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ANC ObservationPID 28
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 07/04/2025 10:37pm
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Data Dictionary Codebook
ANC Observation (PID: 28)
07/04/2025 10:37pm
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 [genral] GENERAL DETAILS descriptive
3 [name_of_the_observer] Name of the Observer text, Required
4 [date] Date text (date_dmy), Required
5 [district_name] District name dropdown, Required
1Sangrur
2Any other
6 [any_other_specific_district]
Show the field ONLY if:
[district_name] = '2'
Any other specific text
7 [block_name] Block name dropdown, Required
1Sangrur
2Sunam
3Dhuri
4Bhawanigrah
5Moonak
6Other
8 [other_specific_block]
Show the field ONLY if:
[block_name] = '6'
Other specific text
9 [type_of_anc_platform] Type of ANC Platform radio, Required
1HWC
2CHC
3FRU
4SDH
5Special clinics -PMSMA
6PHC
7DH
8VHND
10 [name_of_the_facility] Name of the facility
 text, Required
11 [population_covered] Population Covered text (number), Required
12 [observant_details] Observant details radio, Required
1ANM
2CHO
3MO
4Specialist
5Other
13 [any_other_observant_details]
Show the field ONLY if:
[observant_details(5)] = '1'
Any other text
14 [specify_name] Specify name text
15 [type_of_employment] Type of employment radio
1Contractual / RCH
2Permanent
16 [record_the_time_observatio] Record the time observation started- text (time)
Field Annotation: @NOW
17 [participant_details] PARTICIPANT DETAILS descriptive
18 [rch_id_of_the_pregnant] RCH ID of the pregnant woman text (number), Required
19 [age_of_the_pregnant_woman] Age of the pregnant woman text (number), Required
20 [address_of_pregnant_womn] Address of the pregnant woman text, Required
21 [pincode] Pincode text (number), Required
22 [contact_no] Contact no text (number, Min: 1111111111, Max: 9999999999), Required
Field Annotation: @FORCE-MINMAX
23 [number_of_visits] Number of visits radio, Required
11st
22nd
33rd
44th
5Other
24 [other_no_of_anc_visit]
Show the field ONLY if:
[number_of_visits] = '5'
Other text
25 [gpla_score] GPLA Score text
26 [quality_checklist] QUALITY CHECKLISTINTRODUCTION AND HISTORY COLLECTION descriptive
27 [health_worker_greet_pgwn] 1. Did the health worker greet the pregnant woman (and other present) in a friendly and respectful way? radio, Required
1Yes
2No
3Not assessed
28 [remark_introduction_1] Remark text
29 [health_worker_intrduce] 2. Did the health worker introduce him/herself and title
(Nurse, ANM, CHO, MO, specialist etc)
 radio, Required
1Yes
2No
3Not assessed
30 [remark_introduction_2] Remark text
31 [pregnant_woman_asked_about_name] 3. Was the pregnant woman asked about her name? radio, Required
1Yes
2No
3Not assessed
32 [remark_introduction_3] Remark text
33 [addressed_using_her_name] 4. Was she addressed using her appropriate name or title? radio, Required
1Yes
2No
3Not assessed
34 [remark_introduction_4] Remark text
35 [was_she_asked_her_age] 5. Was she asked her age? radio, Required
1Yes
2No
3Not assessed
36 [remark_introduction_5] Remark text
37 [enquired_about_her_age] (Menstrual History) 6. Was she enquired about her age of menarche? radio, Required
1Yes
2No
3Not assessed
38 [remark_introduction_6] Remark text
39 [enquired_about_her_freq_her] 7. Was she enquired about her frequency of menses? radio, Required
1Yes
2No
3Not assessed
40 [remark_introduction_7] Remark text
41 [duration_menses] 8. Was she asked about duration of menses? radio, Required
1Yes
2No
3Not assessed
42 [remark_introduction_8] Remark text
43 [amount_of_blood_flow] 9. Was she asked about amount of blood flow? radio, Required
1Yes
2No
3Not assessed
44 [remark_introduction_9] Remark text
45 [about_when_the_first_day_menstrual] 10. Was she asked about when the first day of her last menstrual period and EDD recorded according to EDD? radio, Required
1Yes
2No
3Not assessed
46 [remark_introduction_10] Remark text
47 [medical_and_obstetric_hist] Medical and Obstetric History descriptive
48 [hstory_chronic_disease] 1.Was she asked about history of any chronic disease? radio, Required
1Yes
2No
3Not assessed
49 [medical_obstetric_hsty_re_1] Remark text
50 [history_of_medication] 2. Was she asked if she was on some medication she is on? radio, Required
1Yes
2No
3Not assessed
51 [medical_obstetric_hsty_re_2] Remark text
52 [previous_history_pregnancies] 3. Was she asked about her previous pregnancies and its outcomes? radio, Required
1Yes
2No
3Not assessd
53 [medical_obstetric_hsty_re_3] Remark text
54 [heavy_bleeding_during] (Did the health worker and pregnant woman discuss any of the following complications for prior pregnancies)   a.Heavy bleeding during or after pregnancy radio, Required
1Yes
2No
3Not assessed
55 [medical_obstetric_hsty_re3a] Remark text
56 [anaemia] b. Anemia radio, Required
1Yes
2No
3Not assessed
57 [medical_obstetric_hsty_re3b] Remark text
58 [high_blood_pressure] c. High blood pressure radio, Required
1Yes
2No
3Not assessed
59 [medical_obstetric_hsty_re3c] Remark text
60 [convulsions] d. Convulsions radio, Required
1Yes
2No
3Not assessed
61 [medical_obstetric_hsty_re3d] Remark text
62 [multiple_pregnancies_twin] e. Multiple pregnancies (twin pregnancies) (specific to BOH) radio, Required
1Yes
2No
3Not assessed
63 [medical_obstetric_hsty_re3e] Remark text
64 [prolonged_labour] f. Prolonged labour radio, Required
1Yes
2No
3Not assessed
65 [medical_obstetric_hsty_re3f] Remark text
66 [c_section] g. C-section radio, Required
