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Facility Assessment Health and Wellness CenterPID 19
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 07/05/2025 1:38am
Field finder: — When viewing this page, collapse:
Data Dictionary Codebook
Facility Assessment Health and Wellness Center (PID: 19)
07/05/2025 1:38am
Instruments
Instrument Form Name
Form 1 form_1
# Variable / Field Name Field Label
Field Note
 Field Attributes (Field Type, Validation, Choices, Calculations, etc.)
Instrument:Form 1(form_1)
1 [record_id] Record ID text
2 [name_of_filed_officer] Name of field officer text
Field Annotation: @HIDEBUTTON @APPUSERNAME-APP
3 [sec_1] Section Header: Stillbirth Rate Reduction - Sangrur Facility Assessment - Health And Wellness Center (HWC) - Non 24/7 PHC - UPHC Section 1- GENERAL INFORMATION OF THE FACILITY descriptive
4 [date_asses] 1.1 Date of assessment: text (date_dmy), Required
5 [name_invest] 1.2 Name of the investigator: text, Required
6 [name_facili] 1.3 Name of the facility: text, Required
7 [type_facility] 1.4 Type of facility: radio, Required
824/7 PHC
9Non 24/7 PHC
10Health and Wellness Center / AAM
11Other
8 [oth_type]
Show the field ONLY if:
[type_facility] = '11'
1.4.1 Specify Other text, Required
9 [gps_crdnts] 1.6 GPS coordinates text
Field Annotation: @LATITUDE @LONGITUDE @READONLY @HIDEBUTTON
10 [district_name] Name of district dropdown
1Sangrur
2Other
11 [other_distict_name]
Show the field ONLY if:
[district_name] = '2'
Specify Other text
12 [name_taluk] 1.7 Name of the Taluk dropdown, Required
1Sangrur
2Sunam
3Dhuri
4Bhavanigarh
5Moonak
6Others
13 [other_taluk]
Show the field ONLY if:
[designatn_9] = '6'
Specify others text
14 [name_vlg] 1.8 Name of the village: text, Required
15 [dstnc_vlg] 1.9 Distance of the facility from village bus stand? in km text (number), Required
16 [catchment_popltn] 1.10 Catchment population: TOTAL :{total} SLUM :
{slum} 		descriptive
17 [total] Total : text (number), Required
18 [slum] Slum : text (number), Required
19 [tble_persnl] Section Header: SECTION 2- PERSONNEL INFORMATION descriptive
20 [name_stff] Name of the staff currently available text, Required
21 [gendr] Gender radio, Required
1Male
2Female
3Specify Other
22 [oth_gendr]
Show the field ONLY if:
[gendr] = '3'
Any other, Specify text, Required
23 [age] Age (years) text (number), Required
24 [designatn] Designation radio, Required
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
25 [oth_desgn]
Show the field ONLY if:
[designatn] = '6'
Other, Specify text, Required
26 [educ_qual] Educational Qualification: radio, Required
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
27 [edu_oth]
Show the field ONLY if:
[educ_qual] = '6'
other text, Required
28 [name_stff_1] Name of the staff currently available text, Required
29 [gendr_1] Gender radio, Required
1Male
2Female
3Specify Other
30 [oth_gendr_1]
Show the field ONLY if:
[gendr_1] = '3'
Any other, Specify text, Required
31 [age_1] Age (years) text (number), Required
32 [designatn_1] Designation radio, Required
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
33 [oth_desgn_1]
Show the field ONLY if:
[designatn_1] = '6'
Other, Specify text, Required
34 [educ_qual_1] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
35 [edu_oth_1]
Show the field ONLY if:
[educ_qual_1] = '6'
other text, Required
36 [name_stff_2] Name of the staff currently available text, Required
37 [gendr_2] Gender radio, Required
1Male
2Female
3Specify Other
38 [oth_gendr_2]
Show the field ONLY if:
[gendr_2] = '3'
Any other, Specify text, Required
39 [age_2] Age (years) text (number), Required
