v2_v2] Clinical Tests Conducted in the ANC visit descriptive
314 [height_checked_v2_v2_v2_v2] Height checked yesno, Required
1Yes
0No
315 [were_you_informed_about_th_v2_v2_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
316 [value_of_height_in_cm_v2_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_th_v2_v2_v2_v2] = '1'
Value of height in cm
text (number), Required
317 [any_hrp_complication_ht_v2_v2_v2_v2]
Show the field ONLY if:
[height_checked_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
318 [medicines_treatment_provid_ht_v2_v2_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
319 [referred_hrp_ht_v2_v2_v2_v2]
Show the field ONLY if:
[any_hrp_complication_ht_v2_v2_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
320 [weight_checked_v2_v2_v2_v2] Weight Checked yesno, Required
1Yes
0No
321 [informed_about_wt_v2_v2_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2_v2_v2] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
322 [value_wt_v2_v2_v2_v2]
Show the field ONLY if:
[informed_about_wt_v2_v2_v2_v2] = '1'
Value in Kg text (integer), Required
323 [was_any_hrp_complication_i_v2_v2_v2_v2]
Show the field ONLY if:
[weight_checked_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
324 [medicines_treatment_provid_wt_v2_v2_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
325 [referred_wt_v2_v2_v2_v2]
Show the field ONLY if:
[was_any_hrp_complication_i_v2_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
326 [blood_pressure_v2_v2_v2_v2] Blood Pressure checked yesno, Required
1Yes
0No
327 [were_you_informed_about_bp_v2_v2_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2_v2_v2] = '1'
Were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
328 [value_bp_v2_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_bp_v2_v2_v2_v2] = '1'
Value
text, Required
329 [hrp_complication_bp_v2_v2_v2_v2]
Show the field ONLY if:
[blood_pressure_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
330 [medicines_treatment_provid_bp_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
331 [referred_bp_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_bp_v2_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
332 [abdominal_check_up_v2_v2_v2_v2] Abdominal check up
yesno, Required
1Yes
0No
333 [were_you_informed_abdomin_v2_v2_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2_v2_v2] = '1'
were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
334 [value_v2_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_abdomin_v2_v2_v2_v2] = '1'
Value text, Required
335 [hrp_complication_abdomin_v2_v2_v2_v2]
Show the field ONLY if:
[abdominal_check_up_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
336 [medicines_treatment_abdomin_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
337 [referred_abdomin_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_abdomin_v2_v2_v2_v2] = '1'
Referred
 yesno, Required
1Yes
0No
338 [investigation_done_in_the_v2_v2_v2_v2] Investigation done in the ANC visit descriptive
339 [hemoglobin_v2_v2_v2_v2] Hemoglobin
 yesno, Required
1Yes
0No
340 [were_you_informed_about_hb_v2_v2_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
341 [value_hb_v2_v2_v2_v2]
Show the field ONLY if:
[were_you_informed_about_hb_v2_v2_v2_v2] = '1'
Value text (number), Required
342 [hrp_complication_hb_v2_v2_v2_v2]
Show the field ONLY if:
[hemoglobin_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
343 [medicines_hb_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
344 [referred_hb_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_hb_v2_v2_v2_v2] = '1'
Referred yesno, Required
1Yes
0No
345 [blood_glucose_sugar_rbs_or_v2_v2_v2_v2] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
346 [informed_rbs_v2_v2_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
347 [value_rbs_v2_v2_v2_v2]
Show the field ONLY if:
[informed_rbs_v2_v2_v2_v2] = '1'
Value
text (integer), Required
348 [hrp_complication_rbs_v2_v2_v2_v2]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
349 [medicines_treatment_rbs_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
350 [referred_rbs_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_rbs_v2_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
351 [urine_test_v2_v2_v2_v2] Urine Test
 yesno, Required
1Yes
0No
352 [were_you_informed_urne_v2_v2_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
353 [hrp_complication_urn_v2_v2_v2_v2]
Show the field ONLY if:
[urine_test_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
354 [medicines_treatment_urne_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
355 [referred_urn_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_urn_v2_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
356 [usg_v2_v2_v2_v2] USG
 yesno, Required
1Yes
0No
357 [informed_about_usg_v2_v2_v2_v2]
Show the field ONLY if:
[usg_v2_v2_v2_v2] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
358 [hrp_complication_usg_v2_v2_v2_v2]
Show the field ONLY if:
[usg_v2_v2_v2_v2] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
359 [medicines_treatment_usg_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2_v2_v2] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
360 [referred_usg_v2_v2_v2_v2]
Show the field ONLY if:
[hrp_complication_usg_v2_v2_v2_v2] = '1'
Referred
yesno, Required
1Yes
0No
361 [danger_signs_v2_v2_v2_v2] Danger Signs descriptive
362 [did_you_experience_any_of_v2_v2_v2_v2] "Did you experience any of the following danger signs during anytime of the pregnancy? checkbox, Required
1did_you_experience_any_of_v2_v2_v2_v2___1Vaginal Bleeding
2did_you_experience_any_of_v2_v2_v2_v2___2Severe Headaches
3did_you_experience_any_of_v2_v2_v2_v2___3Blurred Vision
4did_you_experience_any_of_v2_v2_v2_v2___4Reduced fetal movements