1Yes
2No
3Not assessed
67 [medical_obstetric_hsty_re3g] Remark text
68 [assisted_delivery] h. Assisted delivery (forceps, ventouse) radio, Required
1Yes
2No
3Not assessed
69 [medical_obstetric_hsty_re3h] Remark text
70 [prior_neonatal_death_bab] i. Prior neonatal death (baby < 1 month old) radio, Required
1Yes
2No
3Not assessed
71 [medical_obstetric_hsty_re3i] Remark text
72 [prior_stillbirth] j. Prior stillbirth (baby born dead that does not breathe or cry) (specific to BOH) radio, Required
1Yes
2No
3Not assessed
73 [medical_obstetric_hsty_re3j] Remark text
74 [prior_abortion_miscarria] k. Prior abortion/miscarriage (loss of pregnancy) radio, Required
1Yes
2No
3Not assessed
75 [medical_obstetric_hsty_re3k] Remark text
76 [prior_congenital_malformat] L. Prior congenital malformation of the child/fetus radio, Required
1Yes
2No
3Not assessed
77 [medical_obstetric_hsty_re3l] Remark text
78 [obstructed_labor_specifi] m. Obstructed labor (specific to BOH) radio, Required
1Yes
2No
3Not assessed
79 [medical_obstetric_hsty_re3m] Remark text
80 [history_hospitalization] 4. Was she asked if she had any history of hospitalization anytime in the past? radio, Required
1Yes
2No
3Not assessed
81 [medical_obstetric_hsty_re4] Remark text
82 [history_surgical_producer_past] 5. Was she asked about history of any surgical procedure done any time in the past? radio, Required
1Yes
2No
3Not assessed
83 [medical_obstetric_hsty_re5] Remark text
84 [family_history_chronic_disease] 6. Was she asked about family history of any chronic disease (hypertension, diabetes etc.), presence of any hereditary diseases like (thalassemia, sickle cell anemia, spina bifida etc.) radio, Required
1Yes
2No
3Not assessed
85 [medical_obstetric_hsty_re6] Remark text
86 [did_the_health_worker_ask] Did the health worker ask about or the client mention any of the following for current pregnancy? descriptive
87 [a_vaginal_bleeding] a. Vaginal bleeding radio, Required
1Yes
2No
3Not assessed
88 [vaginal_bleeding_a] Remark text
89 [b_excessive_vomiting] b. Excessive vomiting radio, Required
1Yes
2No
3Not assessd
90 [excessive_vomiting_b] Remark text
91 [d_fever_100_4_f] c. Fever (>100.4°F) radio
1Yes
2No
3Not assessed
92 [fever_c] Remark text
93 [e_headaches_or_blurred_vis] d. Headaches or blurred vision radio, Required
1Yes
2No
3Not assessed
94 [headech_blurred_vision] Remark text
95 [swollen_face_or_hands] e. Swollen face or hands radio, Required
1Yes
2No
3Not assessed
96 [swollen_face_re] Remark text
97 [f_convulsions] f. Convulsions or loss of consciousness radio, Required
1Yes
2No
3Not assessed
98 [convulsions_re] Remark text
99 [g_severe_difficulty_breath] g. Severe difficulty breathing/Fast breathing radio, Required
1Yes
2No
3Not assessed
100 [difficulty_breath_re] Remark text
101 [persistent_cough_2week_more] h. Persistent cough for 2 weeks or more radio, Required
1Yes
2No
3Not assessed
102 [cough_2week_more_re] Remark text
103 [i_severe_abdominal_pain] i. Severe abdominal pain radio, Required
1Yes
2No
3Not assessed
104 [abdominal_pain_re] Remark text
105 [vaginal_discharge] j. Vaginal discharge radio, Required
1Yes
2No
3Not assessed
106 [vaginal_discharge_re] Remark text
107 [k_foul_smelling_discharge] k. Foul smelling discharge radio, Required
1Yes
2No
3Not assessed
108 [smelling_discharge_re] Remark text
109 [l_frequent_or_painful_urin] l. Frequent or painful urination radio, Required
1Yes
2No
3Not assessed
110 [painful_urin_re] Remark text
111 [m_ulcers_around_genital_region] m. Ulcers around genital region radio, Required
1Yes
2No
3Not assessed
112 [ulcers_around_genital_re] Remark text
113 [n_heart_disease_developed] n. heart disease developed during the pregnancy radio, Required
1Yes
2No
3Not assessed
114 [heart_disease_dev_re] Remark text
115 [o_kidney_disorders_develop] o. Kidney disorders developed during the pregnancy (chronic renal disease) radio, Required
1Yes
2No
3Not assessed
116 [kidney_disorder_dev_re] Remark text
117 [p_liver_diseases_jaundice] p. Liver diseases (Jaundice) radio, Required
1Yes
2No
3Not assessed
118 [liver_diseases_jaundice_re] Remark text
119 [q_lung_disorders_copd_asth] q. Lung disorders (COPD, asthma, pneumonia) radio, Required
1Yes
2No
3Not assessed
120 [lung_disorders_copd_re] Remark text
121 [r_urinary_tract_infection] r. Urinary tract infection (s/o burning micturition, blood in urine) radio, Required
1Yes
2No
3Not assessed
122 [urinary_tract_infection_re] Remark text
123 [s_tuberculosis] s. Tuberculosis radio, Required
1Yes
2No
3Not assessed
124 [tuberculosis_re] Remark text
125 [t_whether_the_pregnant_woman_felt_reduction] t. Whether the pregnant woman has felt a reduction or cessation of foetal movements radio, Required
1Yes
2No
3Not assessed
126 [whether_the_pregnant_woman_felt_reduction_re] Remark text
127 [u_there_any_other_problems_woman_is_concerned] u. If there are any other problems the pregnant woman is concerned about radio, Required
1Yes
2No
3Not assessed
128 [other_problems_woman_is_concerned_re] Remark text
129 [physical_examination] PHYSICAL EXAMINATION (full compliance = 2, Partial compliance=1, Not performed= 0,Not assessed=99) descriptive
130 [temp_assessed_recorded] (General examination procedures)1. Was temperature assessed and recorded? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
131 [remark_physical_exam_1] Remark text
132 [bp_assessed_record] 2. Was blood pressure assessed and recorded? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
133 [remark_physical_exam_2] Remark text