40 [designatn_2] Designation radio, Required
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
41 [oth_desgn_2]
Show the field ONLY if:
[designatn_2] = '6'
Other, Specify text, Required
42 [educ_qual_2] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
43 [edu_oth_2]
Show the field ONLY if:
[educ_qual_2] = '6'
other text
44 [name_stff_3] Name of the staff currently available text
45 [gendr_3] Gender radio
1Male
2Female
3Specify Other
46 [oth_gendr_3]
Show the field ONLY if:
[gendr_3] = '3'
Any other, Specify text
47 [age_3] Age (years) text (number)
48 [designatn_3] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
49 [oth_desgn_3]
Show the field ONLY if:
[designatn_3] = '6'
Other, Specify text
50 [educ_qual_3] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
51 [edu_oth_3]
Show the field ONLY if:
[educ_qual_3] = '6'
other text
52 [name_stff_4] Name of the staff currently available text
53 [gendr_4] Gender radio
1Male
2Female
3Specify Other
54 [oth_gendr_4]
Show the field ONLY if:
[gendr_4] = '3'
Any other, Specify text
55 [age_4] Age (years) text (number)
56 [designatn_4] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
57 [oth_desgn_4]
Show the field ONLY if:
[designatn_4] = '6'
Other, Specify text
58 [educ_qual_4] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
59 [edu_oth_4]
Show the field ONLY if:
[educ_qual_4] = '6'
other text
60 [name_stff_5] Name of the staff currently available text
61 [gendr_5] Gender radio
1Male
2Female
3Specify Other
62 [oth_gendr_5]
Show the field ONLY if:
[gendr_5] = '3'
Any other, Specify text
63 [age_5] Age (years) text (number)
64 [designatn_5] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
65 [oth_desgn_5]
Show the field ONLY if:
[designatn_5] = '6'
Other, Specify text
66 [educ_qual_5] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
67 [edu_oth_5]
Show the field ONLY if:
[educ_qual_5] = '6'
other text
68 [name_stff_6] Name of the staff currently available text
69 [gendr_6] Gender radio
1Male
2Female
3Specify Other
70 [oth_gendr_6]
Show the field ONLY if:
[gendr_6] = '3'
Any other, Specify text
71 [age_6] Age (years) text (number)
72 [designatn_6] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
73 [oth_desgn_6]
Show the field ONLY if:
[designatn_6] = '6'
Other, Specify text
74 [educ_qual_6] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
75 [edu_oth_6]
Show the field ONLY if:
[educ_qual_6] = '6'
other text
76 [name_stff_7] Name of the staff currently available text
77 [gendr_7] Gender radio
1Male
2Female
3Specify Other
78 [oth_gendr_7]
Show the field ONLY if:
[gendr_7] = '3'
Any other, Specify text
79 [age_7] Age (years) text (number)
80 [designatn_7] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
81 [oth_desgn_7]
Show the field ONLY if:
[designatn_7] = '6'
Other, Specify text
82 [educ_qual_7] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
83 [edu_oth_7]
Show the field ONLY if:
[educ_qual_7] = '6'
other text
84 [name_stff_8] Name of the staff currently available text
85 [gendr_8] Gender radio
1Male
2Female
3Specify Other
86 [oth_gendr_8]
Show the field ONLY if:
[gendr_8] = '3'
Any other, Specify text
87 [age_8] Age (years) text (number)
88 [designatn_8] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
89 [oth_desgn_8]
Show the field ONLY if:
[designatn_8] = '6'
Other, Specify text
90 [educ_qual_8] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
91 [edu_oth_8]
Show the field ONLY if:
[educ_qual_8] = '6'
other text
92 [name_stff_9] Name of the staff currently available text
93 [gendr_9] Gender radio
1Male
2Female
3Specify Other
94 [oth_gendr_9]
Show the field ONLY if:
[gendr_9] = '3'
