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Aam Aadmi Mohalla Clinic - Facility ChecklistPID 34
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 08/19/2025 9:17am
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Data Dictionary Codebook
Aam Aadmi Mohalla Clinic - Facility Checklist (PID: 34)
08/19/2025 9:17am
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) Enabled as survey
1 [record_id] Record ID text
2 [basic_facility_information] Basic Facility Information descriptive
3 [a1_name_of_clinic] A1. Name of Clinic text, Required
4 [name_of_village] Name of village text, Required
5 [a2_name_of_block] A2. Name of Block text, Required
6 [a3_date_of_visit] A3. Date of Visit text (date_dmy), Required
7 [day_of_visit] Day of Visit radio, Required
1Sunday
2Monday
3Tuesday
4Wednesday
5Thursday
6Friday
7Saturday
8 [a4_name_of_assessor] A4. Name of Assessor text, Required
Field Annotation: @APPUSERNAME-APP
9 [a6_urban_rural] A6. Urban / Rural dropdown, Required
1Urban
2Rural
10 [a7_population_covered] A7. Population Covered text (number)
11 [b_infrastructure_equipment] B. Infrastructure & Equipment descriptive
12 [b1_is_the_facility_name_vi] Is the facility name and signage visible from outside? yesno, Required
1Yes
0No
13 [is_the_facility_name_board] B2. Is the facility name board in local language Punjabi? yesno, Required
1Yes
0No
14 [then_which_language]
Show the field ONLY if:
[is_the_facility_name_board] = '0'
Then which language? checkbox, Required
1then_which_language___1Hindi
2then_which_language___2English
15 [are_there_sign_boards_disp] B3. Are there sign boards displayed in local language for checkbox, Required
1are_there_sign_boards_disp___1a. Reception
2are_there_sign_boards_disp___2b.Waiting area
3are_there_sign_boards_disp___3c. Pharmacy
4are_there_sign_boards_disp___4d. Doctor's room
5are_there_sign_boards_disp___5e. laboratory
6are_there_sign_boards_disp___6f. Toilets
7are_there_sign_boards_disp___7g. Drinking water
8are_there_sign_boards_disp___8None of the above
16 [b4_is_the_aamc_facility_st] B4. Is the AAMC facility standalone or collocated with HWC radio, Required
1Standalone
2Colocated
17 [name_of_phc_attached]
Show the field ONLY if:
[b4_is_the_aamc_facility_st]='2'
Name of PHC attached text, Required
18 [b5_from_where_your_clinic] B5. From where your clinic receives financial aid text, Required
19 [where_your_clinic_rec_logi] From where your clinic receives logistical support text, Required
20 [b6_do_you_receive_any_spec] B6. Do you receive any specific fund or monthly budget? yesno, Required
1Yes
0No
21 [b7_please_specify_who_mana] B7. Please Specify who manages it and how? text
22 [b8_is_waiting_area_with_se] B8. Is Waiting area with seating available? yesno, Required
1Yes
0No
23 [b9_is_a_triage_area_presen] B9. Is a triage area present ? yesno, Required
1Yes
0No
24 [b10_is_clean_drinking_wate] B10. Is Clean drinking water available yesno, Required
1Yes
0No
25 [b10_is_electricity_with_ba] B10. Is Electricity with backup available? yesno, Required
1Yes
0No
26 [b11_is_functional_toilet_s] B11. Is Functional toilet (separate for staff and patients if possible) available? yesno, Required
1Yes
0No
27 [b12_is_a_handwashing_stati] B12. Is a Handwashing station with soap/sanitizer available? yesno, Required
1Yes
0No
28 [b13_is_there_any_education] B13. Is there any educational material displayed on the wall?
Are they related to:
 yesno, Required
1Yes
0No
29 [a_anc_visits]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
a. ANC Visits yesno, Required
1Yes
0No
30 [b_institutional_delivery]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
b. Institutional delivery yesno, Required
1Yes
0No
31 [c_ifa_tablets_signs]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
c. IFA tablets Signs yesno, Required
1Yes
0No
32 [d_mother_and_child_immuniz]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
d. Mother and child Immunization yesno, Required
1Yes
0No
33 [e_nutrition_during_pregnan]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
e. Nutrition during pregnancy yesno, Required
1Yes
0No
34 [f_eclampsia_preeclampsia]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
f. Eclampsia/ Preeclampsia yesno, Required
1Yes
0No
35 [g_danger_signs]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
g. Danger signs yesno, Required
1Yes
0No
36 [h_birth_preparedness]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
h. Birth preparedness yesno, Required
1Yes
0No
37 [i_handwashing]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
i. Handwashing yesno, Required
1Yes
0No
38 [j_k_non_communicable_disea]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
j. Non-communicable diseases yesno, Required
1Yes
0No
39 [mention_the_theme_ncd]
Show the field ONLY if:
[j_k_non_communicable_disea] = '1'
Mention the theme text, Required
40 [k_hypertension]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
k. Hypertension yesno, Required
1Yes
0No
41 [l_diabetes]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
l. Diabetes yesno, Required
1Yes
0No
42 [m_medicines_available_at_a]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
m. Medicines available at AAM clinic yesno, Required
1Yes
0No
43 [n_medicines_available_at_a]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
n. Medicines available at AAM clinic yesno, Required
1Yes
0No
44 [o_diagnostic_services_avai]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
o. Diagnostic services available at AAM clinic yesno, Required
1Yes
0No
45 [p_any_other]
Show the field ONLY if:
[b13_is_there_any_education] = '1'
p. Any other text, Required
46 [b14_printed_health_educati] B14. Printed health-educational materials, posters and leaflets (ANC, NCD, hygiene) yesno, Required
1Yes
0No
47 [b15_are_biomedical_waste_b] B15. Are Biomedical waste bins color-coded and available?