134 [cuff_size_appropriately] 3. Were cuff size chosen appropriately? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
135 [remark_physical_exam_3] Remark text
136 [did_examiner_check_if_air] 4. Did examiner check if air plug is securely inserted in the main unit? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
137 [remark_physical_exam_4] Remark text
138 [remove_tight_fitted_clothintg] 5. Was she asked to remove tight-fitted clothing if any from the upper left arm? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
139 [remark_physical_exam_5] Remark text
140 [chair_with_wheel_arm_placed] 6. Is it ensured that the pregnant woman is sat in a chair with her feet flat on the floor and her arm is placed on a table (To ensure that the cuff is at the same level as the heart) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
141 [remark_physical_exam_6] Remark text
142 [cuff_applied_to_pregnant_wmn] 7. Was the cuff applied to the pregnant woman's upper arm? (Ensure air tube slightly medially with the bottom of the cuff ½ inch above the cubital fossa) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
143 [remark_physical_exam_7] Remark text
144 [measured_bp_entered_in_mcp] 8. Was measured BP entered in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
145 [remark_physical_exam_8] Remark text
146 [bp_result_expln_to_pgwmn] 9. Was result of the BP the measured explained to pregnant woman? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
147 [remark_physical_exam_9] Remark text
148 [hypertensive_provide_advice_medicine] 10. If diagnosed Hypertensive, was advise given/treatment provided? (Drugs/further investigations/follow-up visits/referrals) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
149 [remark_physical_exam_10] Remark text
150 [respiratory_rate_measured_rec] 11. Was respiratory rate measured and recorded? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
151 [remark_physical_exam_11] Remark text
152 [pgwmn_built_assessed_record] 12. Was built of the pregnant woman assessed and recorded? (Obese/average/thin) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
153 [remark_physical_exam_12] Remark text
154 [nutrition_status_assessed] 13. Nutrition status assessed. (Good/average/poor) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
155 [remark_physical_exam_13] Remark text
156 [instrument_available] 14. Was instrument available to measure weight of the pregnant woman? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
157 [remark_physical_exam_14] Remark text
158 [previous_records_wt_available] 15. Was the previous records for weight available and date radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
159 [remark_physical_exam_15] Remark text
160 [weight_of_the_pgwmn_mesuare_record] a. Was weight of the pregnant woman measured and recorded? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
161 [weight_of_the_pgwmn_mesuare_record_a_re] Remark text
162 [procedure_of_weight_measuring_expln] b. procedure of weight measuring explained to the pregnant woman? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
163 [procedure_of_weight_measuring_expln_b_re] Remark text
164 [weighing_scale_kept_on_flat_and_hard] c. Was the weighing scale kept on a flat and hard surface? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
165 [weighing_scale_kept_on_flat_and_hard_c_re] Remark text
166 [ensured_the_weighing_scale_not_contact_with_wall] d. Was it ensured that the weighing scale was away/not in contact with walls and other objects? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
167 [ensured_the_weighing_scale_not_contact_with_wall_d_re] Remark text
168 [scale_was_adjusted_zero] e. Ensure that the scale was adjusted to zero radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
169 [scale_was_adjusted_zero_e_re] Remark text
170 [the_scale_calibrated] f. Was the scale calibrated? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
171 [the_scale_calibrated_f_re] Remark text
172 [measured_weight_recorded_in_mcp_card] g. Was the measured weight recorded in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
173 [weight_recorded_in_mcp_card_g_re] Remark text
174 [expln_weighing_result] h. Was the pregnant woman explained the weighing result? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
175 [expln_weighing_result_h_re] Remark text
176 [measure_ht_pgwmn] 16. Was instrument available to measure height of the pregnant woman? (Measure height if not recorded at previous visit) (Measuring tape/stadiometer) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
177 [remark_physical_exam_16] Remark text
178 [ht_measured] a. Was the pregnant woman's height measured? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
179 [ht_measured_a_re] Remark text
180 [ht_entered_in_mcp_card] b. Was the measured height entered in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
181 [ht_entered_in_mcp_card_b_re] Remark text
182 [measured_result_expln] c. Was the measured result explained to the pregnant woman? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
183 [measured_result_expln_c_re] Remark text
184 [ht_145_expln_cndtn] d. If measured height is classified as short stature (< 145cm), was she advised related to her condition/delivery method/ investigations/follow up visits/referral etc) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
185 [ht_145_expln_cndtn_d_re] Remark text
186 [assesed_pollar] 17. Was pregnant woman assessed for pallor?