Any other, Specify text
95 [age_9] Age (years) text (number)
96 [designatn_9] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
97 [oth_desgn_9]
Show the field ONLY if:
[designatn_9] = '6'
Other, Specify text
98 [educ_qual_9] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
99 [edu_oth_9]
Show the field ONLY if:
[educ_qual_9] = '6'
other text
100 [name_stff_10] Name of the staff currently available text
101 [gendr_10] Gender radio
1Male
2Female
3Specify Other
102 [oth_gendr_10]
Show the field ONLY if:
[gendr_10] = '3'
Any other, Specify text
103 [age_10] Age (years) text (number)
104 [designatn_10] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
105 [oth_desgn_10]
Show the field ONLY if:
[designatn_10] = '6'
Other, Specify text
106 [educ_qual_10] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
107 [edu_oth_10]
Show the field ONLY if:
[educ_qual_10] = '6'
other text
108 [name_stff_11] Name of the staff currently available text
109 [gendr_11] Gender radio
1Male
2Female
3Specify Other
110 [oth_gendr_11]
Show the field ONLY if:
[gendr_11] = '3'
Any other, Specify text
111 [age_11] Age (years) text (number)
112 [designatn_11] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
113 [oth_desgn_11]
Show the field ONLY if:
[designatn_11] = '6'
Other, Specify text
114 [educ_qual_11] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
115 [edu_oth_11]
Show the field ONLY if:
[educ_qual_11] = '6'
other text
116 [name_stff_12] Name of the staff currently available text
117 [gendr_12] Gender radio
1Male
2Female
3Specify Other
118 [oth_gendr_12]
Show the field ONLY if:
[gendr_12] = '3'
Any other, Specify text
119 [age_12] Age (years) text (number)
120 [designatn_12] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
121 [oth_desgn_12]
Show the field ONLY if:
[designatn_12] = '6'
Other, Specify text
122 [educ_qual_12] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
123 [edu_oth_12]
Show the field ONLY if:
[educ_qual_12] = '6'
other text
124 [name_stff_13] Name of the staff currently available text
125 [gendr_13] Gender radio
1Male
2Female
3Specify Other
126 [oth_gendr_13]
Show the field ONLY if:
[gendr_13] = '3'
Any other, Specify text
127 [age_13] Age (years) text (number)
128 [designatn_13] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
129 [oth_desgn_13]
Show the field ONLY if:
[designatn_13] = '6'
Other, Specify text
130 [educ_qual_13] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
131 [edu_oth_13]
Show the field ONLY if:
[educ_qual_13] = '6'
other text
132 [name_stff_14] Name of the staff currently available text
133 [gendr_14] Gender radio
1Male
2Female
3Specify Other
134 [oth_gendr_14]
Show the field ONLY if:
[gendr_14] = '3'
Any other, Specify text
135 [age_14] Age (years) text (number)
136 [designatn_14] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
137 [oth_desgn_14]
Show the field ONLY if:
[designatn_14] = '6'
Other, Specify text
138 [educ_qual_14] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
139 [edu_oth_14]
Show the field ONLY if:
[educ_qual_14] = '6'
other text
140 [name_stff_15] Name of the staff currently available text
141 [gendr_15] Gender radio
1Male
2Female
3Specify Other
142 [oth_gendr_15]
Show the field ONLY if:
[gendr_15] = '3'
Any other, Specify text
143 [age_15] Age (years) text (number)
144 [designatn_15] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
145 [oth_desgn_15]
Show the field ONLY if:
[designatn_15] = '6'
Other, Specify text
146 [educ_qual_15] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
147 [edu_oth_15]
Show the field ONLY if:
[educ_qual_15] = '6'
other text
148 [name_stff_16] Name of the staff currently available text
