Date

Version Number

Author

Approved By

Document change reference

12/12/2022

1.0

Madhava Ramu

Initial draft for Phase -1 activity of Sakhi 1.0

02/02/2023

1.1

Madhava Ramu

Revised draft for Phase-1 activity

07/04/2023

2.0

Madhava Ramu

First draft for Phase-2 activity

19/05/2023

2.1

Madhava Ramu

Eligible Couple Module

25/05/2023

2.2

Madhava Ramu

Revised Eligible Couple Module, PW, ANC, Scheduler Modules

29/05/2023

2.2.1

Madhava Ramu

Updated after discussion with team
In Eligible Couple Module, PW, ANC Modules

06/06/2023

2.3

Madhava Ramu

New modules added Delivery Outcome, PNC, Infant registration, Child registration
And Revised fields in Beneficiary registration (0-15 Age)

07/06/2023

2.3.1

Madhava Ramu

New modules TB Screening is added

08/06/2023

2.3.2

Madhava Ramu

04/08/2023

2.3.2.1

Madhava Ramu

22/08/2023

2.3.3

Madhava Ramu

S. No

Term / Acronym / Abbreviation

Full form/ Definition

1

FLW

Frontline Health Workers; i.e. ASHA, ANM and AWW

2

ASHA

Accredited Social Health Activist

3

ANM

Auxiliary Nurse Mid-Wife

4

AWW

Anganwadi Worker

5

MO/ MOIC

Medical Officer/ MOIC – Medical Officer In charge

6

RCH

Reproductive and Child Health

7

VHND/ VHSND

Village Health Nutrition Day / Village Health Sanitation and Nutrition Day

8

NDD

National Deworming Day

9

M/O

Mandatory/Optional

10

EC

Eligible couple

11

PW

Pregnant Woman

12

HRP

High Risk Pregnancy

13

ANC

Antenatal Care: A pregnant Woman has 3 stages first trimester, second trimester and third trimester.

14

PNC

Postnatal Care: Post Delivery period for Mother and Infant up 42 Days.

15

LMP

Last Menstrual Period

16

EDD

Expected Date of Delivery

17

DOB

Date of Birth

18

LBW

Low Birth Weight Baby

19

RMNCH+A

Reproductive, Maternal, Newborn, Child and Adolescent Health

20

RMNCAH+N

Reproductive, Maternal, Newborn, Child, Adolescent Health Plus Nutrition

21

HBNC

Home Based Newborn Care

22

HBYC

Home-Based Care for Young Child

23

SNCU

Special Newborn Care Units

24

NCD

25

CBAC

Community Based Assessment Checklist

26

CDR

Child Death Review

27

MDSR

Maternal Death Surveillance and Response

28

MCTS

Mother and Child Tracking System

29

NHM

National Health Mission

30

NRHM

National Rural Health Mission

31

NUHM

National Urban Health Mission

32

NIC

National Informatics Centre

CDC

Centers for Disease Control and Prevention

NCVBDC

The National Center for Vector Borne Diseases Control

NVBDCP

National Anti-Malaria Program (NAMP) renamed as
National Vector Borne Disease Control Program

S. No

Primary Actor

Role

1

ASHA

Household survey, Registration, Follow-ups and mobilization

2

ANM

Primary Care, Maternal Care and Immunization

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

First Name of Head of the family

Textbox

Is Mandatory

• Input method: Speech to Text feature
• Accept alphabets only
• Character limit 50
• All letter should be in caps

2

Last Name/ Surname

Textbox

• Input method: Speech to Text feature
• Accept alphabets only
• Character limit 50
• All letter should be in caps

3

Mobile No of Head of the family

Textbox

Is Mandatory

• Accept numeric (integer) value only
• Accept 10 digits only
• Should not start form zero
• Should start with digit 6, 7, 8 or 9
• Should Not accept all same digits