(Sites to be noted are lower palpebral conjunctiva, dorsum of the tongue, and nail beds)
 radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
187 [remark_physical_exam_17] Remark text
188 [assessed_jaundice] 18. Was pregnant woman assessed for Jaundice? (Sites to be noted are bulbar conjunctiva, under surface of the tongue, hard palate and skin) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
189 [remark_physical_exam_18] Remark text
190 [assesed_gums_tonsils_tongue] 19. Were her gums, teeth, tonsils and tongue assessed (evidence of malnutrition are evident from glossitis and stomatitis) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
191 [remark_physical_exam_19] Remark text
192 [neck_examined] 20. Is neck examined for assessing neck veins, thyroid gland, lymph glands for any abnormalities. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
193 [remark_physical_exam_20] Remark text
194 [back_assessed] 21. Is back assessed for normalcy of spine and symmetry, Rhomboid of Michaelis radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
195 [remark_physical_exam_21] Remark text
196 [obstetric_examination_proc] Obstetric Examination procedures descriptive
197 [examination_area_prepared_beforehand_with_supplies] 1. Is examination area prepared beforehand with necessary supplies and equipment? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
198 [obstetric_examin_proc_re_1] Remark text
200 [obstetric_examin_proc_re_2] Remark text
201 [women_emptied_bladder] 3. Check that the woman has emptied the bladder, and she is lying in a straight position radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
202 [obstetric_examin_proc_re_3] Remark text
203 [health_worker_wash_hand_wth_soap] 4. Did the health worker wash hands with soap and water using appropriate hand washing techniques and dried with clean dry cloth? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
204 [obstetric_examin_proc_re_4] Remark text
205 [womwn_made_to_lie_down] 5. Was woman made to lie down on her back with knees slightly bent and abdomen uncovered. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
206 [obstetric_examin_proc_re_5] Remark text
207 [assessed_standings_at_pgwm_rt_hnd_side] 6. Did health worker assess standing at the pregnant woman's right-hand side. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
208 [obstetric_examin_proc_re_6] Remark text
209 [assessed_scars] 7. Was pregnant woman visually accessed for any scars, skin condition of abdomen for evidence of any ringworm or scabies, and identification for pubic symphysis. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
210 [obstetric_examin_proc_re_7] Remark text
211 [check_linea_nigra_and_stria] 8. Check for Linea nigra and stria gravidarum. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
212 [obstetric_examin_proc_re_8] Remark text
213 [measure_distance_between_symphsispubis_and_fundus] 9. Was distance between symphysis pubis and fundus measured in cm with the tape face down radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
214 [obstetric_examin_proc_re_9] Remark text
215 [fundal_height_measured] 10. Was fundal height measured: (in inches) Using the ulnar border of the left hand, the examiner should ideally start palpating gently from the xiphisternum downwards till they meet the first resistance (fundus of the uterus) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
216 [obstetrc_examin_proc_re_10] Remark text
217 [abdominal_girth_measur] 11. Was abdominal girth measured (in cms) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
218 [obstetrc_examin_proc_re_11] Remark text
219 [fundal_grip] 12. Fundal grip: (facing the pregnant woman's face) Whole of fundal area is palpated using both hands laid flat on over the fundus and determined which pole of the foetus is lying in the fundus.Broad, soft, irregular mass: breechSmooth, hard or globular mass: headIn transverse lie neither of the foetal poles are palpated in the fundus radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
220 [obstetrc_examin_proc_re_12] Remark text
221 [lateral_grip_facing_the_pr] 13. Lateral grip: (facing the pregnant woman's face) After examining fundal grip, the examiner has to slip/slide their hands to both lateral sides of abdomen. Keep a hand on one side of the abdomen and palpate the other side of the abdomen with the other hand and repeat the manoeuvre to identify which side is the back, limbs and anterior shoulder of the foetus and determine the lie.Smooth curve resistant feel: Back of the foetusComparatively empty and small knob like irregular parts: limb side of the foetus. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
222 [obstetrc_examin_proc_re_13] Remark text
223 [first_pelvic_grip] 14. First pelvic grip: (facing the face of the mother) Four fingers of both hands are placed on either side of midline in lower pole of uterus and parallel to inguinal ligament. The fingers are pressed downwards and backwards in a manner of approximation of fingertips to palpate the part occupying the lower pole of uterus. Divergence of fingers indicate head is engaged.Convergence of fingers indicate head is not engaged. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
224 [obstetrc_examin_proc_re_14] Remark text
225 [second_pelvic_grip] 15. Second pelvic grip (Pawlik's grip): (facing the legs of the mother).