149 [gendr_16] Gender radio
1Male
2Female
3Specify Other
150 [oth_gendr_16]
Show the field ONLY if:
[gendr_16] = '3'
Any other, Specify text
151 [age_16] Age (years) text (number)
152 [designatn_16] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
153 [oth_desgn_16]
Show the field ONLY if:
[designatn_16] = '6'
Other, Specify text
154 [educ_qual_16] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
155 [edu_oth_16]
Show the field ONLY if:
[educ_qual_16] = '6'
other text
156 [name_stff_17] Name of the staff currently available text
157 [gendr_17] Gender radio
1Male
2Female
3Specify Other
158 [oth_gendr_17]
Show the field ONLY if:
[gendr_17] = '3'
Any other, Specify text
159 [age_17] Age (years) text (number)
160 [designatn_17] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
161 [oth_desgn_17]
Show the field ONLY if:
[designatn_17] = '6'
Other, Specify text
162 [educ_qual_17] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
163 [edu_oth_17]
Show the field ONLY if:
[educ_qual_17] = '6'
other text
164 [name_stff_18] Name of the staff currently available text
165 [gendr_18] Gender radio
1Male
2Female
3Specify Other
166 [oth_gendr_18]
Show the field ONLY if:
[gendr_18] = '3'
Any other, Specify text
167 [age_18] Age (years) text (number)
168 [designatn_18] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
169 [oth_desgn_18]
Show the field ONLY if:
[designatn_18] = '6'
Other, Specify text
170 [educ_qual_18] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
171 [edu_oth_18]
Show the field ONLY if:
[educ_qual_18] = '6'
other text
172 [name_stff_19] Name of the staff currently available text
173 [gendr_19] Gender radio
1Male
2Female
3Specify Other
174 [oth_gendr_19]
Show the field ONLY if:
[gendr_19] = '3'
Any other, Specify text
175 [age_19] Age (years) text (number)
176 [designatn_19] Designation radio
1MO
2ANM / PHCO
3CHO
4HIO
5Asha
6Other
177 [oth_desgn_19]
Show the field ONLY if:
[designatn_19] = '6'
Other, Specify text
178 [educ_qual_19] Educational Qualification: radio
1MBBS
2AYUSH (Ayurveda/ Unani/Siddha/Homeopathy)
3Diploma (GNM) - Nurse
4Graduate (BSc) - Nurse
5ANM
6Specify Other
179 [edu_oth_19]
Show the field ONLY if:
[educ_qual_19] = '6'
other text
180 [instrct] Section Header: SECTION 3 - SERVICES PROVIDED Instructions: List all the services provided and load of services for the last three months descriptive
181 [name_of_month_1] Name of month 1 text, Required
182 [name_of_month_3] Name of month 2 text, Required
183 [name_of_month_2] Name of month 3 text, Required
184 [anc_regs] 3.1 ANC registration yesno, Required
1Yes
0No
185 [num_anc_regs_mnt_1]
Show the field ONLY if:
[anc_regs]='1'
Number of ANC registration Month 1 text (number)
186 [num_anc_regs_mnt_2]
Show the field ONLY if:
[anc_regs]='1'
Number of ANC registration Month 2 text (number)
187 [num_anc_regs_mnt_3]
Show the field ONLY if:
[anc_regs]='1'
Number of ANC registration Month 3 text (number)
188 [follow_up] 3.1.1 Follow-up of high-risk pregnancies (HRP) yesno, Required
1Yes
0No
189 [no_follow_up_mnth_1]
Show the field ONLY if:
[follow_up]='1'
Number of Follow-up of high-risk pregnancies (HRP) in month 1 text (number)
190 [no_follow_up_mnth_2]
Show the field ONLY if:
[follow_up]='1'
Number of Follow-up of high-risk pregnancies (HRP) in month 2 text (number)
191 [no_follow_up_mnth_3]
Show the field ONLY if:
[follow_up]='1'
Number of Follow-up of high-risk pregnancies (HRP) in month 3 text (number)
192 [hrp_rfrd_hgh_facili] 3.1.2 HRP referred to higher facility (PMSMA) yesno, Required
1Yes
0No
193 [no_hrp_rfrd_facili_mnth_1]
Show the field ONLY if:
[hrp_rfrd_hgh_facili]='1'
Number of HRP referred to higher facility (PMSMA) in month 1 text (number)
194 [no_hrp_rfrd_facili_mnth_2]
Show the field ONLY if:
[hrp_rfrd_hgh_facili]='1'
Number of HRP referred to higher facility (PMSMA) in month 2 text (number)
195 [no_hrp_rfrd_facili_mnth_3]
Show the field ONLY if:
[hrp_rfrd_hgh_facili]='1'
Number of HRP referred to higher facility (PMSMA) in month 3 text (number)
196 [tt_immun] 3.2 TT Immunization for pregnant women yesno, Required
1Yes
0No
197 [no_tt_immuni_mnth_1]
Show the field ONLY if:
[tt_immun]='1'
Number of TT Immunization for pregnant women in month 1 text (number)
198 [no_tt_immuni_mnth_2]
Show the field ONLY if:
[tt_immun]='1'
Number of TT Immunization for pregnant women in month 2 text (number)
199 [no_tt_immuni_mnth_3]
Show the field ONLY if:
[tt_immun]='1'
Number of TT Immunization for pregnant women in month 3 text (number)
200 [ifa_provd] 3.3 IFA provided yesno, Required
1Yes
0No
201 [no_ifa_provid_mnth_1]
Show the field ONLY if:
[ifa_provd]='1'
Number of IFA provided in month 1 text (number)
202 [no_ifa_provid_mnth_2]
Show the field ONLY if:
[ifa_provd]='1'
Number of IFA provided in month 2 text (number)
203 [no_ifa_provid_mnth_3]
Show the field ONLY if:
[ifa_provd]='1'
Number of IFA provided in month 3 text (number)
204 [dspns_tab] 3.4 Dispenses Tab Calcium yesno, Required
1Yes
0No
205 [no_dspns_tab_mnth_1]
Show the field ONLY if:
[dspns_tab]='1'
Number of Dispenses Tab Calcium in month 1 text (number)
206 [no_dspns_tab_mnth_2]
Show the field ONLY if:
[dspns_tab]='1'
Number of Dispenses Tab Calcium in month 2 text (number)
207 [no_dspns_tab_mnth_3]
Show the field ONLY if:
[dspns_tab]='1'
Number of Dispenses Tab Calcium in month 3 text (number)
208 [rapid_blood_tst] 3.5 Rapid blood tests descriptive
209 [hb] 3.5.1 Hb yesno, Required
1Yes
0No
210 [no_hb_test_mnth_1]
Show the field ONLY if:
[hb]='1'
Number of HB test done in month 1 text (number)
211 [no_hb_test_mnth_2]
Show the field ONLY if:
[hb]='1'
Number of HB test done in month 2 text (number)
212 [no_hb_test_mnth_3]
Show the field ONLY if:
[hb]='1'
Number of HB test done in month 3 text (number)
213 [vdrl] 3.5.2 VDRL / Syphilis yesno, Required
1Yes
0No
214 [no_vdrl_test_mnth_1]
Show the field ONLY if:
[vdrl]='1'
Number of VDRL / Syphilis test done in month 1 text (number)
215 [no_vdrl_test_mnth_2]
Show the field ONLY if:
[vdrl]='1'
Number of VDRL / Syphilis test done in month 2 text (number)
216 [no_vdrl_test_mnth_3]
Show the field ONLY if:
[vdrl]='1'
Number of VDRL / Syphilis test done in month 3 text (number)
217 [hiv] 3.5.3 HIV yesno, Required
1Yes
0No
218 [no_hiv_done_mnth_1]
Show the field ONLY if:
[hiv]='1'
No of HIV test done in month 1 text (number)
219 [no_hiv_done_mnth_2]
Show the field ONLY if:
[hiv]='1'
No of HIV test done in month 2 text (number)
220 [no_hiv_done_mnth_3]
Show the field ONLY if:
[hiv]='1'
No of HIV test done in month 3 text (number)
221 [malar] 3.5.4 Malaria yesno, Required
1Yes
0No
222 [no_malar_mnth_1]
Show the field ONLY if:
[malar]='1'
No of Malaria test done in month 1 text (number)
223 [no_malar_mnth_2]
Show the field ONLY if:
[malar]='1'
No of Malaria test done in month 2 text (number)
224 [no_malar_mnth_3]
Show the field ONLY if:
[malar]='1'
No of Malaria test done in month 3 text (number)
225 [hbsag] 3.5.5 HbsAg yesno, Required
1Yes
0No
226 [no_hbsag_done_month_1]
Show the field ONLY if:
[hbsag]='1'
No of HbsAg test done in month 1 text (number)
227 [no_hbsag_done_month_2]
Show the field ONLY if:
[hbsag]='1'
No of HbsAg test done in month 2 text (number)
228 [no_hbsag_done_month_3]
Show the field ONLY if:
[hbsag]='1'