4

House No

Textbox

• Allow Alphanumeric Character and special Characters
• Character limit 100

5

Ward No

Textbox

• Allow Alphanumeric Character and special Characters
• Character limit 100

6

Ward Name

Textbox

• Allow Alphanumeric Character and special Characters
• Character limit 100

7

Mohalla Name

Textbox

• Allow Alphanumeric Character and special Characters
• Character limit 100

8

Economic Status

Spinner

Is Mandatory
Choose:

• APL
• BPL
• Don't know

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Type of Residential area

Spinner

Choose:

• Rural
• Urban
• Tribal
• Tea Garden
• Other

2

Other Type of Residential area

Textbox

• Enable if other is selected above
• Is Mandatory if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

3

Type of House

Spinner

Is Mandatory
Choose:

• Kuchha
• Pucca
• None
• Other

4

House ownership

Spinner

Is Mandatory
Choose:

• Yes
• No

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Separate Kitchen

Spinner

Is Mandatory
Choose:

• Yes
• No

2

Type of Fuel used for cooking

Spinner

Is Mandatory
Choose:
Firewood, Crop Residue, Cow Dung Cake, Coal, Kerosene, LPG, Other

3

Other type of fuel used for cooking

Textbox

• Enable if other is selected above
• Is Mandatory if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

4

Primary Source of water

Spinner

Is Mandatory
Choose:
Tap Water, Handpump Inside House, Handpump Outside House, Well, Tank, River, Pond, Other

5

Other Source of Water

Textbox

• Enable if other is selected above
• Is Mandatory if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

6

Availability of Electricity

Spinner

Is Mandatory
Choose:
Electricity Supply, Generator, Solar Power, Kerosene Lamp, Other

7

Other Availability of electricity

Textbox

• Enable if other is selected above
• Is Mandatory if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

8

Availability of Toilet

Spinner

Is Mandatory
Choose:
Flush Toilet with Running Water, Flush Toilet without Water, Pit Toilet with Running Water Supply, Pit Toilet without Water Supply, Other, None

9

Other Availability of Toilet

Textbox

• Enable if other is selected above
• Is Mandatory if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

After Household registration is completed, show below alert in pop:
"Do you want to proceed with registration of Head of the family"; "Yes" or "No"
If "Yes", navigate to the Beneficiary Registration
If "No", land back to Household list screen

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

**** Every Beneficiary Registration should be linked with any one of the Household (HHID)

**** Beneficiary Registration is two types, based on the Age, that is as below

1. Adult Registration: Age 15 years and above
2. Newborn/ Child/ Adolescent Registration: Age 0 to less than 15 Years
   *** Based on the selected Age, fields in the form changes respectively as mentioned here in the logic column

I

Adult Registration (Age 15 years and above)

1

1. Head of family Registration OR
2. Family Member Registration

Show this sub heading based on the type of member registration

2

Date of Registration

Calendar/ Date Picker

• Is Mandatory
• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value Today's Date

• Not greater than Today's Date
• should not allow date less than 1/1/2020
• should not allow to update in edit or once submitted

Relationship with head of family

Self

Place of order of this field should change bases on the type of registration, as below
In case of HoF registration, auto select "Self" and show it here or just show title
In case of family member registration, show this field after "Gender" field

3

Photo

Camera

Is Optional

Should have face detection/ Facial recognition
Camera should identify & capture human face but not any objects
Show an Alert if Photo is not captured, just as reminder but Not Mandatory
Alert: "Do you like to Take Photo", Yes or No
If "Yes", open Camera; If "No", go to next

4

First Name

Textbox

Is Mandatory

• In case of HoF registration, auto select from HH details
• Input method: Speech to Text feature
• Accept alphabets only
• Character limit 50
• All letter should be in caps

5

Last Name/ Surname

Textbox

Is Mandatory

• In case of HoF registration, auto select from HH details
• Input method: Speech to Text feature
• Accept alphabets only
• Character limit 50
• All letter should be in caps

Select: Date of Birth OR Age

6

Date of Birth

Calendar
Date Picker

Is Mandatory

• Auto Calculate 'Age' based on the DOB entered
• Allow Age 15 years and above

7

Age (in Years)

Textbox

Is Mandatory

• Auto Calculate 'Date of Birth' based on the Age entered
• Allow Age 15 years and above
• Character limit 2