5did_you_experience_any_of_v2_v2_v2_v2___5Excessive swelling in face or hands or feet
6did_you_experience_any_of_v2_v2_v2_v2___6Convulsions
7did_you_experience_any_of_v2_v2_v2_v2___7Fever
8did_you_experience_any_of_v2_v2_v2_v2___8Severe Abdominal Pain
9did_you_experience_any_of_v2_v2_v2_v2___9Dizziness and Lightheadedness
10did_you_experience_any_of_v2_v2_v2_v2___10Fatigue and Weakness
11did_you_experience_any_of_v2_v2_v2_v2___11Fast or difficult Breathing/shortness of breath
12did_you_experience_any_of_v2_v2_v2_v2___12No
13did_you_experience_any_of_v2_v2_v2_v2___13Any other
363 [specify_dangersign_v2_v2_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2_v2_v2(13)] = '1'
Specify text, Required
364 [if_experienced_any_danger_v2_v2_v2_v2]
Show the field ONLY if:
[did_you_experience_any_of_v2_v2_v2_v2(1)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(2)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(3)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(4)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(5)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(6)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(7)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(8)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(9)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(10)] = '1' OR [did_you_experience_any_of_v2_v2_v2_v2(11)] = '1' or [did_you_experience_any_of_v2_v2_v2_v2(13)] = '1'
If experienced any danger sign, how did you manage it? radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 365 [form_6th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:Form 7th Month(form_7th_month) Enabled as survey
366 [name_of_interviwer] Name of Interviwer text, Required
Field Annotation: @APPUSERNAME-APP
367 [date_of_survey] Date of survey
text (date_dmy), Required
Field Annotation: @TODAY-UTC
368 [rch_id] RCH id (to be given by ASHA)
 text (number), Required
369 [name_of_the_mother] Name of pregnant women
text, Required
370 [name_of_spouse] Name of spouse
 text, Required
371 [phone_number_pg] Phone Number of pregnant women text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
372 [phone_number_2] Phone number of the pregnant woman's husband
if second no is not available (9999999999)
 text (integer, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
373 [phone_number_of_the_pregna] Phone number of the pregnant woman which can be used to contact her
(other than her husband's number)
not available then enter 9999999999
 text (number, Min: 5555555555, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
374 [b_preferred_time_of_the_da] B. Preferred time of the day to contact the woman. text, Required
375 [age_in_years] Age (in years)
 text (number), Required
376 [lmp] LMP
 text (date_dmy), Required
377 [edd] EDD
 text (date_dmy), Required
378 [gestational_age_in_weeks] Gestational age (in weeks)When ANC for your 7th month of pregnancy was received / due text (integer), Required
379 [gravida] Gravida
 text (integer), Required
380 [parity] Parity
 text (number), Required
381 [living] No of children living text (integer), Required
382 [type_of_resident] Type of resident radio, Required
1Permanent
2Migrant (long term - more than a year - from other state)
3Migrant (short term - less than 6 months - from other state)
383 [previous_pregnancy_history] Previous Pregnancy History descriptive
384 [previous_history_of_stillb] Previous history of stillbirth
 yesno, Required
1Yes
0No
385 [count_stillbirth]
Show the field ONLY if:
[previous_history_of_stillb] = '1'
specify the count text (integer), Required
386 [previous_history_of_neonat] Previous history of Neonatal death
 yesno, Required
1Yes
0No
387 [count_neonatal]
Show the field ONLY if:
[previous_history_of_neonat] = '1'
Specify the count text (number), Required
388 [history_of_aborti] Previous history of Abortions
 yesno, Required
1Yes
0No
389 [count_aborstion]
Show the field ONLY if:
[history_of_aborti]="1"
specify the count text (integer), Required
390 [previous_history_of_lscs] Previous history of LSCS
 yesno, Required
1Yes
0No
391 [count_lscs]
Show the field ONLY if:
[previous_history_of_lscs] = '1'
specify the count text (number), Required
392 [history_of_any_illness_at] History of any illness at any time during previous pregnancy
yesno, Required
1Yes
0No
393 [illness]
Show the field ONLY if:
[history_of_any_illness_at] = '1'
What was the illness? (Multiple responses are possible) checkbox, Required
1illness___1Diabetes
2illness___2Hypertension
3illness___3Eclampsia/ Pre-eclampsia
4illness___4Thyroid disease
5illness___5pre-existing medical conditions such as heart disease, kidney disease, or epilepsy
6illness___6Allergy
7illness___7TB
8illness___8HIV
9illness___9Fever with rash
10illness___10Severe Anemia / Hb less than 7 g/dl
11illness___11Excessive bleeding (antepartum)
12illness___12Others
394 [specify_illness]
Show the field ONLY if:
[illness(12)] = '1'
Specify text, Required
395 [anc_details] ANC details descriptive
396 [registered_with_health_facili] Have you registered with any health facility for ANC during this pregnancy?
 yesno, Required
1Yes
0No
397 [no_of_anc_visits_done]
Show the field ONLY if:
[registered_with_health_facili] = '1'
No. of ANC visits done till now
text (integer), Required
398 [type_of_facility]
Show the field ONLY if:
[registered_with_health_facili] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
399 [other_health_facility]
Show the field ONLY if:
[type_of_facility] = '4'
Other text, Required
400 [month_preg_in_anc_done]
Show the field ONLY if:
[registered_with_health_facili] = '1'
In which month of your pregnancy did you have the first ANC visit (for your current pregnancy)?
text (integer), Required
401 [most_recent_anc] When was your most recent ANC visit?




