|
1 |
[record_id] |
Record ID |
text |
|
2 |
[name_of_the_nurse] |
Name of the nurse |
text, Required Field Annotation: @APPUSERNAME-APP |
|
3 |
[section_1_facility_informa] |
Section 1: Facility Information |
descriptive |
|
4 |
[name_of_the_healthcare_fac] |
1. Name of the healthcare facility |
text, Required |
|
5 |
[facility_type_hwc_sc_phc_c] |
2. Facility type |
radio, Required1 | HWC | 2 | SC | 3 | PHC | 4 | CHC | 5 | SDH | 6 | District hospital | 7 | Private clinic | 8 | Other |
|
|
6 |
[other_facility_type]
Show the field ONLY if:
[facility_type_hwc_sc_phc_c] = '8'
|
Other facility type |
text, Required |
|
7 |
[name_of_village] |
3. Name of village |
text, Required |
|
8 |
[name_of_sub_center] |
4. Name of sub-center |
text, Required |
|
9 |
[block] |
5. Block |
radio, Required1 | Sherpur | 2 | Sangrur | 3 | Bhawanigarh | 4 | Sunam | 5 | Longowal | 6 | Moonak | 7 | Kauhrian | 8 | Dhuri |
|
|
10 |
[name_of_district] |
6. Name of district |
text, Required |
|
11 |
[total_number_of_medical_of] |
7.0 Total number of medical officers recruited to work at this facility |
text (number), Required |
|
12 |
[name_of_the_medical_doctor] |
7.1 Name of the medical officer present during PMSMA session |
text, Required |
|
13 |
[highest_qualification_of_t] |
7.2 Highest qualification of the medical officer, if present, during PMSMA session |
text, Required |
|
14 |
[contact_information_of_the] |
7.3 Contact information of the medical officer |
text (number, Min: 4444444444, Max: 9999999999), Required Field Annotation: @FORCE-MINMAX |
|
15 |
[date_of_pmsma_session_obse] |
8. Date of PMSMA session observation |
text (date_dmy), Required |
|
16 |
[total_hours_dedicated_to_p] |
9.Total hours dedicated to PMSMA session: |
text (number), Required |
|
17 |
[section_2_human_resource_b] |
Section 2: Human resource & beneficiaries |
descriptive, Required |
|
18 |
[total_number_of_asha_worke] |
10.0 Total number of ASHA workers recruited to work at this facility |
text (number), Required |
|
19 |
[number_of_asha_workers_pre] |
10. Number of ASHA workers present in PMSMA session: |
text (integer), Required |
|
20 |
[total_number_of_anm_worker] |
11.0 Total number of ANM workers recruited to work at this facility |
text (number), Required |
|
21 |
[number_of_anms_present_in] |
11. Number of ANMs present in PMSMA session: |
text (integer), Required |
|
22 |
[total_number_of_obstetrici] |
12.0 Total number of Obstetricians recruited to work at this facility |
text (number), Required |
|
23 |
[number_of_obstetricians_av] |
12. Number of Obstetricians available in PMSMA session |
text (integer), Required |
|
24 |
[total_number_of_gynecologi] |
13.0 Total number of Gynecologists recruited to work at this facility |
text (number), Required |
|
25 |
[number_of_gynecologists_av] |
13.Number of Gynecologists available in PMSMA session:
|
text (integer), Required |
|
26 |
[total_number_of_radiologis] |
14.0 Total number of Radiologists/Sonologists recruited to work at this facility |
text (number), Required |
|
27 |
[number_of_radiologists_ava] |
14.Number of Radiologists / Sonologists available in PMSMA session |
text (integer), Required |
|
28 |
[total_number_of_pregnant_w] |
15. Total number of pregnant women who attended PMSMA session at that facility: |
text (integer), Required |
|
29 |
[number_of_antenatal_check] |
16.Number of antenatal check-ups done in PMSMA session |
text (integer), Required |
|
30 |
[number_of_high_risk_pregna] |
17. Number of high-risk pregnancies identified in PMSMA session
|
text (integer), Required |
|
31 |
[number_of_pregnant_women_r] |
18.Number of pregnant women referred for specialist consultation in PMSMA session: |
text (integer), Required |
|
32 |
[section_3_services_deliver] |
Section 3: Services delivered |
descriptive, Required |
|
33 |
[general_antenatal_check_up] |
1. General antenatal check-up done for all pregnant women attending PMSMA session |
yesno, Required |
|
34 |
[gestational_age_recorded_i] |
2. Gestational age recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
35 |
[whether_a_functional_weigh] |
3. Whether a functional weighing machine available in PMSMA session |