8

Gender

Spinner

Is Mandatory
Choose:

• Male
• Female
• Transgender

Based on the Gender selected, show below family relationships

9

Relationship with head of family

Spinner

Is Mandatory
Choose: (this is sample List, get this list form old app or currently what we have)
Example: for Male
Son, Husband, Father, Nephew, Son-in-law, Brother, Grandson, Grand Father, Father-in-law, others
Example: for Female

Wife, Daughter, Mother, Niece, Daughter-in-law, Sister, Grand Daughter, Grand Mother, Mother-in-law, others

In case of HoF registration, hide this field (NA)
In case of family member registration, show this field after "Gender" field
Show all family relationships based on the Gender criteria, as below

• When Gender is Male or Transgender, show all male relationships
• When Gender is Female, show all Female relationships
  
  Whomever you are registering his/her relation should selected here

10

Other Relationship with head of family

Textbox

In case of HoF registration, hide this field (NA)

• Enable if other is selected above
• Is Mandatory if other is selected above
• Enable if other is selected above
• Is Mandatory if other is selected above

11

Mobile Number of

Spinner

Is Mandatory
Choose:
Self, Husband, Father, Mother, Family head, others

In case of HoF registration, hide this field (NA)

• If married and Male show Wife
• If married and Female show Husband
• If unmarried don't show above both

12

Enter Relation with Mobile Number

Textbox

In case of HoF registration, hide this field (NA)

• Enable if other is selected above
• Is Mandatory if other is selected above
• Enable if other is selected above
• Is Mandatory if other is selected above

13

Mobile Number

Textbox

Is Mandatory

In case of HoF registration, auto select from HH details
Show after 'Mobile Number of' is selected

• If "Family head" is selected above, then auto populate Mobile Number of 'Head of the family'
• Similarly, for other relationships Husband" or "Wife"

14

Marital Status

Spinner

Is Mandatory
Choose:

• Unmarried
• Married
• Divorced
• Separated
• Widow
• Widower

• Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years)
• Show this field once above Gender is selected
• If "Unmarried" is selected hide below three fields from S. No. 15, 16, 17
• Based on the 'Gender' values in this dropdown list should change as follows:
• In case of 'Gender' = "Female" show "Widow" and hide "Widower"
• In case of 'Gender' = "Male" show "Widower" and hide "Widow"
  Above in field 'Relationship with head of family' is selected as "Husband" or "Wife" then auto select "Married"

15

Husband's/ Wife's Name

Textbox

Is Conditionally Mandatory

In case of "Married" and any one is already registered, then auto select Name from 'Husband' or 'Wife' details; base on the Relationship with Hof

• Input method: Speech to Text feature
• Hide this field in case of 'Marital Status' = "Unmarried"
• Optional (Not Mandatory) in case of 'Marital Status' = "Divorced"
• Based on the Gender show label name as: 'Husband's' or 'Wife's Name'
• Accept alphabets only
• Character limit 50
• All letter should be in caps

16

Date of Marriage

Calendar
Date Picker

Is Conditionally Mandatory

In case of "Married" and any one is already registered, and date if available then auto select from 'Husband' or 'Wife' details; base on the Relationship with Hof

• Hide this field in case of 'Marital Status' = "Unmarried"
• Show only when below 'Age at Marriage' is equal to above 'Actual Age'

17

Age at Marriage

Textbox

Is Mandatory

• Hide this field in case of 'Marital Status' = "Unmarried"
• Accept numbers only
• Character limit 2 digits
• Allow Age greater or equals to 15 Years
• Marriage Age should Not be greater than actual Age

18

Father's Name

Textbox

Is Conditionally Mandatory

Base on the Relationship with Hof, in case of Son or Daughter auto populate Name

• Input method: Speech to Text feature
• Optional (Not Mandatory) in case of 'Gender' = "Female" and 'Marital Status' = "Married"
• Accept alphabets only
• Character limit 50
• All letter should be in caps