 radio, Required
1Less than 1 week ago
2Between 2-4 weeks ago
3More than 1 month ago
4Never had an ANC visit
5Others specify
402 [other_recent_anc]
Show the field ONLY if:
[most_recent_anc] = '5'
Other text, Required
403 [clinical_tests_conducted_i] Clinical Tests Conducted in the ANC visit descriptive
404 [height_checked] Height checked yesno, Required
1Yes
0No
405 [were_you_informed_about_th]
Show the field ONLY if:
[height_checked] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
406 [value_of_height_in_cm]
Show the field ONLY if:
[were_you_informed_about_th] = '1'
Value of height in cm
text (number), Required
407 [any_hrp_complication_ht]
Show the field ONLY if:
[height_checked] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
408 [medicines_treatment_provid_ht]
Show the field ONLY if:
[any_hrp_complication_ht] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
409 [referred_hrp_ht]
Show the field ONLY if:
[any_hrp_complication_ht] = '1'
Referred
 yesno, Required
1Yes
0No
410 [weight_checked] Weight Checked yesno, Required
1Yes
0No
411 [informed_about_wt]
Show the field ONLY if:
[weight_checked] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
412 [value_wt]
Show the field ONLY if:
[informed_about_wt] = '1'
Value in Kg text (integer), Required
413 [was_any_hrp_complication_i]
Show the field ONLY if:
[weight_checked] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
414 [medicines_treatment_provid_wt]
Show the field ONLY if:
[was_any_hrp_complication_i] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
415 [referred_wt]
Show the field ONLY if:
[was_any_hrp_complication_i] = '1'
Referred
yesno, Required
1Yes
0No
416 [blood_pressure] Blood Pressure checked yesno, Required
1Yes
0No
417 [were_you_informed_about_bp]
Show the field ONLY if:
[blood_pressure] = '1'
Were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
418 [value_bp]
Show the field ONLY if:
[were_you_informed_about_bp] = '1'
Value
text, Required
419 [hrp_complication_bp]
Show the field ONLY if:
[blood_pressure] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
420 [medicines_treatment_provid_bp]
Show the field ONLY if:
[hrp_complication_bp] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
421 [referred_bp]
Show the field ONLY if:
[hrp_complication_bp] = '1'
Referred
yesno, Required
1Yes
0No
422 [abdominal_check_up] Abdominal check up
yesno, Required
1Yes
0No
423 [were_you_informed_abdomin]
Show the field ONLY if:
[abdominal_check_up] = '1'
were you informed about the result? (Skip if Not checked)
 yesno, Required
1Yes
0No
424 [value]
Show the field ONLY if:
[were_you_informed_abdomin] = '1'
Value text, Required
425 [hrp_complication_abdomin]
Show the field ONLY if:
[abdominal_check_up] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
426 [medicines_treatment_abdomin]
Show the field ONLY if:
[hrp_complication_abdomin] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
427 [referred_abdomin]
Show the field ONLY if:
[hrp_complication_abdomin] = '1'
Referred
 yesno, Required
1Yes
0No
428 [investigation_done_in_the] Investigation done in the ANC visit descriptive
429 [hemoglobin] Hemoglobin
 yesno, Required
1Yes
0No
430 [were_you_informed_about_hb]
Show the field ONLY if:
[hemoglobin] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
431 [value_hb]
Show the field ONLY if:
[were_you_informed_about_hb] = '1'
Value text (number), Required
432 [hrp_complication_hb]
Show the field ONLY if:
[hemoglobin] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
433 [medicines_hb]
Show the field ONLY if:
[hrp_complication_hb] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
434 [referred_hb]
Show the field ONLY if:
[hrp_complication_hb] = '1'
Referred yesno, Required
1Yes
0No
435 [blood_glucose_sugar_rbs_or] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
436 [informed_rbs]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
437 [value_rbs]
Show the field ONLY if:
[informed_rbs] = '1'
Value
text (integer), Required
438 [hrp_complication_rbs]
Show the field ONLY if:
[blood_glucose_sugar_rbs_or] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
439 [medicines_treatment_rbs]
Show the field ONLY if:
[hrp_complication_rbs] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
440 [referred_rbs]
Show the field ONLY if:
[hrp_complication_rbs] = '1'
Referred
yesno, Required
1Yes
0No
441 [urine_test] Urine Test
 yesno, Required
1Yes
0No
442 [were_you_informed_urne]
Show the field ONLY if:
[urine_test] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
443 [hrp_complication_urn]
Show the field ONLY if:
[urine_test] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
444 [medicines_treatment_urne]
Show the field ONLY if:
[hrp_complication_urn] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
445 [referred_urn]
Show the field ONLY if:
[hrp_complication_urn] = '1'
Referred
yesno, Required
1Yes
0No
446 [usg] USG
 yesno, Required
1Yes
0No
447 [informed_about_usg]
Show the field ONLY if:
[usg] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
448 [hrp_complication_usg]
Show the field ONLY if:
[usg] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
449 [medicines_treatment_usg]
Show the field ONLY if:
[hrp_complication_usg] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
450 [referred_usg]
Show the field ONLY if:
[hrp_complication_usg] = '1'
Referred
yesno, Required
1Yes
0No
451 [danger_signs] Danger Signs descriptive
452 [did_you_experience_any_of] "Did you experience any of the following danger signs during anytime of the pregnancy? checkbox, Required
1did_you_experience_any_of___1Vaginal Bleeding
2did_you_experience_any_of___2Severe Headaches
3did_you_experience_any_of___3Blurred Vision
4did_you_experience_any_of___4Reduced fetal movements
5did_you_experience_any_of___5Excessive swelling in face or hands or feet
6did_you_experience_any_of___6Convulsions
7did_you_experience_any_of___7Fever
8did_you_experience_any_of___8Severe Abdominal Pain
9did_you_experience_any_of___9Dizziness and Lightheadedness
10did_you_experience_any_of___10Fatigue and Weakness
11did_you_experience_any_of___11Fast or difficult Breathing/shortness of breath
12did_you_experience_any_of___12No
13did_you_experience_any_of___13Any other
453 [specify_dangersign]
Show the field ONLY if:
[did_you_experience_any_of(13)] = '1'
Specify text, Required
454 [if_experienced_any_danger]
Show the field ONLY if:
[did_you_experience_any_of(1)] = '1' OR [did_you_experience_any_of(2)] = '1' OR [did_you_experience_any_of(3)] = '1' OR [did_you_experience_any_of(4)] = '1' OR [did_you_experience_any_of(5)] = '1' OR [did_you_experience_any_of(6)] = '1' OR [did_you_experience_any_of(7)] = '1' OR [did_you_experience_any_of(8)] = '1' OR [did_you_experience_any_of(9)] = '1' OR [did_you_experience_any_of(10)] = '1' OR [did_you_experience_any_of(11)] = '1' or [did_you_experience_any_of(13)] = '1'
If experienced any danger sign, how did you manage it? radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 455 [form_7th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:8th month(st_followup_form_8th_month) Enabled as survey
456 [date_of_survey_eight] Date of survey
text (date_dmy), Required
Field Annotation: @NOW
457 [name_of_interviwer_eight] Name of interviwer text
Field Annotation: @APPUSERNAME-APP
458 [name_of_pregnant_women_et] Name of pregnant women text, Required
459 [name_of_spouse_eight] Name of spouse text, Required
460 [rch_id_eight] RCH id text
461 [phone_number_eight_one] Phone number pregnant women 1 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
462 [phone_number_eight_one_2] Phone number pregnant women 2
if second no is not available (9999999999)
 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
463 [anc_details_eight] ANC details descriptive
464 [gestational_age_in_eight] Gestational age (in weeks)When ANC for your 8th month of pregnancy was received / due text (number), Required
465 [anc_visit_mnth_eight] Did you have an ANC visit for this month?