No of HbsAg test done in month 3 text (number)
229 [urine_dipstick_test] 3.6 Urine dipstick test descriptive
230 [albm] 3.6.1 Albumin yesno, Required
1Yes
0No
231 [no_albm_done_mnth_1]
Show the field ONLY if:
[albm]="1"
No of Albumin test done in month1 text (number)
232 [no_albm_done_mnth_2]
Show the field ONLY if:
[albm]="1"
No of Albumin test done in month2 text (number)
233 [no_albm_done_mnth_3]
Show the field ONLY if:
[albm]="1"
No of Albumin test done in month 3 text (number)
234 [sgr] 3.6.2 Sugar yesno, Required
1Yes
0No
235 [no_sugar_done_month_1]
Show the field ONLY if:
[sgr]='1'
Number of sugar test done in month 1 text (number)
236 [no_sugar_done_month_2]
Show the field ONLY if:
[sgr]='1'
Number of sugar test done in month 2 text (number)
237 [no_sugar_done_month_3]
Show the field ONLY if:
[sgr]='1'
Number of sugar test done in month 3 text (number)
238 [fmily_planning] 3.7 Family planning descriptive
239 [insert] 3.7.1 Insertion of Cut yesno, Required
1Yes
0No
240 [no_insertion_mnth_1]
Show the field ONLY if:
[insert]='1'
Number of Insertion of Cut done in month 1 text (number)
241 [no_insertion_mnth_2]
Show the field ONLY if:
[insert]='1'
Number of Insertion of Cut done in month 2 text (number)
242 [no_insertion_mnth_3]
Show the field ONLY if:
[insert]='1'
Number of Insertion of Cut done in month 3 text (number)
243 [disp] 3.7.2 Dispensing contraceptive pills yesno, Required
1Yes
0No
244 [no_disp_given_month_1]
Show the field ONLY if:
[disp]='1'
Number of Dispensing contraceptive pills given in month 1 text (number)
245 [no_disp_given_month_2]
Show the field ONLY if:
[disp]='1'
Number of Dispensing contraceptive pills given in month 2 text (number)
246 [no_disp_given_month_3]
Show the field ONLY if:
[disp]='1'
Number of Dispensing contraceptive pills given in month 2 text (number)
247 [outreach_services] 3.8 Outreach services descriptive
248 [icds] 3.8.1 ICDS Anganwadi referrals yesno, Required
1Yes
0No
249 [no_icds_done_month_1]
Show the field ONLY if:
[icds]='1'
Number of ICDS Anganwadi referrals done in month 1 text (number)
250 [no_icds_done_month_2]
Show the field ONLY if:
[icds]='1'
Number of ICDS Anganwadi referrals done in month 2 text (number)
251 [no_icds_done_month_3]
Show the field ONLY if:
[icds]='1'
Number of ICDS Anganwadi referrals done in month 3 text (number)
252 [schl] 3.8.2 School health program yesno, Required
1Yes
0No
253 [no_schl_pgrm_mnth_1]
Show the field ONLY if:
[schl]='1'
Number of School health program done in month 1 text (number)
254 [no_schl_pgrm_mnth_2]
Show the field ONLY if:
[schl]='1'
Number of School health program done in month 2 text (number)
255 [no_schl_pgrm_mnth_3]
Show the field ONLY if:
[schl]='1'
Number of School health program done in month 3 text (number)
256 [anc_cmp] 3.8.3 ANC camps yesno, Required
1Yes
0No
257 [no_anc_camps_month_1]
Show the field ONLY if:
[anc_cmp]='1'
Number of ANC camps done in month 1 text (number)
258 [no_anc_camps_month_2]
Show the field ONLY if:
[anc_cmp]='1'
Number of ANC camps done in month 2 text (number)
259 [no_anc_camps_month_3]
Show the field ONLY if:
[anc_cmp]='1'
Number of ANC camps done in month 3 text (number)
260 [gnrl_hlth] 3.8.4 General health camps - Diabetes yesno, Required
1Yes
0No
261 [no_genral_hlth_month_1]
Show the field ONLY if:
[gnrl_hlth]='1'
Number of General health camps - Diabetes done in month 1 text (number)
262 [no_genral_hlth_month_2]
Show the field ONLY if:
[gnrl_hlth]='1'
Number of General health camps - Diabetes done in month 2 text (number)
263 [no_genral_hlth_month_3]
Show the field ONLY if:
[gnrl_hlth]='1'
Number of General health camps - Diabetes done in month 3 text (number)