 yesno, Required
1Yes
0No
48 [red]
Show the field ONLY if:
[b15_are_biomedical_waste_b] = '1'
Red yesno, Required
1Yes
0No
49 [blue]
Show the field ONLY if:
[b15_are_biomedical_waste_b] = '1'
Blue yesno, Required
1Yes
0No
50 [yellow]
Show the field ONLY if:
[b15_are_biomedical_waste_b] = '1'
Yellow yesno, Required
1Yes
0No
51 [white]
Show the field ONLY if:
[b15_are_biomedical_waste_b] = '1'
White yesno, Required
1Yes
0No
52 [are_biomedical_waste_dispo] Are Biomedical waste disposal linked with vendor? yesno, Required
1Yes
0No
53 [is_fire_extinguisher_prese] Is Fire extinguisher present and functional? yesno, Required
1Yes
0No
54 [c_human_resources_staff_po] c. Human Resources: Staff Position descriptive
55 [c1_doctor_present] Doctor- Present yesno, Required
1Yes
0No
56 [is_the_post_vacant_or_fill]
Show the field ONLY if:
[c1_doctor_present] = '0'
Is the post vacant or filled radio, Required
1vacant
2filled
57 [name_of_doctor]
Show the field ONLY if:
[is_the_post_vacant_or_fill] = '2' or [c1_doctor_present] = '1'
Name of Doctor text, Required
58 [age_of_doctor]
Show the field ONLY if:
[is_the_post_vacant_or_fill] = '2' or [c1_doctor_present] = '1'
Age of Doctor text (number), Required
59 [educational_qualification_dr]
Show the field ONLY if:
[is_the_post_vacant_or_fill] = '2' or [c1_doctor_present] = '1'
Educational Qualification text, Required
60 [attendance_doc]
Show the field ONLY if:
[is_the_post_vacant_or_fill] = '2' or [c1_doctor_present] = '1'
Attendance frequency text, Required
61 [c2_pharmacist_present] Pharmacist - Present yesno, Required
1Yes
0No
62 [is_the_post_vacant_or_fill_c2]
Show the field ONLY if:
[c2_pharmacist_present] = '0'
Is the post vacant or filled radio, Required
1vacant
2filled
63 [name_of_pharmacist]
Show the field ONLY if:
[is_the_post_vacant_or_fill_c2] = '2' OR [c2_pharmacist_present] = '1'
Name of Pharmacist text, Required
64 [age_of_pharmacist]
Show the field ONLY if:
[is_the_post_vacant_or_fill_c2] = '2' OR [c2_pharmacist_present] = '1'
Age of Pharmacist text (number), Required
65 [educational_qualification_c2]
Show the field ONLY if:
[is_the_post_vacant_or_fill_c2] = '2' OR [c2_pharmacist_present] = '1'
Educational Qualification text, Required
66 [attendance_c2]
Show the field ONLY if:
[is_the_post_vacant_or_fill_c2] = '2' OR [c2_pharmacist_present] = '1'
Attendance frequency text, Required
67 [clinic_assist_support_c3] Clinic Assistant/ Support assistant - Present yesno, Required
1Yes
0No
68 [is_the_post_vacant_c3]
Show the field ONLY if:
[clinic_assist_support_c3] ='0'
Is the post vacant or filled radio, Required
1Vacant
2Filled
69 [name_and_age_c3]
Show the field ONLY if:
[clinic_assist_support_c3] ='1' or [is_the_post_vacant_c3] ='2'
Name and Age text, Required
70 [educational_qualification_c3]
Show the field ONLY if:
[clinic_assist_support_c3] ='1' or [is_the_post_vacant_c3] ='2'
Educational Qualification text, Required
71 [attendance_c3]
Show the field ONLY if:
[clinic_assist_support_c3] ='1' or [is_the_post_vacant_c3] ='2'
Attendance frequency text, Required
72 [sweeper_helper_c4] Sweeper/Helper - Present yesno, Required
1Yes
0No
73 [is_the_post_vacant_c4]
Show the field ONLY if:
[sweeper_helper_c4]='0'
Is the post vacant or filled radio, Required
1Vacant
2Filled
74 [name_and_age_c4]
Show the field ONLY if:
[is_the_post_vacant_c4]='2' OR [sweeper_helper_c4]='1'
Name and age text, Required
75 [educational_qualification]
Show the field ONLY if:
[is_the_post_vacant_c4]='2' OR [sweeper_helper_c4]='1'
Educational Qualification text, Required
76 [attendance_c4]
Show the field ONLY if:
[is_the_post_vacant_c4]='2' OR [sweeper_helper_c4]='1'
Attendance frequency text, Required
77 [d_availability_of_essentia] D. Availability of Essential Medicines: Medicine Names descriptive
78 [d1_analgesics_antipyretics] D1. Analgesics-antipyretics - Available
(1, Paracetamol
2, Lbuprofen
3, Diclofenac, etc) 		yesno, Required
1Yes
0No
79 [was_it_ever_indented_d1]
Show the field ONLY if:
[d1_analgesics_antipyretics] = '0'
was it ever indented yesno, Required
1Yes
0No
80 [name_the_medicine_which_d1]
Show the field ONLY if:
[d1_analgesics_antipyretics] = '1' OR [was_it_ever_indented_d1] = '1'
Name the medicine which are prescribed for pregnant women text, Required
81 [d2_antibiotics] D2. Antibiotics - Available
(e.g. Amoxicillin, Cefixime, Cefpodoxime, Metronidazole, Ornidazole Doxycycline, Norfloxacin, Amoxycillin+Clauvulanic Acid, Framycetin Sulphate, Azithromycin, Silver sulphadiazine, Fusidic acid, Ciprofloxacin etc.) 		yesno, Required
1Yes
0No
82 [was_it_ever_indented_d2]
Show the field ONLY if:
[d2_antibiotics] = '0'
was it ever indented yesno, Required
1Yes
0No
83 [name_the_medicine_which_d2]
Show the field ONLY if:
[d2_antibiotics] = '1' or [was_it_ever_indented_d2] = '1'
Name the medicine which are prescribed for pregnant women text, Required
84 [d3_antidiabetics_present] D3 Antidiabetics - Available
(e.g. Metformin, Insulin etc) 		yesno, Required
1Yes
0No
85 [was_it_ever_indented_d3]
Show the field ONLY if:
[d3_antidiabetics_present] = '0'
was it ever indented yesno, Required
1Yes
0No
86 [medicine_which_d3]
Show the field ONLY if:
[d3_antidiabetics_present]='1' or [was_it_ever_indented_d3] = '1'
Name the medicine which are prescribed for pregnant women text, Required
87 [antihypertensives_avail_d4] D4. Antihypertensives available
(e.g. Amlodipine,Telmisartan, Metoprolol, Atenolol, etc. ) 		yesno, Required
1Yes
0No
88 [was_it_ever_indented_d4]
Show the field ONLY if:
[antihypertensives_avail_d4] = '0'
was it ever indented yesno, Required
1Yes
0No
89 [medicine_which_d4]
Show the field ONLY if:
[antihypertensives_avail_d4] = '1' or [was_it_ever_indented_d4] ='1'
Name the medicine which are prescribed for pregnant women text, Required
90 [d5_anti_allergic_anti_hist] D5. Anti allergic/anti histamine- Available
(e.g. Cetirizine, levocetirizine, Montelukast) 		yesno, Required
1Yes
0No
91 [was_it_ever_indented_d5]
Show the field ONLY if:
[d5_anti_allergic_anti_hist]='0'
was it ever indented yesno, Required
1Yes
0No
92 [medicine_which_d5]
Show the field ONLY if:
[d5_anti_allergic_anti_hist]='1' or [was_it_ever_indented_d5] ='1'
Name the medicine which are prescribed for pregnant women text, Required
93 [d6_anti_anemics_hematinic] D6. Anti anemics/Hematinic - Available
(e.g. Iron Folic Acid (IFA) large red dried ferrous sulphate, tablets) 		yesno, Required
1Yes
0No
94 [was_it_ever_indented_d6]
Show the field ONLY if:
[d6_anti_anemics_hematinic]='0'
was it ever indented yesno, Required
1Yes
0No
95 [medicine_which_d6]
Show the field ONLY if:
[d6_anti_anemics_hematinic]='1' or [was_it_ever_indented_d6] ='1'
Name the medicine which are prescribed for pregnant women text, Required
96 [d7_calcium_tablets_avilabl] D7. Calcium tablets - Available
(e.g. Calcium carbonate, Ca Syrup) 		yesno, Required
1Yes
0No
97 [was_it_ever_indented_d7]
Show the field ONLY if:
[d7_calcium_tablets_avilabl]='0'
was it ever indented yesno, Required
1Yes
0No
98 [medicine_which_d7]
Show the field ONLY if:
[d7_calcium_tablets_avilabl]='1' or [was_it_ever_indented_d7]='1'
Name the medicine which are prescribed for pregnant women text, Required
99 [d8_ors_sachets] D8. ORS sachets - Avilable yesno, Required
1Yes
0No
100 [was_it_ever_indented_d8]
Show the field ONLY if:
[d8_ors_sachets]='0'
was it ever indented yesno, Required
1Yes
0No
101 [medicine_which_d8]
Show the field ONLY if:
[d8_ors_sachets]='1' or [was_it_ever_indented_d8]='1'
Name the medicine which are prescribed for pregnant women text, Required
102 [d9_folic_acid_tablet_avail] D9. Folic acid Tablet - Available yesno, Required
1Yes
0No
103 [was_it_ever_indented_d9]
Show the field ONLY if:
[d9_folic_acid_tablet_avail]='0'
was it ever indented yesno, Required
1Yes
0No
104 [medicine_which_d9]
Show the field ONLY if:
[d9_folic_acid_tablet_avail]='1' or [was_it_ever_indented_d9]='1'
Name the medicine which are prescribed for pregnant women text, Required
105 [d10_zinc_tablets_available] D10. Zinc tablets - Available yesno, Required
1Yes
0No
106 [was_it_ever_indented_d10]
Show the field ONLY if:
[d10_zinc_tablets_available]='0'
was it ever indented yesno, Required
1Yes
0No
107 [medicine_which_d10]
Show the field ONLY if:
[d10_zinc_tablets_available]='1' or [was_it_ever_indented_d10]='1'
Name the medicine which are prescribed for pregnant women text, Required
108 [d11_anti_fungals_available] D11. Anti fungals - Available
(e.g. Miconazole, Cotrimoxazole etc) 		yesno, Required
1Yes
0No
109 [was_it_ever_indented_d11]
Show the field ONLY if:
[d11_anti_fungals_available]='0'
was it ever indented yesno, Required
1Yes
0No
110 [medicine_which_d11]
Show the field ONLY if:
[d11_anti_fungals_available]='1' or [was_it_ever_indented_d11] ='1'
Name the medicine which are prescribed for pregnant women text, Required
111 [anti_spasmodic_available_d12] D12. Anti spasmodic - Available
(e.g. Dicyclomine) 		yesno, Required
1Yes
0No
112 [was_it_ever_indented_d12]
Show the field ONLY if:
[anti_spasmodic_available_d12]='0'
was it ever indented yesno, Required
1Yes
0No
113 [medicine_which_d12]
Show the field ONLY if:
[anti_spasmodic_available_d12]='1' or [was_it_ever_indented_d12] = '1'
Name the medicine which are prescribed for pregnant women text, Required
114 [d13_antacid_available] D13. Antacid - Available
(e.g. Pantoprazole, Antacid gel, Ranitidine, etc.) 		yesno, Required
1Yes
0No
115 [was_it_ever_indented_d13]
Show the field ONLY if:
[d13_antacid_available]='0'
was it ever indented yesno, Required
1Yes
0No
116 [medicine_which_d13]
Show the field ONLY if:
[d13_antacid_available]='1' or [was_it_ever_indented_d13]='1'
Name the medicine which are prescribed for pregnant women text, Required
117 [d14_anticonvulsants_availa] D14. Anticonvulsants - Available
(e.g.Carbamezapine, ) 		yesno, Required
1Yes
0No
118 [was_it_ever_indented_d14]
Show the field ONLY if:
[d14_anticonvulsants_availa]='0'
was it ever indented yesno, Required
1Yes
0No
119 [medicine_which_d14]
Show the field ONLY if:
[d14_anticonvulsants_availa]='1' or [was_it_ever_indented_d14] ='1'
Name the medicine which are prescribed for pregnant women text, Required
120 [d15_multivitamins_availabl] D15. Multivitamins - Available
(e.g. Vit C(Ascorbic acid), Vit D(Cholecalciferol),Vit B12(Methylcarbylamine) etc.) 		yesno, Required
1Yes
0No
121 [was_it_ever_indented_d15]
Show the field ONLY if:
[d15_multivitamins_availabl]='0'
was it ever indented yesno, Required
1Yes
0No
122 [medicine_which_d15]
Show the field ONLY if:
[d15_multivitamins_availabl]='1' or [was_it_ever_indented_d15]='1'
Name the medicine which are prescribed for pregnant women text, Required
123 [d16_corticosteroids_availa] D16. Corticosteroids - Available
(e.g. Prednisolone, Betamethasone, Dexamethasone, Clobetasol, Budesonide, etc.) 		yesno, Required
1Yes
0No
124 [was_it_ever_indented_d16]
Show the field ONLY if:
[d16_corticosteroids_availa]='0'
was it ever indented yesno, Required
1Yes
0No
125 [medicine_which_d16]
Show the field ONLY if:
[d15_multivitamins_availabl]='1' or [was_it_ever_indented_d16]='1'
Name the medicine which are prescribed for pregnant women text, Required
126 [d17_anti_helminthic_availa] D17. Anti helminthic - Available
(e.g. albendazole, etc.) 		yesno, Required
1Yes
0No
127 [was_it_ever_indented_d17]
Show the field ONLY if:
[d17_anti_helminthic_availa]='0'
was it ever indented yesno, Required
1Yes
0No
128 [medicine_which_d17]
Show the field ONLY if:
[d17_anti_helminthic_availa]='1' or [was_it_ever_indented_d17]='1'
Name the medicine which are prescribed for pregnant women text, Required
129 [d18_anti_emetics_available] D18. Anti emetics - Available
(e.g. Domperidone, etc.) 		yesno, Required
1Yes
0No
130 [was_it_ever_indented_d18]
Show the field ONLY if:
[d18_anti_emetics_available]='0'
was it ever indented yesno, Required
1Yes
0No
131 [medicine_which_d18]
Show the field ONLY if:
[d18_anti_emetics_available]='1' or [was_it_ever_indented_d18]='1'
Name the medicine which are prescribed for pregnant women text, Required
132 [d_19_thyroid_hormones_avil] D 19. Thyroid hormones - Avilable
( Thyroxine, etc.) 		yesno, Required
1Yes
0No
133 [was_it_ever_indented_d19]
Show the field ONLY if:
[d_19_thyroid_hormones_avil]='0'
was it ever indented yesno, Required
1Yes
0No
134 [medicine_which_d19]
Show the field ONLY if:
[d_19_thyroid_hormones_avil]='1' or [was_it_ever_indented_d19]='1'