Turn towards the feet of the woman, slightly extending the woman's legs. Keep both hands on either side of the presenting part with fingers towards the pelvis
 radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
226 [obstetrc_examin_proc_re_15] Remark text
227 [auscultation] Auscultation descriptive
228 [fetal_heart_sound_measered] 1.Was fetal heart sound measured (fetoscope placed on the abdomen)(The foetal heart sounds are best audible on the back, left scapular region) In occiput anterior position place fetoscope in the middle of the spino umbilical line on the same side. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
229 [auscultation_re_1] Remark text
230 [examiner_listen_to_heart_sound] 2. Did the examiner listen to heart sound for one full minute. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
231 [auscultation_re_2] Remark text
232 [breast_examination] Breast examination descriptive
233 [womn_drapped_with_cloth_in_such_way_expose] 1. Was the pregnant woman draped with cloth in such a way to expose on the area to be examined? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
234 [breast_examination_re_1] Remark text
235 [supine_position] 2. In the supine position, was the women asked to uncover her body from the waist up, and place her arms at her side? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
236 [breast_examination_re_2] Remark text
237 [assess_overall_appearance] 3. Was visual inspection done to assess overall appearance of women's breast for contours, skin conditions of areola, nipples (like any inverted nipple or cracked nipple) and report any such abnormality. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
238 [breast_examination_re_3] Remark text
239 [investigations] INVESTIGATIONS descriptive
240 [name_of_device] Test for Hemoglobin (Hb) Note type/name of device that health worker uses to measure Hb text, Required
241 [necessary_items_kept_ready] 2. Were necessary items kept ready (thermometer, strips, and lancing device loaded with fresh lancet, cotton, and spirit) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
242 [investigations_re_2] Remark text
243 [match_batch_code_strip] 3. Match batch code strip & true Hb meter. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
244 [investigations_re_3] Remark text
245 [clean_the_tip_fingure] 4. Clean the same tip of the finger and puncture it with a fresh lancing device. radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
246 [investigations_re_4] Remark text
247 [first_drop_blood_discard] 5. Did the health worker discard the first drop of blood. (The punctured finger should not be pressed). radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
248 [investigations_re_5] Remark text
249 [machine_kept_in_ziplock] 6. Is the machine (TruHB and HaemoCue) kept in Ziplock bags? (Poor results on digital Hb meters are due to dust? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
250 [investigations_re_6] Remark text
251 [results_of_hb_test_record_in_mcp] 7. Were results of Hb test recorded in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
252 [investigations_re_7] Remark text
253 [hb_result_explained] 8. Was the pregnant woman explained the result of the Hb test? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
254 [investigations_re_8] Remark text
255 [hb_result_recorde_based_on_severity] 9. Was Hb test result recorded based on level of severity? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
256 [investigations_re_9] Remark text
257 [diagnosed_anemic_was_advise_given] 10. If diagnosed anemic, was advise given/treatment provided? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
258 [investigations_re_10] Remark text
259 [test_for_blood_glucose] Test for Blood Glucose descriptive
260 [glucose_test_instrument_available] 1. Was instrument available to measure blood glucose? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
261 [blood_glucose_re_1] Remark text
262 [fresh_stylets_lancets_avalable] 2. Were fresh stylets/lancets available? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
263 [blood_glucose_re_2] Remark text
264 [blood_glucose_measured] 3. Was blood glucose measured? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
265 [blood_glucose_re_3] Remark text
266 [the_method_used] 4. What was the method used? radio, Required
1OGTT
2Random
267 [blood_glucose_re_4] Remark text
268 [blood_glucose_measured_record_in_mcp_card] 5. Was blood glucose measured recorded in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
269 [blood_glucose_re_5] Remark text
270 [glucose_report_explain] 6. Was the pregnant woman explained the results of the blood glucose investigation? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
271 [blood_glucose_re_6] Remark text
272 [diagnosed_diabetic_advise_given] 7. If diagnosed Diabetic was advise given/treatment provided? (Drugs/ injections/ investigations/ follow-up visits/ referrals) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
273 [blood_glucose_re_7] Remark text
274 [test_for_hiv] Test for HIV descriptive
275 [ask_about_hiv_status] 1. Did the health worker ask about or the pregnant woman mention her HIV status? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
276 [test_for_hiv_re_1] Remark text
277 [health_worker_perform_pgwmn_hiv_test] 2. Did the health worker perform or refer the pregnant woman for HIV test? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
278 [test_for_hiv_re_2] Remark text
279 [is_hiv_positive] 3. Is the pregnant woman HIV positive? (Listen and record answer, choose "Don't know" if HIV status is unknown or status is not discussed) radio, Required
1Positive
2Negative
3Don't Know
4Not discussed
280 [test_for_hiv_re_3] Remark text
281 [health_worker_provide_couselling_for_hiv] 4. Did the health worker provide any counselling for HIV/PMTCT? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
282 [test_for_hiv_re_4] Remark text
283 [couselling_on_hiv_pmtct] Did the health worker provide counselling on the following HIV/PMTCT topics? descriptive
284 [purpose_of_arv_prophylax] a) Purpose of ARV prophylaxis radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