264 [gnrl_thyr] 3.8.5 General health camps - Thyroid yesno, Required
1Yes
0No
265 [no_gnrl_thyr_cmp_mnth_1]
Show the field ONLY if:
[gnrl_thyr]='1'
Number of General health camps - Thyroid done in month 1 text (number)
266 [no_gnrl_thyr_cmp_mnth_2]
Show the field ONLY if:
[gnrl_thyr]='1'
Number of General health camps - Thyroid done in month 2 text (number)
267 [no_gnrl_thyr_cmp_mnth_3]
Show the field ONLY if:
[gnrl_thyr]='1'
Number of General health camps - Thyroid done in month 3 text (number)
268 [gnrl_htn] 3.8.6 General health camps - HTN yesno, Required
1Yes
0No
269 [no_hlth_camps_htn_mnth1]
Show the field ONLY if:
[gnrl_htn]='1'
Number of General health camps - HTN done in month 1 text (number)
270 [no_hlth_camps_htn_mnth2]
Show the field ONLY if:
[gnrl_htn]='1'
Number of General health camps - HTN done in month 2 text (number)
271 [no_hlth_camps_htn_mnth3]
Show the field ONLY if:
[gnrl_htn]='1'
Number of General health camps - HTN done in month 3 text (number)
272 [nutrn] 3.8.7 Nutrition rehabilitation referrals yesno, Required
1Yes
0No
273 [no_nutrn_ref_mnth_1]
Show the field ONLY if:
[nutrn]='1'
Number of Nutrition rehabilitation referrals done in month 1 text (number)
274 [no_nutrn_ref_mnth_2]
Show the field ONLY if:
[nutrn]='1'
Number of Nutrition rehabilitation referrals done in month 2 text (number)
275 [no_nutrn_ref_mnth_3]
Show the field ONLY if:
[nutrn]='1'
Number of Nutrition rehabilitation referrals done in month 3 text (number)
276 [mahila] 3.9 Conducting Mahila Arogya Samiti yesno
1Yes
0No
277 [no_mahila_mnth_1]
Show the field ONLY if:
[mahila]='1'
Number of Conducting Mahila Arogya Samiti done in moth 1 text (number)
278 [no_mahila_mnth_2]
Show the field ONLY if:
[mahila]='1'
Number of Conducting Mahila Arogya Samiti done in moth 2 text (number)
279 [no_mahila_mnth_3]
Show the field ONLY if:
[mahila]='1'
Number of Conducting Mahila Arogya Samiti done in moth 3 text (number)
280 [any_oth] 3.10 Any other related to ANC [ specify] yesno, Required
1Yes
0No
281 [specify_other]
Show the field ONLY if:
[any_oth]='1'
Specify other text
282 [no_other_month_1]
Show the field ONLY if:
[any_oth]='1'
Number of Any other related to ANC done in month 1 text (number)
283 [no_other_month_2]
Show the field ONLY if:
[any_oth]='1'
Number of Any other related to ANC done in month 2 text (number)
284 [no_other_month_3]
Show the field ONLY if:
[any_oth]='1'
Number of Any other related to ANC done in month 3 text (number)
285 [instrct_4] Section Header: SECTION 4 - EQUIPMENT, DRUGS, SUPPLIESAVAILABLE & INFRASTRUCTUREInstructions: Please observe if the following are available at the HWC/AAM by walking through the facility. Ensure that equipment are functional before checking YES. descriptive
286 [equip]   4.1 Equipment - functional descriptive
287 [bp] 4.1.1 BP apparatus yesno
1Yes
0No
288 [thermo] 4.1.2 Thermometer yesno
1Yes
0No
289 [weigh_digi] 4.1.3 Weighing machine (digital / beam) yesno
1Yes
0No
290 [stadio] 4.1.4 Stadiometer yesno
1Yes
0No
291 [steth] 4.1.5 Stethoscope yesno
1Yes
0No
292 [feto] 4.1.6 Fetoscope yesno
1Yes
0No
293 [msure] 4.1.7 Measuring tape yesno
1Yes
0No
294 [oxy_cycl] 4.1.8 Oxygen cylinder - 2 yesno
1Yes
0No
295 [iv_stnd] 4.1.9 IV stand yesno
1Yes
0No
296 [gluco] 4.1.10 Glucometer yesno
1Yes
0No
297 [cmpter] 4.1.11 Computer/ Tab yesno
1Yes
0No
298 [drgs]   4.2 Drugs descriptive
299 [ifa] 4.2.1 IFA yesno
1Yes
0No
300 [calc] 4.2.2 Calcium yesno
1Yes
0No
301 [antibio] 4.2.3 Antibiotics yesno
1Yes
0No
302 [spec_antibio]
Show the field ONLY if:
[antibio]='1'
4.2.3.a If YES, specify what is available text