19

Mother's Name

Textbox

Is Conditionally Mandatory

Base on the Relationship with Hof, in case of Son or Daughter auto populate Name

• Input method: Speech to Text feature
• Optional (Not Mandatory) in case of 'Gender' = "Female" and 'Marital Status' = "Married"
• Accept alphabets only
• Character limit 50
• All letter should be in caps

20

Community

Spinner

Is Mandatory
Choose:

• General
• SC
• ST
• OBC
• OC
• Not Given

• By default, auto select get form HoF
• But it should be editable

21

Religion

Spinner

Is Mandatory
Choose:

• Hindu
• Muslim
• Christen
• Sikhism
• Buddhism
• Jainism
• Parsi
• Other
• Not disclosed

• By default, auto select get form HoF
• But it should be editable

ID Details (Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years))

22

Aadhaar No.

Spinner

Choose:
Yes/ No

23

Aadhaar No.

Textbox

Show this field when 'Aadhaar No.' is selected "Yes"

• Accept numeric (integer) values only
• Accept 12 digits only
• Should not start from 0
• Mandatory if Aadhar number is selected above

24

RCH ID

Textbox

• 12-digit unique number
• Accept numeric (integer) value only
• Character limit up to 12
• Show this field only for 'Gender' = "Female" and 'Gender' = "Male" for Child (Age 0 to less than 15 Years)
• That field is Not Applicable for 'Gender' = "Male" for Age above 15 Years)

II

Below field are only applicable for Newborn/ Child/ Adolescent Registration (Age 0 to less than 15 Years)

Select: Date of Birth OR Age

25

Date of Birth

Calendar
Date Picker

Is Mandatory

• Auto Calculate 'Age' based on the DOB entered
• Allow Age 0 to less than 15 Years

26

Age

Textbox

Is Mandatory

• Auto Calculate 'Date of Birth' based on the Age entered
• Allow Age 0 to less than 15 Years
• Character limit 2
• It is Mandatory to select below 'Age Unit'
• If Age is greater than 3 Years of Age (less than 15 Years), then enable this field below:

1. Is the Child Registered at School?
   (S. No. 28)

27

Age Unit

Textbox

Is Mandatory
Choose:

• Days (s)
• Month (s)
• Year (s)

• When 'Age' is selected above, it is Mandatory to select 'Age Unit'
• In case of 'Date of Birth' is entered, auto select related value "Days (s)/ Month (s), Year (s)"

28

Is the Child Registered at School?

Spinner

Is Mandatory
Choose

• Yes
• No

• If Age is greater than 3 Years of Age (less than 15 Years), then enable this field
• If "Yes" is selected, then select 'Type of School/ Institution'

29

Type of School/ Institution

Spinner

Is Mandatory
Choose:

• Anganwadi
• Primary
• Secondary
• Private

• Enable if "Yes" is selected above
• Is Mandatory if other is selected above

Birth Details

30

RCH ID

Textbox

• 12-digit unique number
• Accept numeric (integer) value only
• Character limit up to 12

31

Birth Certificate No.

Text Box

Default value should be Null

• Accept numeric value and special characters
• Character limit 50

32

Place of Birth

Spinner

Is conditionally Mandatory
Choose:

• Home
• Sub-Centre
• PHC
• CHC
• Sub-District Hospital,
• District Hospital,
• Medical College Hospital
• In Transit
• Private Hospital
• Accredited Private Hospital
• Other

Name of Data Field

Field Type

Field Type

Validation/ Logic/ Condition

Contact Number of /Mobile Number of Head of Family

Text

• After entering the "Mobile number of the Head of the Family," enable the "Send OTP" button

Send OTP

Button

• This Button should be in green on right corner below Contact Number.
• It initiates a request to generate OTP & send OTP Via SMS to the Registered mobile number
• In case of failed attempt, clicking on "Refresh button"

Refresh

Button

• Regenerate OTP and send to the Registered mobile number

OTP Verification

Textbox

A)Online Mode
1.New Household Registration:

• After entering the "Mobile number of the Head of the Family," enable the "Send OTP" button in green on right corner
  
  2.Family Member Registration:
• Under "Members," after entering the Contact Number, enable the "Send OTP" button in green.
  