yesno, Required |
|
36 |
[weight_measurement_done_fo] |
4.Weight measurement done for all pregnant women attending PMSMA session |
yesno, Required |
|
37 |
[was_weight_recorded_in_reg] |
5.was weight recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
38 |
[whether_a_functional_sphyg] |
6. Whether a functional sphygmomanometer and stethoscope available in PMSMA session OR anywhere else within the premise that was used to check the BP of all pregnant women attending PMSMA session |
yesno, Required |
|
39 |
[blood_pressure_measurement] |
7.Blood pressure measurement done for all pregnant women attending PMSMA session |
yesno, Required |
|
40 |
[was_blood_pressure_recorde] |
8. was Blood pressure recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
41 |
[were_diagnostic_services_a] |
9. were diagnostic services available for hemoglobin screening in PMSMA session |
yesno, Required |
|
42 |
[hemoglobin_estimation_done] |
10. Hemoglobin estimation done for all pregnant women attending PMSMA session |
yesno, Required |
|
43 |
[was_hemoglobin_estimation] |
11. was hemoglobin estimation recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
44 |
[bld_glucoz_screening] |
12. were diagnostic services available for Blood Glucose screening in PMSMA session |
yesno, Required |
|
45 |
[blood_sugar_testing_done_f] |
13. Blood sugar testing done for all pregnant women attending PMSMA session |
yesno, Required |
|
46 |
[was_glucose_estimation_rec] |
14. was glucose estimation recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
47 |
[sugar_prot_scren] |
15. were diagnostic services available for urine test for sugar/protein screening in PMSMA session |
yesno, Required |
|
48 |
[urine_test_for_sugar_prote] |
16. Urine test for sugar/protein done for all pregnant women attending PMSMA session |
yesno, Required |
|
49 |
[were_urine_test_results_fo] |
17. were urine test results for sugar/protein recorded in ANC registers for all pregnant women attending PMSMA session |
yesno, Required |
|
50 |
[usg_screening] |
18.were diagnostic services available for USG screening in PMSMA session |
yesno, Required |
|
51 |
[ultrasound_examination_don] |
19. Ultrasound examination done for all pregnant women attending PMSMA session |
yesno, Required |
|
52 |
[were_usg_results_of_hrps_r] |
20. were USG results of HRPs recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
53 |
[were_functional_instrument] |
21. were functional instruments available for checking the FHS in PMSMA session |
yesno, Required |
|
54 |
[was_fhs_checked_for_all_pr] |
22. was FHS checked for all pregnant women attending PMSMA session |
yesno, Required |
|
55 |
[was_fhs_recorded_in_regist] |
23. was FHS recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
56 |
[vdrl_screening] |
24. were diagnostic services available for VDRL/Syphilis screening in PMSMA session |
yesno, Required |
|
57 |
[was_vdrl_syphilis_screenin] |
25. was VDRL/Syphilis screening done for all pregnant women attending PMSMA session |
yesno, Required |
|
58 |
[were_vdrl_syphilis_screeni] |
26. were VDRL/Syphilis screening results recorded in registers for all pregnant women attending PMSMA session |
yesno, Required |
|
59 |
[were_hrps_identified_among] |
27. were HRPs identified among all pregnant women attending PMSMA session |
yesno, Required |
|
60 |
[were_line_list_of_hrps_mai] |
28. were line-list of HRPs maintained (including place of deliveries) for all pregnant women attending PMSMA session |
yesno, Required |
|
61 |
[were_hrps_referred_to_high] |
29. were HRPs referred to higher facility in PMSMA session |
yesno, Required |
|
62 |
[counseling_on_diet_and_nut] |
30. Counseling on diet and nutrition in PMSMA session |
yesno, Required |
|
63 |
[counseling_on_birth_planni] |
31.Counseling on birth planning/preparedness in PMSMA session |
yesno, Required |
|
64 |
[counseling_on_birth_compli] |
32. Counseling on birth complication readiness/danger signs of pregnancy given in PMSMA session |
yesno, Required |
|
65 |
[counseling_on_jssk_benefit] |
33. Counseling on JSSK benefits given in PMSMA session |
yesno, Required |
|
66 |
[was_calcium_supplementatio] |