Name the medicine which are prescribed for pregnant women text, Required
135 [d_20_tetanus_toxoid_avilab] D 20. Tetanus toxoid - Avilable yesno, Required
1Yes
0No
136 [was_it_ever_indented_d20]
Show the field ONLY if:
[d_20_tetanus_toxoid_avilab]='0'
was it ever indented yesno, Required
1Yes
0No
137 [medicine_which_d20]
Show the field ONLY if:
[d_20_tetanus_toxoid_avilab]='1' or [was_it_ever_indented_d20]='1'
Name the medicine which are prescribed for pregnant women text, Required
138 [d21_anti_diarrheal_zinc_su] D21. Anti diarrheal - Available
(Zinc sulphate dispersible tablet) 		yesno, Required
1Yes
0No
139 [was_it_ever_indented_d21]
Show the field ONLY if:
[d21_anti_diarrheal_zinc_su]='0'
was it ever indented yesno, Required
1Yes
0No
140 [medicine_which_d21]
Show the field ONLY if:
[d21_anti_diarrheal_zinc_su]='1' or [was_it_ever_indented_d21]='1'
Name the medicine which are prescribed for pregnant women text, Required
141 [d_22_laxative_e_g_lactulos] D 22. Laxative
(e.g. Lactulose) 		yesno, Required
1Yes
0No
142 [was_it_ever_indented_d22]
Show the field ONLY if:
[d_22_laxative_e_g_lactulos]='0'
was it ever indented yesno, Required
1Yes
0No
143 [medicine_which_d22]
Show the field ONLY if:
[d_22_laxative_e_g_lactulos]='1' or [was_it_ever_indented_d22]='1'
Name the medicine which are prescribed for pregnant women text, Required
144 [d23_antiseptic_available_e] D23. Antiseptic - Available
(e.g. Povidone-Iodine) 		yesno, Required
1Yes
0No
145 [was_it_ever_indented_d23]
Show the field ONLY if:
[d23_antiseptic_available_e]='0'
was it ever indented yesno, Required
1Yes
0No
146 [medicine_which_d23]
Show the field ONLY if:
[d23_antiseptic_available_e]='1' or [was_it_ever_indented_d23]='1'
Name the medicine which are prescribed for pregnant women text, Required
147 [d24_insecticide_available] D24. Insecticide - Available
(e.g. Permethrin) 		yesno, Required
1Yes
0No
148 [was_it_ever_indented_d24]
Show the field ONLY if:
[d24_insecticide_available]='0'
was it ever indented yesno, Required
1Yes
0No
149 [medicine_which_d24]
Show the field ONLY if:
[d24_insecticide_available]='1' or [was_it_ever_indented_d24]='1'
Name the medicine which are prescribed for pregnant women text, Required
150 [e_laboratory_diagnostics_t] E. Laboratory/Diagnostics Test Availability descriptive
151 [e1_hemoglobin_hb_available] E1. Hemoglobin (Hb) - Available yesno, Required
1Yes
0No
152 [functional_equipment_e1] Functional Equipment for Hemoglobin (Hb) yesno, Required
1Yes
0No
153 [trained_staff_e1] Trained Staff - Hemoglobin (Hb) yesno, Required
1Yes
0No
154 [e2_blood_sugar_random_fast] E2. Blood sugar (random/fasting) yesno, Required
1Yes
0No
155 [functional_equipment_e2] Functional Equipment for Blood sugar (random/fasting) yesno, Required
1Yes
0No
156 [trained_staff_e2] Trained Staff - Blood sugar (random/fasting) yesno, Required
1Yes
0No
157 [e3_ogtt] E3. OGTT yesno, Required
1Yes
0No
158 [functional_equipment_e3] Functional Equipment for OGTT yesno, Required
1Yes
0No
159 [trained_staff_e3] Trained Staff - OGTT yesno, Required
1Yes
0No
160 [e4_urine_culture] E4. Urine culture yesno, Required
1Yes
0No
161 [functional_equipment_e4] Functional Equipment for Urine culture yesno, Required
1Yes
0No
162 [trained_staff_e4] Trained Staff - Urine culture yesno, Required
1Yes
0No
163 [e5_urine_microscopy] E5. Urine microscopy yesno, Required
1Yes
0No
164 [functional_equipment_e5] Functional Equipment for Urine microscopy yesno, Required
1Yes
0No
165 [trained_staff_e5] Trained Staff yesno, Required
1Yes
0No
166 [e6_urine_microalbumin] E6. Urine microalbumin yesno, Required
1Yes
0No
167 [functional_equipment_e6] Functional Equipment yesno, Required
1Yes
0No
168 [trained_staff_e6] Trained Staff - Urine microscopy yesno, Required
1Yes
0No
169 [e7_malaria_test_rdt] E7. Malaria test (RDT) yesno, Required
1Yes
0No
170 [functional_equipment_e7] Functional Equipment - Malaria test (RDT) yesno, Required
1Yes
0No
171 [trained_staff_e7] Trained Staff - Malaria test (RDT) yesno, Required
1Yes
0No
172 [e8_typhoid_widal] E8 Typhoid (Widal) yesno, Required
1Yes
0No