  3.All Beneficiaries:
• If OTP verification is pending, display a navigation button to "Verify OTP."
  
  4.OTP Verification Details
• Allowed OTP: Numerical codes only, 4 digits long.
• Verification Process:
• Verify OTP against the generated code.
• Set a 15-minute time limit for OTP entry.
• Valid OTP within timeframe: Display "OTP Verified successfully."
• Invalid OTP or timeout:
• Display "Session Expired"
• ASHA needs to request a new OTP in subsequent visits.
• Not validated from server: Keep in draft mode
  
  5.Enable Mode (During Internet Availability)
• Display a green "Send OTP" button.
• If no OTP is received, allow editing of the mobile number and resending the OTP.
  
  C)Offline Mode
  1.New Registration:
• After entering the mobile number, Disable the "Send OTP" button.
• Allow form submission and save as draft.
• On the card, display a "Verify OTP" navigation button beside the contact number in orange.
• This beneficiary should not sync to the server.
• Clicking the button opens the consent form in edit mode with no data loss.
  
  2.Household Submission
• Do not sync or generate an ID until the Head of Family's consent management is completed and verified..
  
  D)OTP Verification Status Indicators
  1.Verification Pending: Orange icon with text beside the contact number.
  2.Verification Not Done: Red icon with text in the right corner of the card.
  3.Verification Done: Green icon with text.
  Additional Features
• Auto-Submit: Automatically submit once all OTP digits are entered.
• Auto-Close: Close the card after OTP verification attempt (successful or unsuccessful).

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Date of Registration

Calendar
Date Picker

• Is Mandatory
• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value Today's Date

• Not greater than Today's Date
• Accept date greater or equal to Date of beneficiary registration
• should not allow to update in edit or once submitted

2

RCH ID No. of Woman

Text Box

Default as 0

• 12-digit unique number
• Accept numeric (integer) value only
• Character limit up to 12

3

Name of Woman

Text Box

Auto fill from beneficiary details

4

Name of Husband

Text Box

Auto fill from beneficiary details

5

Current Age of Woman

Custom Number Picker

• Accept Integer Value

• Character limit 2
• Accept values from 10 to 50

6

Age of Woman at Marriage

Custom Number Picker

• Accept Integer Value

• Character limit 2
• Accept values from 10 to 50
• Value should be less than or equal to current age

Details of Woman

label

7

Aadhaar Number of Woman

Edit Text Box

• Default value 0

• Accept numeric (integer) values only
• Accept 12 digits only
• Should not start from Zero
• Mandatory if Aadhar number is selected

8

Bank AC No or
Post Office AC No

Edit Text Box

Default value 0

• Accept numeric (integer) values only
• Accept value greater than 0 (Account Number Accepting the value greater than zero)
• Character limit of 20 digits

9

Bank Name

10

Branch Name

Edit Text Box

• Default value null

• Accept alphabets
• Character limit 50

11

IFSC Code

Edit Text Box

• Default value null

• 11-digit alpha numeric code
• Not Mandatory, even Account Number is entered

12

Total No. of Children Born

Custom Number Picker

Default Value 0

• Accepts values from 0 to 9
• Auto increment the value, when this Women give Birth to a Baby

13

No. of Live Children

Custom Number Picker

Default Value 0

• Accepts values from 0 to 9
• Auto increment the value, when this Women give Birth to a Live Baby in the Delivery Outcome section

14

Details of 1st Child

label

• If Total No. of Children Born = "1"
• If Total No. of Children Born is greater than "1"
• Then repeat the below 4 fields based on the "No of Children" (i.e. S. No. 15, 16, 17, 18) with respective Child count

15

1st Child Date of Birth

Calendar
Date Picker

• Auto Calculate 'Age' based on the DOB entered
• Allow Age up to 15 Years

16

1st Child Age

Custom Number Picker

• Auto Calculate 'Date of Birth' based on the Age entered
• Allow Age up to 15Years
• Character limit 2

17

1st Child Sex

Spinner

Choose:

• Male
• Female

18

Gap between Date of marriage and 1st child

Text Box

• The difference between Date of Marriage and 1st child date of birth in month (Auto calculate and display)
• Incentive Logic:

ADD Rs 500 Per case, incentive for ASHA if gap between Marriage(Marriage Date =calculate Age at marriage of beneficiary &Age of beneficiary at 1^st child Birth)marriage and 1^stChild Date of Birth = 2years.