34. was Calcium supplementation provided in PMSMA session |
yesno, Required |
|
67 |
[was_ifa_supplementation_pr] |
35. was IFA supplementation provided in PMSMA session |
yesno |
|
68 |
[were_iec_material_s_availa] |
36. were IEC material/s available in PMSMA session |
yesno, Required |
|
69 |
[did_the_venue_has_clean_to] |
36. did the venue has clean toilet and drinking water available |
yesno, Required |
|
70 |
[any_other_observation_spec] |
37. Any other observation (specify) |
text, Required |
|
71 |
[section_4_data_collection] |
Section 4: Data Collection and Reporting |
descriptive |
|
72 |
[was_the_standardized_pmsma] |
19. Was the standardized PMSMA data format used for data entry? |
yesno, Required |
|
73 |
[was_there_a_dedicated_pmsm] |
20. Was there a dedicated PMSMA register maintained for PMSMA session entries? |
yesno, Required |
|
74 |
[why_not]
Show the field ONLY if:
[was_there_a_dedicated_pmsm] = '0'
|
20.1 why not? |
text, Required |
|
75 |
[where_were_the_entries_bei]
Show the field ONLY if:
[was_there_a_dedicated_pmsm] = '0'
|
20.2 . where were the entries being recorded? |
text, Required |
|
76 |
[were_the_service_details_c] |
21. Were the service details compiled and submitted by the ANM to the facility in-charge? |
yesno, Required |
|
77 |
[did_the_facility_submit_th] |
22. Did the facility submit the compiled report to the district authorities within the stipulated timeframe? |
yesno, Required |
|
78 |
[were_any_discrepancies_not] |
23. Were any discrepancies noted in data collection or reporting? |
yesno, Required |
|
79 |
[specify_record_dispenciary]
Show the field ONLY if:
[were_any_discrepancies_not] = '1'
|
specify |
text, Required |
|
80 |
[monitoring_and_supervision] |
Section 5: Monitoring and Supervision |
descriptive |
|
81 |
[were_monitoring_officials] |
24. Were monitoring officials present on the PMSMA day? |
yesno, Required |
|
82 |
[specify_their_designation]
Show the field ONLY if:
[were_monitoring_officials] = '1'
|
24.1 . specify their designation |
text, Required |
|
83 |
[were_any_gaps_or_challenge] |
25. Were any gaps or challenges identified in service delivery by monitoring officials present on the PMSMA day? |
yesno, Required |
|
84 |
[specify_gap]
Show the field ONLY if:
[were_any_gaps_or_challenge] = '1'
|
specify |
text, Required |
|
85 |
[were_corrective_actions_su] |
26. Were corrective actions suggested and implemented by monitoring officials present on the PMSMA day? |
yesno, Required |
|
86 |
[specify_corrective_action]
Show the field ONLY if:
[were_corrective_actions_su] = '1'
|
specify |
text, Required |
|
87 |
[section_6_pmsma_app_e_pmsm] |
Section 6: PMSMA App & e-PMSMA Tracking |
descriptive |
|
88 |
[was_the_pmsma_app_used_for] |
27.Was the PMSMA app used for volunteer registration and engagement? |
yesno, Required |
|
89 |
[were_private_voluntary_ret] |
28.Were private/voluntary/retired doctors involved in providing free antenatal services? |
yesno, Required |
|
90 |
[specify_number_antal_services]
Show the field ONLY if:
[were_private_voluntary_ret] = '1'
|
specify number |
text (number), Required |
|
91 |
[was_e_pmsma_used_to_track] |
29.Was e-PMSMA used to track high-risk pregnancies? |
yesno, Required |
|
92 |
[hrp_update_epsmas] |
30. Number of high-risk pregnancies updated in the e-PMSMA system |
text (integer), Required |
|
93 |
[feedbacd] |
Section 7: Feedback and Recommendations |
descriptive |
|
94 |
[was_a_dedicated_pmsma_sess] |
31.1. Was a dedicated PMSMA session being conducted at the facility? |
yesno, Required |
|
95 |
[why_not_psma_at_facili]
Show the field ONLY if:
[was_a_dedicated_pmsma_sess] = '0'
|
why not? |
text, Required |
|
96 |
[challenges_faced_during_pm] |
32. Challenges faced during PMSMA implementation |
text, Required |
|
97 |
[suggestions_for_improving] |
33. Suggestions for improving PMSMA service delivery |
text, Required |
|
99 |
[filled_by] |
Filled by: |
text, Required |
|
100 |
[designation] |
Designation: |
text, Required |
|
101 |
[date_pmsa] |
Date: |
text (date_dmy), Required |
|
102 |
[form_1_complete] |
Section Header: Form Status
Complete?
|
dropdown0 | Incomplete | 1 | Unverified | 2 | Complete |
|