285 [couselling_on_hiv_pmtct_re_a] Remark text
286 [explain_when_to_collect_nvp] b)Explains when to collect NVP (Nevirapine) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
287 [couselling_on_hiv_pmtct_re_b] Remark text
288 [explains_when_take_nvp] c)Explains when to take NVP at the onset of labour radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
289 [couselling_on_hiv_pmtct_re_c] Remark text
290 [explains_how_to_take_azt] d) Explains how to take AZT at 14weeks radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
291 [couselling_on_hiv_pmtct_re_d] Remark text
292 [advantages_side_effect_of_art] e)Explains the advantages and side effects of ART radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
293 [couselling_on_hiv_pmtct_re_e] Remark text
294 [explains_feeding_options_for_babies] f) Explains feeding options for exposed babies radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
295 [couselling_on_hiv_pmtct_re_f] Remark text
296 [importance_of_bringing_exposed_baby] 2. Explains about importance of bringing exposed baby back for testing radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
297 [couselling_on_hiv_pmtct_re_2] Remark text
298 [urine_test_and_albumin_sug] Urine Test and Albumin sugar descriptive
299 [procedure_explaine] 1. Was the procedure explained to the patient before collecting the sample? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
300 [urine_test_alb_sug_re_1] Remark text
301 [container_tightly_closed] 2. Was the container tightly closed after removing one strip? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
302 [urine_test_alb_sug_re_2] Remark text
303 [strip_dipped_in_urine_sample] 3. Was the indicator side of the strip dipped in the urine sample, and taped at the edge of the container to remove excess urine? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
304 [urine_test_alb_sug_re_3] Remark text
305 [sugar_reagent_part_compared_with_sugar_chart] 4. Was the sugar reagent part compared with the sugar chart on the container? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
306 [urine_test_alb_sug_re_4] Remark text
307 [albumin_reagent_part_compared_alb_reslut_chart] 5. Was the albumin reagent part compared with the albumin results chart on the side of the bottle? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
308 [urine_test_alb_sug_re_5] Remark text
309 [results_explained_record_case_sheet] Were the results explained to the patient and recorded on the case sheet/OPD slip? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
310 [urine_test_alb_sug_re_6] Remark text
311 [syphilis_test] Syphilis Test descriptive
312 [syphilis_test_performe] 1. Was Syphilis test performed or pregnant women referred for syphilis test? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
313 [syphilis_test_1] Remark text
314 [blood_grouping_rh_typing] Blood Grouping RH typing descriptive
315 [blood_grouping_done] 1. Was test for Blood grouping and RH type done? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
316 [bld_grping_rh_typing_re_1] Remark text
317 [blood_grp_recorded_in_mcp] 2. Was blood group recorded in the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
318 [bld_grping_rh_typing_re_2] Remark text
319 [informed_abt_bld_grp] 3. Was pregnant woman informed her blood group? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
320 [bld_grping_rh_typing_re_3] Remark text
321 [ultrasound_examination] Ultrasound Examination descriptive
322 [usg_privious_carriedout] 1. Has pregnant woman had an ultrasound examination carried out previously? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
323 [usg_examination_re_1] Remark text
324 [type_of_previous_usg]
Show the field ONLY if:
[usg_privious_carriedout] = '1'
what was the type of previous USG? radio
11.Dated (1T)
22.Anamoly (2T)
33.Growth (3T)
325 [type_of_previous_usg_2]
Show the field ONLY if:
[usg_privious_carriedout] = '2'
what was the type of previous USG? radio
11.Dated (1T)
22.Anamoly (2T)
33.Growth (3T)
326 [test_documented_usg] 2. Was the test documented? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
327 [remark_test_documented] Remark text
328 [the_place_of_usg] 3. What was the place of ultrasound radio, Required
1Public
2Private
329 [name_of_facility] 4. Name of facility text, Required
330 [usg_performed_in_curnt_visit] 5. Was USG performed in the current visit? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
331 [usg_performed_in_curnt_visit_re] Remark text
332 [type_of_usg_perform]
Show the field ONLY if:
[usg_performed_in_curnt_visit] = '1'
What was the type of USG performed radio
1Dated (1T)
2Anamoly (2T)
3Growth (3T)
333 [type_of_usg_perform_2]
Show the field ONLY if:
[usg_performed_in_curnt_visit] = '2'
What was the type of USG performed radio
1Dated (1T)
2Anamoly (2T)
3Growth (3T)
334 [documented_on_the_opd_slip] 6. Was it documented on the OPD slips? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
335 [documented_on_the_opd_slip_re] Remark text
336 [place_of_usg] 7. What was the place of USG? radio
1Public
2Private
337 [name_of_the_facility_crnt] 8. Name of the facility? text
338 [finding_of_usg] 9. Describe the finding of the USG in detail text
339 [information_on_immunizatio] Information on immunization and Supplements descriptive
340 [hstr_of_immunization] 1. Did the health worker ask for a history of immunization in the current pregnancy radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
341 [infrmn_on_immunizatio_re_1] Remark text
342 [prescribed_of_tt] 2. Was pregnant woman prescribed or given an inj. of tetanus toxoid (TT). radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
343 [infrmn_on_immunizatio_re_2] Remark text
344 [expln_prpose_of_tt] 3. Was pregnant woman explained the purpose of TT injection radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
345 [infrmn_on_immunizatio_re_3] Remark text
346 [perscrible_of_folic_acid] 4. Did the health worker prescribe the pregnant woman for folic acid? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
347 [number_of_folic_acid]
Show the field ONLY if:
[perscrible_of_folic_acid] = '1'