173 [functional_equipment_e8] Functional Equipment - Typhoid (Widal) yesno, Required
1Yes
0No
174 [trained_staff_e8] Trained Staff - Typhoid (Widal) yesno, Required
1Yes
0No
175 [e9_dengue_ns1_igm] E9 Dengue NS1 / IgM yesno, Required
1Yes
0No
176 [functional_equipment_e9] Functional Equipment - Dengue NS1 / IgM yesno, Required
1Yes
0No
177 [trained_staff_e9] Trained Staff - Dengue NS1 / IgM yesno, Required
1Yes
0No
178 [e10_lipid_profile] E10. Lipid profile yesno, Required
1Yes
0No
179 [functional_equipment_e10] Functional Equipment - Lipid profile yesno, Required
1Yes
0No
180 [trained_staff_e10] Trained Staff - Lipid profile yesno, Required
1Yes
0No
181 [e11_liver_function_test_lf] E11. Liver function test (LFT) yesno, Required
1Yes
0No
182 [functional_equipment_e11] Functional Equipment - Liver function test (LFT) yesno, Required
1Yes
0No
183 [trained_staff_e11] Trained Staff - Liver function test (LFT) yesno, Required
1Yes
0No
184 [e12_kidney_function_test_k] E12. Kidney function test (KFT) yesno, Required
1Yes
0No
185 [functional_equipment_e12] Functional Equipment - Kidney function test (KFT) yesno, Required
1Yes
0No
186 [trained_staff_e12] Trained Staff - Kidney function test (KFT) yesno, Required
1Yes
0No
187 [e13_ecg_if_available] E13 ECG (if available) yesno, Required
1Yes
0No
188 [functional_equipment_e13] Functional Equipment - ECG (if available) yesno, Required
1Yes
0No
189 [trained_staff_e13] Trained Staff - ECG (if available) yesno, Required
1Yes
0No
190 [e14_hiv_screening_test] E14. HIV screening test yesno, Required
1Yes
0No
191 [functional_equipment_e14] Functional Equipment - HIV screening test yesno, Required
1Yes
0No
192 [trained_staff_e14] Trained Staff - HIV screening test yesno, Required
1Yes
0No
193 [e15_hbsag] E15 HBsAg yesno, Required
1Yes
0No
194 [functional_equipment_e15] Functional Equipment - HBsAg yesno, Required
1Yes
0No
195 [trained_staff_e15] Trained Staff - HBsAg yesno, Required
1Yes
0No
196 [e16_hcv] E16 HCV yesno, Required
1Yes
0No
197 [functional_equipment_e16] Functional Equipment - HCV yesno, Required
1Yes
0No
198 [trained_staff_e16] Trained Staff - HCV yesno, Required
1Yes
0No
199 [e17_syphilis_rpr_vdrl] E17. Syphilis (RPR/VDRL) yesno, Required
1Yes
0No
200 [functional_equipment_e17] Functional Equipment - Syphilis (RPR/VDRL) yesno, Required
1Yes
0No
201 [trained_staff_e17] Trained Staff - Syphilis (RPR/VDRL) yesno, Required
1Yes
0No
202 [e18_covid_19_rapid_antigen] E18. COVID-19 Rapid Antigen Test yesno, Required
1Yes
0No
203 [functional_equipment_e18] Functional Equipment - COVID-19 Rapid Antigen Test yesno, Required
1Yes
0No
204 [trained_staff_e18] Trained Staff - COVID-19 Rapid Antigen Test yesno, Required
1Yes
0No
205 [e19_pap_smear_if_applicabl] E19. PAP smear (if applicable) yesno, Required
1Yes
0No
206 [functional_equipment_e19] Functional Equipment - PAP smear yesno, Required
1Yes
0No
207 [trained_staff_e19] Trained Staff - PAP smear yesno, Required
1Yes
0No
208 [e20_urine_sugar] E20. Urine sugar yesno, Required
1Yes
0No
209 [functional_equipment_e20] Functional Equipment - Urine sugar yesno, Required
1Yes
0No
210 [trained_staff_e20] Trained Staff - Urine sugar yesno, Required
1Yes
0No
211 [e21_thyroid_profile] E21. Thyroid profile yesno, Required
1Yes
0No
212 [functional_equipment_e21] Functional Equipment - Thyroid profile yesno, Required
1Yes
0No
213 [trained_staff_e21] Trained Staff - Thyroid profile yesno, Required
1Yes
0No
214 [e22_blood_pressure_measure] E22. Blood pressure measurement yesno, Required
1Yes
0No
215 [functional_equipment_e22] Functional Equipment - Blood pressure measurement yesno, Required
1Yes
0No
216 [trained_staff_e22] Trained Staff - Blood pressure measurement yesno, Required
1Yes
0No
217 [e23_weight_measurement] E23. Weight measurement yesno, Required
1Yes
0No
218 [functional_equipment_e23] Functional Equipment - Weight measurement yesno, Required
1Yes
0No
219 [trained_staff_e23] Trained Staff - Weight measurement yesno, Required
1Yes
0No
220 [e24_height_measurement] E24. Height measurement yesno, Required
1Yes
0No
221 [functional_equipment_e24] Functional Equipment - Height measurement yesno, Required