 radio, Required
1Yes
2Could not go
3Did not think it was needed
4Didn't know it was due
5other reasons
466 [reason_anc_vst_eight]
Show the field ONLY if:
[anc_visit_mnth_eight] = '5'
Reason text, Required
467 [date_of_anc_visit_eight]
Show the field ONLY if:
[anc_visit_mnth_eight] = '1'
Date of ANC visit
 text (date_dmy), Required
468 [type_of_facility_eight]
Show the field ONLY if:
[anc_visit_mnth_eight] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
469 [other_plc_anc_vst_eight]
Show the field ONLY if:
[type_of_facility_eight] = '4'
Other text, Required
470 [clinical_tests_conducted_eight] Clinical Tests Conducted in the ANC visit descriptive
471 [weight_ckd_eight] Weight Checked
 yesno, Required
1Yes
0No
472 [informed_abt_wt_eight]
Show the field ONLY if:
[weight_ckd_eight] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
473 [value_wt_eight]
Show the field ONLY if:
[informed_abt_wt_eight] = '1'
Value in Kg text (integer), Required
474 [hrp_complication_wt_eight]
Show the field ONLY if:
[weight_ckd_eight] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
475 [medicines_treat_wt_et]
Show the field ONLY if:
[hrp_complication_wt_eight] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
476 [referred_wt_et]
Show the field ONLY if:
[hrp_complication_wt_eight] = '1'
Referred
 yesno, Required
1Yes
0No
477 [bp_ckd_et] Blood Pressure Checked yesno, Required
1Yes
0No
478 [informed_abt_bp_et]
Show the field ONLY if:
[bp_ckd_et] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
479 [value_bp_et]
Show the field ONLY if:
[informed_abt_bp_et] = '1'
Value blood pressure text, Required
480 [hrp_complication_bp_et]
Show the field ONLY if:
[bp_ckd_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
481 [medicines_provid_bp_et]
Show the field ONLY if:
[hrp_complication_bp_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
482 [referred_bp_et]
Show the field ONLY if:
[hrp_complication_bp_et] = '1'
Referred yesno, Required
1Yes
0No
483 [abdominal_check_up_et] Abdominal check up done
 yesno, Required
1Yes
0No
484 [informed_abt_abd_et]
Show the field ONLY if:
[abdominal_check_up_et] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
485 [value_abd_et]
Show the field ONLY if:
[informed_abt_abd_et] = '1'
Value
text, Required
486 [hrp_complication_abd_et]
Show the field ONLY if:
[abdominal_check_up_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
487 [medicines_treatment_abd_et]
Show the field ONLY if:
[hrp_complication_abd_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
488 [referred_abd_et]
Show the field ONLY if:
[abdominal_check_up_et] = '1'
Referred yesno, Required
1Yes
0No
489 [investigation_done_in_et] Investigation done in the ANC visit descriptive
490 [hb_et] Hemoglobin
 yesno, Required
1Yes
0No
491 [informed_abt_hb_et]
Show the field ONLY if:
[hb_et] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
492 [value_hb_et]
Show the field ONLY if:
[informed_abt_hb_et] = '1'
Value
text (integer), Required
493 [hrp_complication_hb_et]
Show the field ONLY if:
[hb_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
494 [medicines_treatment_hb_et]
Show the field ONLY if:
[hrp_complication_hb_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
495 [referred_hb_et]
Show the field ONLY if:
[hrp_complication_hb_et] = '1'
Referred yesno, Required
1Yes
0No
496 [rbs_et] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
497 [informed_abt_rbs_et]
Show the field ONLY if:
[rbs_et] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
498 [value_rbs_et]
Show the field ONLY if:
[informed_abt_rbs_et] = '1'
Value text (number), Required
499 [hrp_complication_rbs_et]
Show the field ONLY if:
[rbs_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
500 [medicines_provid_rbs_et]
Show the field ONLY if:
[hrp_complication_rbs_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
501 [referred_rbs_et]
Show the field ONLY if:
[hrp_complication_rbs_et] = '1'
Referred yesno, Required
1Yes
0No
502 [urine_et] Urine Test
 yesno, Required
1Yes
0No
503 [informed_abt_urin_et]
Show the field ONLY if:
[urine_et] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
504 [hrp_complication_urn_et]
Show the field ONLY if:
[urine_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
505 [medicines_treat_urn_et]
Show the field ONLY if:
[hrp_complication_urn_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
506 [referred_urn_et]
Show the field ONLY if:
[medicines_treat_urn_et] = '1'
Referred yesno, Required
1Yes
0No
507 [usg_et] USG is done yesno, Required
1Yes
0No
508 [informed_about_usg_et]
Show the field ONLY if:
[usg_et] = '1'
Were you informed about the result? yesno, Required
1Yes
0No
509 [hrp_complication_usg_et]
Show the field ONLY if:
[usg_et] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
510 [medicines_treatment_usg_et]
Show the field ONLY if:
[hrp_complication_usg_et] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
511 [referred_usg_et]
Show the field ONLY if:
[hrp_complication_usg_et] = '1'
Referred yesno, Required
1Yes
0No
512 [danger_signs_et] Danger Signs descriptive
513 [danger_sign_et] "Did you experience any of the following danger signs anytime after the last interview?