What was the number of tablets issued? text (number), Required
348 [number_of_folic_acid_2]
Show the field ONLY if:
[perscrible_of_folic_acid] = '2'
What was the number of tablets issued? text (number), Required
349 [infrmn_on_suppliment_re_4] Remark text
350 [prescribe_ifa] 5. Did the health worker prescribe the pregnant woman for iron folic acid tablets (IFA)? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
351 [infrmn_on_suppliment_re_5] Remark text
352 [she_given_supply_of_ifa] 6. Was she given supply of iron folic acid? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
353 [infrmn_on_suppliment_re_6] Remark text
354 [dosage_advice]
Show the field ONLY if:
[she_given_supply_of_ifa] = '1'
What dosage she was advised? radio, Required
1Single dose/day
2Two doses/day
355 [dosage_advice_2]
Show the field ONLY if:
[she_given_supply_of_ifa] = '2'
What dosage she was advised? radio, Required
1Single dose/day
2Two doses/day
356 [no_of_tablet_issued]
Show the field ONLY if:
[she_given_supply_of_ifa] = '1'
How many IFA tablets were issued to the pregnant woman? text (number)
357 [no_of_tablet_issued_2]
Show the field ONLY if:
[she_given_supply_of_ifa] = '2'
How many IFA tablets were issued to the pregnant woman? text (number)
358 [explained_the_purpse_ifa] 7. Was she explained the purpose of consuming IFA tablets? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
359 [infrmn_on_suppliment_re_7] Remark text
360 [prescribe_ifa_appropriate] 8. Is ANM/CHO/MO prescribing the appropriate number (< =11 gm/dl should be given double dose per day) of IFA tablets for their Hb values (checking from records) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
361 [infrmn_on_suppliment_re_8] Remark text
362 [explained_side_effect] 9. Was she explained the side effects of IFA tablets? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
363 [infrmn_on_suppliment_re_9] Remark text
364 [ifa_issuing_record_on_mcp_card] 10. Was the issuing of IFA tablets recorded on the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
365 [infrmn_on_suppliment_re_10] Remark text
366 [pregnant_deworming_tab] 11. Was the pregnant woman prescribed or given deworming tablets? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
367 [infrmn_on_suppliment_re_11] Remark text
368 [explained_the_purps_deworming] 12. Was she explained the purpose of deworming tablets? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
369 [infrmn_on_suppliment_re_12] Remark text
370 [explained_how_to_take_deworning_tab] 13. Was she explained how to take deworming tablets? (Should be asked to chew upon the tablets) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
371 [infrmn_on_suppliment_re_13] Remark text
372 [explained_the_side_effects_deworming] 14. Was she explained the side effects of deworming tablets? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
373 [infrmn_on_suppliment_re_14] Remark text
374 [issuing_record_of_deworming_on_mcp_card] 15. Was the issuing of deworming tablet recorded on the MCP card? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
375 [infrmn_on_suppliment_re_15] Remark text
376 [calcium_tablets_issue] 16. Were Calcium tablets issued to the pregnant woman? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
377 [how_many_calcium_tablets_issued]
Show the field ONLY if:
[calcium_tablets_issue] = '1'
how many Calcium tablets were issued to the pregnant woman? text (number), Required
378 [how_many_calcium_tablets_issued_2]
Show the field ONLY if:
[calcium_tablets_issue] = '2'
how many Calcium tablets were issued to the pregnant woman? text (number), Required
379 [infrmn_on_suppliment_re_16] Remark text
380 [counselling_details] Counselling details descriptive
381 [health_worker_info_progress_of_pregnancy] 1. Did the health worker inform the pregnant woman about the progress of the pregnancy? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
382 [couselling_deatails_re_1] Remark text
383 [health_worker_counsel_to_pgwm_on_following_condition] 2. Did the health worker counsel the pregnant woman in any of the following reasons to seek immediate medical care? descriptive
384 [immediate_care_if_vaginal_bleeding] a) Seek immediate care if she has vaginal bleeding radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
385 [couselling_deatails_re_2a] Remark text
386 [has_convulsions] b) If she has convulsions radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
387 [couselling_deatails_re_2b] Remark text
388 [severe_headach_blurred_vision] c. If she has severe headaches or blurred visions radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
389 [couselling_deatails_re_2c] Remark text
390 [fever_and_is_too_weak] d) If she has fever and is too weak to get out of bed radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
391 [couselling_deatails_re_2d] Remark text
392 [severe_abdominal_pain] e) If she has severe abdominal pain radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
393 [couselling_deatails_re_2e] Remark text
394 [fast_or_difficult_in_breathing] f) If she has fast or difficult breathing radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
395 [couselling_deatails_re_2f] Remark text
396 [high_fever] g) If she has high fever radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
397 [couselling_deatails_re_2g] Remark text
398 [foul_smelling_dschrg_vagina] h. If she has foul smelling discharge per vagina radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
399 [couselling_deatails_re_2h] Remark text
400 [counsel_abt_birth_preparation] 3. Did the health worker counsel the pregnant woman in any of the following ways about birth preparation? descriptive
401 [where_she_will_deliver_and_encoraged_to_have_facility_delevery] a. Asked the client where she will deliver and encouraged her to have a facility delivery? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
402 [couselling_deatails_re_3a] Remark text
403 [advised_prepare_for_delivery] b. Advised the client to prepare for delivery?(set aside money, arrange for emergency transportation) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
404 [couselling_deatails_re_3b] Remark text