303 [antihyper] 4.2.4 Antihypertensives yesno
1Yes
0No
304 [spec_antihyper]
Show the field ONLY if:
[antihyper]='1'
4.2.4.a If YES, specify what is available text
305 [antidia] 4.2.5 Antidiabetics yesno
1Yes
0No
306 [spec_antidia]
Show the field ONLY if:
[antidia]='1'
4.2.5.a If YES, specify what is available text
307 [antipyre] 4.2.6 Antipyretics yesno
1Yes
0No
308 [spec_antipyre]
Show the field ONLY if:
[antipyre]='1'
4.2.6.a If YES, specify what is available text
309 [iv_flds] 4.2.7 IV fluids (NS / 5% Dextrose / 5% DNS) yesno
1Yes
0No
310 [oth_rltd] 4.2.8 Any other related to antenatal care yesno
1Yes
0No
311 [oth_antntl]
Show the field ONLY if:
[oth_rltd]='1'
4.2.8.a If Yes, Specify text
312 [supplies]   4.3 Supplies descriptive
313 [ctn] 4.3.1 Cotton yesno
1Yes
0No
314 [gauze] 4.3.2 Gauze yesno
1Yes
0No
315 [dress_bin] 4.3.3 Dressing bin with cotton and gauze yesno
1Yes
0No
316 [adhes] 4.3.4 Adhesive yesno
1Yes
0No
317 [syrnges] 4.3.5 Syringes and needles yesno
1Yes
0No
318 [iv_set] 4.3.6 IV set yesno
1Yes
0No
319 [iv_needle] 4.3.7 IV needle / ventflon yesno
1Yes
0No
320 [rapid_bld] 4.3.8 Rapid blood test kits yesno
1Yes
0No
321 [urine_dip] 4.3.9 Urine dipsticks yesno
1Yes
0No
322 [mcp_card] 4.3.10 MCP card yesno, Required
1Yes
0No
323 [instr_4_4]   4.4 Instruments descriptive
324 [chetle] 4.4.1 Cheatle forceps yesno
1Yes
0No
325 [dress_kits] 4.4.2 Dressing kits sterile yesno
1Yes
0No
326 [sterile] 4.4.3 Sterile scissors yesno
1Yes
0No
327 [infra] 4.5 Infrastructure descriptive
328 [wshng] 4.5.1 Washing basin with facilities for hand
hygiene 		yesno
1Yes
0No
329 [tele] 4.5.2 Telephone yesno
1Yes
0No
330 [seat_arrng] 4.5.3 Seating arrangement in the waiting area yesno
1Yes
0No
331 [exam_tbl] 4.5.4 Examination table/bed yesno
1Yes
0No
332 [elec_supp] 4.5.5 Electricity supply uninterrupted - during OPD
hours 		yesno
1Yes
0No
333 [wtr_supp] 4.5.6 Water supply uninterrupted -during OPD
hours 		yesno
1Yes
0No
334 [ramp] 4.5.7 Ramp to enter building yesno
1Yes
0No
335 [rgstr] 4.5.8 Registration counter yesno
1Yes
0No
336 [mdcn_disp] 4.5.9 Medicine dispensing area yesno
1Yes
0No
337 [utlty_area] 4.5.10 Utility area yesno
1Yes
0No
338 [toilet] 4.5.11 Toilet yesno
1Yes
0No
339 [prtble_drnkng_wtr] 4.5.12 Potable drinking water yesno
1Yes
0No
340 [iec_mtrl] 4.6 IEC material  descriptive
341 [poster] 4.6.1 Poster yesno
1Yes
0No
342 [fmly_plan] 4.6.2 Family planning and spacing yesno
1Yes
0No
343 [diet] 4.6.3 Diet yesno
1Yes
0No
344 [brst_feed] 4.6.4 Breastfeeding yesno
1Yes
0No
345 [antntl_chk] 4.6.5 Antenatal check-up and danger signs during
pregnancy 		yesno
1Yes
0No
346 [oth] 4.6.6 Any other yesno
1Yes
0No
347 [oth_spec]
Show the field ONLY if:
[oth]='1'
Any other specify text
348 [connctd_rcho_prtl] 4.7 Connected to RCHO portal? yesno
1Yes
0No
349 [checked_by] Checked by descriptive
350 [field_investigator_name] Field Investigator name text, Required
351 [date] Date text (date_dmy)
352 [supervisor_name] Supervisor name text, Required
353 [date_2] Date text (date_dmy)
354 [taluk_coordinator_name] Taluk coordinator name text, Required
355 [date_3] Date text (date_dmy)
356 [par_joindate] Install Date text (datetime_seconds_ymd)
Field Annotation: @MC-PARTICIPANT-JOINDATE @HIDDEN
357 [par_joindate_utc] Install Date (UTC) text (datetime_seconds_ymd)
Field Annotation: @MC-PARTICIPANT-JOINDATE-UTC @HIDDEN
358 [par_timezone] Participant Timezone text
Field Annotation: @MC-PARTICIPANT-TIMEZONE @HIDDEN
359 [par_code] Participant Code text
Field Annotation: @MC-PARTICIPANT-CODE @HIDDEN
 
 360 [form_1_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
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