1Yes
0No
222 [trained_staff_e24] Trained Staff - Height measurement yesno, Required
1Yes
0No
223 [f_maternal_health_antenata] F. Maternal Health & Antenatal Care (ANC) descriptive
224 [f1_are_pregnant_women_regi] F1. Are pregnant women registered? yesno, Required
1Yes
0No
225 [f2_are_the_pregnant_women] F2. Are the pregnant women connected with the ASHA/ANM after the registration? yesno, Required
1Yes
0No
226 [f3_please_explain_the_proc] F3. Please explain the procedure for tracking. (exp-lore for any portal or register maintained for tracking) text, Required
227 [f4_does_the_clinic_provide] F4. Does the clinic provide calcium to pregnant women? yesno, Required
1Yes
0No
228 [f5_does_the_clinic_provide] F5.Does the clinic provide IFA to pregnant women? yesno, Required
1Yes
0No
229 [f5_is_bp_measured_for_pw_v] F5. Is BP measured for PW visiting the facility? yesno, Required
1Yes
0No
230 [f6_is_weight_measured_for] F6. Is weight measured for PW visiting the facility? yesno, Required
1Yes
0No
231 [f7_is_blood_sugar_test_don] F7. Is Blood sugar test done for pregnant women in the facility? yesno, Required
1Yes
0No
232 [f8_is_hb_test_done_for_pre] F8. Is Hb test done for pregnant women onsite? yesno, Required
1Yes
0No
233 [f9_is_tt_injection_adminis] F9. Is TT injection administered to PW ? yesno, Required
1Yes
0No
234 [f10_is_there_an_ultrasound] F10. Is there an ultrasound facility for PW visiting for ANC? yesno, Required
1Yes
0No
235 [is_there_any_tie_up_with_a]
Show the field ONLY if:
[f10_is_there_an_ultrasound]='0'
is there any tie up with any organization(USG empanelment), specify text, Required
236 [f11_are_pw_visiting_for_an] F11. Are PW visiting for ANC referred to higher facilities? yesno, Required
1Yes
0No
237 [please_specify_for_which_s]
Show the field ONLY if:
[f11_are_pw_visiting_for_an]='1'
please specify for which services are PW referred to higher facilities?
 radio, Required
1a. Checkup by gynecologist- Yes/ No
2b. Ultrasound- Yes/ No
3c. Any lab test- Yes/No
4d. Specify the test
238 [d_specify_the_test]
Show the field ONLY if:
[please_specify_for_which_s] = '4'
d. Specify the test text, Required
239 [f13_please_tell_us_about_t]
Show the field ONLY if:
[f11_are_pw_visiting_for_an]='1'
F13. Please tell us about the referral mechanism. (how is it operational) text, Required
240 [f14_is_test_for_urine_suga] F14. Is test for urine sugar done for pregnant women in the facility? yesno, Required
1Yes
0No
241 [f15_is_test_for_urine_cult] F15. Is test for urine culture done for pregnant women in the facility? yesno, Required
1Yes
0No
242 [f16_is_thyroid_profile_tsh] F16. Is thyroid profile (TSH/ T3) done for pregnant women in the facility? yesno, Required
1Yes
0No
243 [f17_does_the_clinic_mainta] F17. Does the clinic maintain ANC registers or digital records? yesno, Required
1Yes
0No
244 [f18_are_immunization_servi] F18. Are immunization services available for pregnant women? yesno, Required
1Yes
0No
245 [f19_are_postnatal_care_pnc] F19. Are postnatal care (PNC) visits recorded/followed up? yesno, Required
1Yes
0No
246 [f20_specify_the_services] F20. Specify the services text, Required
247 [f21_number_of_pw_who_visit] F21. Number of PW who visited for ANC services in the last month text (number), Required
248 [f21_number_of_pw_who_visit_2] F21. Number of PW who visited for ANC services in the Second last month text (number), Required
249 [f21_number_of_pw_who_visit_3] F21. Number of PW who visited for ANC services in the last third month text (number), Required
250 [g_service_delivery_data_ma] G. Service Delivery & Data Management descriptive
251 [g1_are_daily_opd_services] G1. Are Daily OPD services functional? yesno, Required
1Yes
0No
252 [g2_is_basic_first_aid_done] G2. Is Basic first aid done? yesno, Required
1Yes
0No
253 [g3_are_minor_procedures_do] G3. Are minor procedures done? yesno, Required
1Yes
0No
254 [please_specify]
Show the field ONLY if:
[g3_are_minor_procedures_do]='1'
Please specify text, Required
255 [g4_are_family_planning_ser] G4. Are family planning services provided ?