405 [advised_used_skill_health_worker] c) Advised the client to use a skilled health worker during delivery? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
406 [couselling_deatails_re_3c] Remark text
407 [carry_things_when_lb_pain_start] d) What all to carry when the labour pain starts? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
408 [couselling_deatails_re_3d] Remark text
409 [discuss_nutrition_and_healrthy_eating_during_preg] 4. Did the health worker discuss nutrition and healthy eating during pregnancy? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
410 [couselling_deatails_re_4] Remark text
411 [guidence_for_intake_hcm] 5. Did the health worker provide guidance for intake of Hot cooked Meals (HCM)/Take home rations (THR) from AWCs? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
412 [couselling_deatails_re_5] Remark text
413 [discuss_breastfeeding] 6. Did the health worker discuss breastfeeding? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
414 [couselling_deatails_re_6] Remark text
415 [discuss_on_family_planning] 7. Did the health worker discuss family planning for use after delivery? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
416 [couselling_deatails_re_7] Remark text
417 [discuss_on_nxt_visit] 8. Did the health worker counsel on when to return for next visit? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
418 [couselling_deatails_re_8] Remark text
419 [ask_any_other_question] 9. Did the health worker ask whether the pregnant woman had any questions? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
420 [couselling_deatails_re_9] Remark text
421 [use_visual_aids_for_education] 10. Did the health worker use any visual aids for health education or counselling during the consultation? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
422 [couselling_deatails_re_10] Remark text
423 [speak_easy_to_understand] 11. Did the health worker speak using easy-to-understand language for the health worker? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
424 [couselling_deatails_re_11] Remark text
425 [look_at_pgmn_mcp_health_card] 12. Did the health worker look at the pregnant woman's MCP/ health card/booklet, either before beginning the consultation or while collecting information or examining her?(Choose "Not assessed" if MCP card not available) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
426 [couselling_deatails_re_12] Remark text
427 [write_on_clients_health_card] 13. Did the health worker write on the client's health card? (Choose "Not assessed" if no card/booklet) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
428 [couselling_deatails_re_13] Remark text
429 [identification_of_high_ris] Identification of High Risk descriptive
430 [identified_as_high_risk] 1. Was the pregnant woman identified as High risk? (Did the facility recognise/record the woman as High risk) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
431 [high_risk_identification1] Remark text
432 [reason_for_high_risk]
Show the field ONLY if:
[identified_as_high_risk] = '1'
Reason for high risk checkbox, Required
1reason_for_high_risk___1Hypertension
2reason_for_high_risk___2Diabetes
3reason_for_high_risk___3Moderate/Severe Anemia
4reason_for_high_risk___4BOH
5reason_for_high_risk___5Other
433 [reason_for_high_risk_2]
Show the field ONLY if:
[identified_as_high_risk] = '2'
Reason for high risk checkbox, Required
1reason_for_high_risk_2___1Hypertension
2reason_for_high_risk_2___2Diabetes
3reason_for_high_risk_2___3Moderate/Severe Anemia
4reason_for_high_risk_2___4BOH
5reason_for_high_risk_2___5Other
434 [other_high_risk]
Show the field ONLY if:
[reason_for_high_risk(5)] = '1'
Other text
435 [women_detected_for_hrp] 2. Was the women detected for HRP in previous visit radio, Required
1Yes
2No
3NA
436 [was_the_diagnosis_hrp]
Show the field ONLY if:
[women_detected_for_hrp] = '1'
What was the diagnosis text
437 [management_given_complied] 3. Management given Complied
radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
438 [hgh_risk_idntfction_re_3] Remark text
439 [how_pgwmn_manged] 4. How was the pregnant woman managed? radio, Required
1Managed at the facility
2Referred to a higher Centre
3Other
440 [other_managed_women]
Show the field ONLY if:
[how_pgwmn_manged]='3'
Other text
441 [facility_describe_management]
Show the field ONLY if:
[how_pgwmn_manged]='1'
If managed at the facility, describe the management (Drugs administered/injections administered/other investigations/counselling provided) radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
442 [high_risk_identification4]
Show the field ONLY if:
[how_pgwmn_manged]='1'
Remark text
443 [course_of_managemet_of_hrp] 4. Was the course of management and nature of HRP explained to the family members? radio, Required
1Full Compliance
2Partially compliance
3Not performed
4Not assessed
444 [hgh_risk_idntfction_re_4] Remark text
445 [outcome_of_visit] Outcome of Visit: descriptive
446 [health_worker_whether_this_was_a_referral_visit] 1. Ask health worker whether this was a referral visit or a routine ANC visit radio, Required
1Referral Visit
2ANC visit
447 [ask_the_health_worker_how] 2. Ask the health worker how many weeks pregnant the woman is(in weeks) text (number), Required
448 [record_the_outcome_of_the_consulation] Record the outcome of the consultation- radio, Required
1Pregnant woman goes home
2Pregnant woman referred (same facility)
3Pregnant woman admitted (same facility)
4Pregnant woman referred to other facility
449 [referral_was_slip_provide]
Show the field ONLY if:
[record_the_outcome_of_the_consulation] = '2'
In case of referral was referral slip provided? yesno, Required
1Yes
0No
450 [referral_was_slip_provide_2]
Show the field ONLY if:
[record_the_outcome_of_the_consulation] = '4'
In case of referral was referral slip provided? yesno, Required
1Yes
0No
451 [observation_end_time] 3. Observation End Time-
text (time_hh_mm_ss)
Field Annotation: @NOW
452 [name_of_field_officer] Name of field officer text
Field Annotation: @HIDEBUTTON @APPUSERNAME-APP
 
 453 [form_1_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
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