(Multiple responses can be selected)"
 checkbox, Required
1danger_sign_et___1Vaginal Bleeding
2danger_sign_et___2Severe Headaches
3danger_sign_et___3Blurred Vision
4danger_sign_et___4Reduced fetal movements
5danger_sign_et___5Excessive swelling in face or hands or feet
6danger_sign_et___6Convulsions
7danger_sign_et___7Fever
8danger_sign_et___8Severe Abdominal Pain
9danger_sign_et___9Dizziness and Lightheadedness
10danger_sign_et___10Fatigue and Weakness
11danger_sign_et___11Fast or difficult Breathing/shortness of breath
12danger_sign_et___12No
13danger_sign_et___13Any other
514 [any_other_specify_et]
Show the field ONLY if:
[danger_sign_et(13)] = '1'
Any other specify text, Required
515 [mange_danger_et]
Show the field ONLY if:
[danger_sign_et(1)] = '1' OR [danger_sign_et(2)] = '1' OR [danger_sign_et(3)] = '1' OR [danger_sign_et(4)] = '1' OR [danger_sign_et(5)] = '1' OR [danger_sign_et(6)] = '1' OR [danger_sign_et(7)] = '1' OR [danger_sign_et(8)] = '1' OR [danger_sign_et(9)] = '1' OR [danger_sign_et(10)] = '1' OR [danger_sign_et(11)] = '1' OR [danger_sign_et(13)] = '1'
How did you manage it?



 radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 516 [st_followup_form_8th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:form 9th month(nd_followup_form_9th_month) Enabled as survey
517 [name_of_interviwer_9_th] Name of interviewer text, Required
Field Annotation: @APPUSERNAME-APP
518 [date_of_survey_9] Date of survey
text (date_dmy), Required
519 [pregnant_women_nineth] Name of pregnant women text, Required
520 [name_of_spouse_nine] Name of spouse text, Required
521 [rch_id_nine] RCH id (to be given by ASHA)
 text, Required
522 [mobile_no_nine] Phone number of pregnant women no 1 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
523 [mobile_no_nine_2] Phone number of pregnant women no 2
if second no is not available (9999999999)
 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
524 [anc_details_nine] ANC details descriptive, Required
525 [gestational_nine] Gestational age (in weeks)When ANC for your 9th month of pregnancy was received / due text (integer), Required
526 [anc_vst_nine] Did you have an ANC visit for this month?




 radio, Required
1Yes
2Could not go
3Did not think it was needed
4Didn't know it was due
5other reasons
527 [other_not_vst]
Show the field ONLY if:
[anc_vst_nine] = '5'
Other text, Required
528 [date_of_anc_visit_nine]
Show the field ONLY if:
[anc_vst_nine] = '1'
Date of ANC visit
 text (date_dmy), Required
529 [type_of_facility_nine]
Show the field ONLY if:
[anc_vst_nine] = '1'
Type of facility



 radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
530 [other_place_anc_vst_nine]
Show the field ONLY if:
[type_of_facility_nine] = '4'
Other text, Required
531 [clinical_tests_conduct_nine] Clinical Tests Conducted in the ANC visit descriptive
532 [weight_nine] Weight
 yesno, Required
1Yes
0No
533 [informed_about_wt_ni]
Show the field ONLY if:
[weight_nine] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
534 [value_wt_ni]
Show the field ONLY if:
[informed_about_wt_ni] = '1'
Value in kgs text (integer), Required
535 [hrp_complication_wt_nine]
Show the field ONLY if:
[weight_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
536 [medicines_treatmen_wt_nine]
Show the field ONLY if:
[hrp_complication_wt_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
537 [referred_wt_nine]
Show the field ONLY if:
[hrp_complication_wt_nine] = '1'
Referred
yesno, Required
1Yes
0No
538 [bp_checked_nine] Blood Pressure checked yesno, Required
1Yes
0No
539 [informed_abt_bp_nine]
Show the field ONLY if:
[bp_checked_nine] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
540 [value_bp_nine]
Show the field ONLY if:
[informed_abt_bp_nine] = '1'
Value
 text, Required
541 [hrp_complication_bp_nine]
Show the field ONLY if:
[bp_checked_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
542 [medicines_tret_bp_nine]
Show the field ONLY if:
[hrp_complication_bp_nine] = '1'
Medicines / treatment provided
 yesno, Required
1Yes
0No
543 [referred_bp_nine]
Show the field ONLY if:
[hrp_complication_bp_nine] = '1'
Referred
yesno, Required
1Yes
0No
544 [abdominal_check_up_done] Abdominal check up done
 yesno, Required
1Yes
0No
545 [informed_about_ad_nine]
Show the field ONLY if:
[abdominal_check_up_done] = '1'
Were you informed about the result?
yesno, Required
1Yes
0No
546 [value_ad_nine]
Show the field ONLY if:
[informed_about_ad_nine] = '1'
Value
 text, Required
547 [hrp_complication_ad_nine]
Show the field ONLY if:
[abdominal_check_up_done] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
548 [medicines_treatment_ab_nine]
Show the field ONLY if:
[hrp_complication_ad_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
549 [referred_ad_nine]
Show the field ONLY if:
[hrp_complication_ad_nine] = '1'
Referred
yesno, Required
1Yes
0No
550 [hb_nine] Hemoglobin
 yesno, Required
1Yes
0No
551 [informed_hb_nine]
Show the field ONLY if:
[hb_nine] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
552 [value_hb_nine]
Show the field ONLY if:
[informed_hb_nine] = '1'
Value
text (integer), Required
553 [hrp_complication_hb_nine]
Show the field ONLY if:
[hb_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
554 [medicines_treatment_ad_nine]
Show the field ONLY if:
[hrp_complication_hb_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
555 [referred_hb_nine]
Show the field ONLY if:
[hrp_complication_hb_nine] = '1'
Referred yesno
1Yes
0No
556 [rbs_nine] Blood Glucose/Sugar (RBS or fasting or OGTT)
 yesno, Required
1Yes
0No
557 [informed_abt_rbs_nine]
Show the field ONLY if:
[rbs_nine] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
558 [value_rbs_nine]
Show the field ONLY if:
[informed_abt_rbs_nine] = '1'
Value
text, Required
559 [hrp_complication_rbs_nine]
Show the field ONLY if:
[rbs_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
560 [medicines_treatment_rbs_nine]
Show the field ONLY if:
[hrp_complication_rbs_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
561 [referred_rbs_nine]
Show the field ONLY if:
[hrp_complication_rbs_nine] = '1'
Referred
 yesno, Required
1Yes
0No
562 [urine_nine] Urine Test
 yesno, Required
1Yes
0No
563 [informed_abt_urin_nine]
Show the field ONLY if:
[urine_nine] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
564 [hrp_complication_urine_nine]
Show the field ONLY if:
[urine_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
565 [medicines_urine_nine]
Show the field ONLY if:
[hrp_complication_urine_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
566 [referred_urine_nine]
Show the field ONLY if:
[hrp_complication_urine_nine] = '1'
Referred
 yesno, Required
1Yes
0No
567 [usg_nine] USG checked yesno, Required
1Yes
0No
568 [informed_abt_usg_nine]
Show the field ONLY if:
[usg_nine] = '1'
Were you informed about the result?
 yesno, Required
1Yes
0No
569 [hrp_complication_usg_nine]
Show the field ONLY if:
[usg_nine] = '1'
Was any HRP/complication identified based upon the test results?
 yesno, Required
1Yes
0No
570 [medicines_usg_nine]
Show the field ONLY if:
[hrp_complication_usg_nine] = '1'
Medicines/ treatment provided
 yesno, Required
1Yes
0No
571 [referred_usg_nine]
Show the field ONLY if:
[hrp_complication_usg_nine] = '1'
Referred
 yesno, Required
1Yes
0No
572 [danger_signs_nine] Danger Signs descriptive
573 [did_you_experience_nine] "Did you experience any of the following danger signs anytime after the last interview?

(Multiple responses can be selected)"





 checkbox, Required
1did_you_experience_nine___1Vaginal Bleeding
2did_you_experience_nine___2Severe Headaches
3did_you_experience_nine___3Blurred Vision
4did_you_experience_nine___4Reduced fetal movements
5did_you_experience_nine___5Excessive swelling in face or hands or feet
6did_you_experience_nine___6Convulsions
7did_you_experience_nine___7Fever
8did_you_experience_nine___8Severe Abdominal Pain
9did_you_experience_nine___9Dizziness and Lightheadedness
10did_you_experience_nine___10Fatigue and Weakness
11did_you_experience_nine___11Fast or difficult Breathing/shortness of breath
12did_you_experience_nine___12No
13did_you_experience_nine___13Any other
574 [any_other_specify_nine]
Show the field ONLY if:
[did_you_experience_nine(13)] = '1'
Any other, specify
 text, Required
575 [experia_any_danger_sig_nine]
Show the field ONLY if:
[did_you_experience_nine(1)] = '1' or [did_you_experience_nine(2)] = '1' or [did_you_experience_nine(3)] = '1' or [did_you_experience_nine(4)] = '1' or [did_you_experience_nine(5)] = '1' or [did_you_experience_nine(6)] = '1' or [did_you_experience_nine(6)] = '1' or [did_you_experience_nine(7)] = '1' or [did_you_experience_nine(8)] = '1' or [did_you_experience_nine(9)] = '1' or [did_you_experience_nine(10)] = '1' or [did_you_experience_nine(11)] = '1' or [did_you_experience_nine(13)] = '1'
Experienced any danger sign, how did you manage it?