 yesno, Required
1Yes
0No
256 [which_services_are_availab]
Show the field ONLY if:
[g4_are_family_planning_ser] = '1'
Which services are available? text, Required
257 [g5_is_a_separate_record_fo] G5. Is a Separate record for NCD patients available? yesno, Required
1Yes
0No
258 [g6_is_a_separate_record_pw] G6. Is a Separate record for PW or line listing of PW done for those coming to the clinic? yesno, Required
1Yes
0No
259 [g7_is_there_use_of_abha_or] G7. Is there use of ABHA or any digital health ID? yesno, Required
1Yes
0No
260 [g8_are_referral_slips_note] G8. Are referral slips/notes maintained? text, Required
261 [g9_do_medicines_and_consum] G9. Do medicines and consumables run out of stock? yesno, Required
1Yes
0No
262 [g10_how_often_are_they_rep]
Show the field ONLY if:
[g9_do_medicines_and_consum]='1'
G10. how often are they replenished? Are there delays in receiving the stock? text, Required
263 [h_digital_health_applicati] H. Digital Health Application use and Data entry descriptive
264 [h1_name_of_the_software_ap] H1. Name of the software/application used for patient data entry (e.g., e-Sushrut AAC) yesno, Required
1Yes
0No
265 [h2_is_the_software_applica] H2. Is the software application functional on the day of visit?( Observation based) yesno, Required
1Yes
0No
266 [h4_is_data_entry_done_in_r] H4. Is data entry done in real-time or entered at the end of the day by the following:
Doctor 		radio, Required
1Real-time
2End of day
3Not done
267 [h4_is_data_entry_done_in_r_2] H4. Is data entry done in real-time or entered at the end of the day by the following:
Clinical Assistance 		radio, Required
1Real-time
2End of day
3Not done
268 [h4_is_data_entry_done_in_r_3] H4. Is data entry done in real-time or entered at the end of the day by the following:
Pharmacist 		radio, Required
1Real-time
2End of day
3Not done
269 [h5_are_unique_patient_ids] H5 Are unique patient IDs (e.g., ABHA or mobile-based IDs) generated? yesno, Required
1Yes
0No
270 [h6_is_the_clinic_linked_to] H6. Is the clinic linked to ABDM ecosystem (Ayushman Bharat Digital Mission)? radio, Required
1Yes
2No
3Don't Know
271 [then_how_is_the_data_linke]
Show the field ONLY if:
[h6_is_the_clinic_linked_to] = '2'
then how is the data linked to HMIS or RCH portal, please specify? text, Required
272 [h8_are_previous_visit_reco] H8. Are previous visit records retrievable from the system? yesno, Required
1Yes
0No
273 [h9_are_digital_records_mai] H9. Are digital records maintained for: ANC visits yesno, Required
1Yes
0No
274 [h10_are_digital_records_ma] H10. Are digital records maintained for: NCD follow-up yesno, Required
1Yes
0No
275 [h11_are_tablets_laptops_de] H11. Are Tablets/laptops/desktops used for digital patient records? yesno, Required
1Yes
0No
276 [h12_is_there_an_internet_c] H12. Is there an internet connection at the facility?

 yesno, Required
1Yes
0No
277 [how_is_the_data_entry_bein]
Show the field ONLY if:
[h12_is_there_an_internet_c] = '0'
H13. how is the data entry being done and how is data synced later please specify? text, Required
278 [h14_are_staff_trained_in_s] H14. Are staff trained in software use and troubleshooting? radio, Required
1Yes
2No
3Needs refresher
279 [h16_are_the_staff_for_data] H15. Are the staff for data entry being provided with refresher training? yesno, Required
1Yes
0No
280 [how_often]
Show the field ONLY if:
[h16_are_the_staff_for_data] = '1'
how often? text, Required
281 [h18_is_there_any_technical] H18. Is there any technical support available for resolving software issues? yesno, Required
1Yes
0No
282 [h19_is_there_any_provision] H19. Is there any provision for annual maintenance charges yesno, Required
1Yes
0No
283 [h20_who_is_responsible_for] H20. Who is responsible for it? text, Required
284 [i_feedback_grievance_redre] I. Feedback & Grievance Redressal descriptive
285 [i1_is_there_any_grievance] I1. Is there any grievance redressal mechanism in place?
 yesno, Required
1Yes
0No
286 [type_of_grievance_redressa]
Show the field ONLY if:
[i1_is_there_any_grievance] = '1'
Type of grievance redressal mechanism in place?
 checkbox, Required
1type_of_grievance_redressa___1Are there any suggestions/complaint box available for beneficiaries?
2type_of_grievance_redressa___2Any register
3type_of_grievance_redressa___3Any helpline number
287 [i2_have_you_received_any_c] I2. Have you received any complaints or suggestions from the local people?

 yesno, Required
1Yes
0No
288 [how_many]
Show the field ONLY if:
[i2_have_you_received_any_c] = '1'
How many ? text
290 [have_they_been_resolved]
Show the field ONLY if:
[i2_have_you_received_any_c] = '1'
Have they been resolved? text, Required
291 [is_any_prescription_slip_p] 3. Is any prescription slip/ Health records provided? yesno, Required
1Yes
0No
 
 292 [form_1_complete]
Section Header: Form Status
Complete? 		dropdown
0Incomplete
1Unverified
2Complete
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