 radio, Required
1At home
2Visited government facility
3Visited private facility
4Consulted religious practitioners
 
 576 [nd_followup_form_9th_month_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
Instrument:After delivery form(after_delivery_form) Enabled as survey
577 [date_of_survey_fnl] Date of survey
text (date_dmy), Required
578 [name_of_interviwer_final] Name of interviewer text, Required
Field Annotation: @APPUSERNAME-APP
579 [name_of_pregnant_women_fin] Name of pregnant women text, Required
580 [name_of_spouse_final] Name of spouse text, Required
581 [rch_id_final] RCH id text
582 [phone_number_final] Phone Number of pregnant women 1 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
583 [phone_number_final_2] Phone Number of pregnant women 2
if second no is not available (9999999999)
 text (number, Min: 3333333333, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
584 [maternal_outcome] Maternal outcome descriptive
585 [mother_s_current_status] Mother's current status

 radio, Required
1Live
2Dead
586 [relation_of_respondent]
Show the field ONLY if:
[mother_s_current_status] = '2'
Specify the relation of the respondent with the baby text, Required
587 [fetal_outcome] Fetal outcome descriptive
588 [delivery_date] What was the date of your delivery?
 text (date_dmy), Required
589 [type_of_facility_delivery] Type of facility where baby was delivered radio, Required
1Public/government facility
2Private facility
3Semi/aided facility
4Other
590 [other_place_delivery]
Show the field ONLY if:
[type_of_facility_delivery] = '4'
Other text, Required
591 [what_was_the_baby_s_sex] What was the baby's sex?
 radio, Required
1Male
2Female
592 [outcome_of_delivery] Outcome of Delivery

 radio, Required
1Live Birth
2Still birth
593 [current_status]
Show the field ONLY if:
[outcome_of_delivery] = '1'
current Status? radio, Required
1Live
2Dead
594 [the_date_of_death]
Show the field ONLY if:
[current_status] = '2'
The date of death?
 text (date_dmy), Required
595 [appearance_of_baby]
Show the field ONLY if:
[outcome_of_delivery] = '2'
How was the appearance of the baby?


 radio, Required
1Fresh
2Decomposed or macerated
3Don't know
596 [before_labour] Before labour descriptive, Required
597 [labor_induced] Was the labor induced or augmented (any medicine given to increase pain?)
 yesno, Required
1Yes
0No
598 [put_a_pressure_abdomen] Did anyone put a pressure on your abdomen during labour?
 yesno, Required
1Yes
0No
599 [gestational_age_at_labour] Gestational age at the time of delivery
 text (number), Required
600 [gestational_age_at]
Show the field ONLY if:
[gestational_age_at_labour] < 34
Ask if Gestational age at the time of labor < 34 weeks, any injection given to stop the pain (Antenatal corticosteroid)?

 yesno, Required
1Yes
0No
601 [how_many_times_was_the_inj]
Show the field ONLY if:
[gestational_age_at] = '1'
How many times was the injection given?

 radio, Required
1Specify
2Don't remember
602 [specify_number_inje]
Show the field ONLY if:
[how_many_times_was_the_inj] = '1'
Specify number text (integer), Required
603 [what_was_the_interval_betw]
Show the field ONLY if:
[gestational_age_at] = '1'
What was the interval between last dose of injection and delivery?
 radio, Required
1Specify
2Don't remember
604 [specify_in_minutes_or_hour]
Show the field ONLY if:
[what_was_the_interval_betw]='1'
Specify in minutes or hours text, Required
605 [during_labour_and_delivery] During labour and delivery descriptive
606 [where_was_the_baby_deliver] Where was the baby delivered?
 radio, Required
1Government Hospital
2Private Hospital
3Government-aided Hospital
4On route to hospital
5Home
6Others
607 [others_place_delivery]
Show the field ONLY if:
[where_was_the_baby_deliver] = '6'
Other text, Required
608 [how_was_the_baby_delivered] How was the baby delivered?



 radio, Required
1Normal vaginal delivery
2Assisted vaginal delivery
3Cesarean section
4Don't Know
609 [did_you_encounter_any_of_t] Did you encounter any of the following problems during labour?






 checkbox, Required
1did_you_encounter_any_of_t___1Convulsions
2did_you_encounter_any_of_t___2High blood pressure
3did_you_encounter_any_of_t___3Fever
4did_you_encounter_any_of_t___4Excessive bleeding
5did_you_encounter_any_of_t___5Cord around the child's neck
6did_you_encounter_any_of_t___6Others
7did_you_encounter_any_of_t___7No
610 [other_prblm_during_del]
Show the field ONLY if:
[did_you_encounter_any_of_t] = '6'
Other text, Required
 
 611 [after_delivery_form_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
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