19

Details of 2nd Child

label

• If Total No. of Children Born = "1"

20

2nd Child Date of Birth

Calendar
Date Picker

• Auto Calculate 'Age' based on the DOB entered
• Allow Age up to 15 Years

21

2nd Child Age

Custom Number Picker

• Auto Calculate 'Date of Birth' based on the Age entered
• Allow Age up to 15 Years
• Character limit 2

22

2nd Child Sex

Spinner

Choose:

• Male
• Female

23

Gap between 1st child and 2nd child

Text Box

• The difference between 1st child date of birth and 2nd child date of birth in month (Auto calculate and display)
• Incentive Logic :

ADD Rs 500 Per case ,incentive for ASHA if gap between 1st Child Date of Birth and 2nd Child Date=3years

24

Male

Text Box

• Read only field
• Show value based on above selection
• Accept only if 'Total No. of Live Children' data field is greater than "0".
• Should be less than "Total No. of Children Born – Male".
  Auto increment the value, when this Women give Birth to a Baby Boy (Male) from Infant section

25

Female

Text Box

• Read only field
• Show value based on above selection
• Accept only if "Total No. of Children - Male & Female" data field is greater than 0.
• Should be less than "Total No. of Children Born – Female".
  Auto increment the value, when this Women give Birth to a Baby Girl (Female) from Infant section

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Date of Visit

Calendar
Date Picker

• Is Mandatory
• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value Today's Date

• Not greater than Today's Date
• Accept date greater or equal to Date of EC registration
• should not allow to update in edit or once submitted

Financial Year

Auto-populated

• Default Null

• Depends on Date of visit
• visit date based Financial Year

Visit Month

Spinner

Select Month
Default value is current Month

• Auto select current Month
• And should be editable

Is Pregnancy Test done?

Radio Button

• Default Value null
• Yes
• No
• Don't Know - D

• If "Is Pregnancy Test done?" = "Yes", then open "Pregnancy Test Result" data field and is mandatory.
• If "Is Pregnancy Test done?" = "No", then hide this field 'Is the Woman Pregnant?'

Pregnancy Test Result

Radio Group

Choose:

• Negative
• Positive
  Default value Null

• Default Value null
• If 'Pregnancy Test Result' = "Positive" then
  
  'Is the Woman Pregnant?'="Yes"
  then move the EC to 'Pregnant Woman' section for PW Registration
• Then, Status of Woman should change to "Pregnant Woman"
• If 'Pregnancy Test Result' = "Negative" then enable "Are you using Family Planning Method?" field below.

Is the woman pregnant?

Radio Group

• Default Value null
• Yes - Y
• No - N
• Don't Know - D

• If "No", enable "Are you using Family Planning Method?" field below.
• If "Yes", then move the EC to 'Pregnant Woman' section for PW Registration
• Then, Status of Woman should change to "Pregnant Woman"

Are you using Family Planning Method?

Radio Group

• Options as
  
  Yes / No

• Default Value null
• if "Yes" is chosen, enable "Method of Contraception" field below

Method of Contraception

Spinner

• Self
• ANTRA Injection
• Copper T (IUCD)
• Condom
• Mala N
• Chaya
• ECP
• Any Other Method

• Default Value null
• Open "Any Other Method" Text Box on selection of "Any Other Method" option and is mandatory.
• The difference between two doses should not be less than 75 days and more than 120 days.
• Incentive Logic:
• If gap is more than 120 days, the beneficiary has to register for 1st dose 
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  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="eb9588da-7aa2-443a-b55b-c08fbda69518"><ac:plain-text-body><![CDATA* If beneficiary receives the ANTRA injection 3rd dose, ASHA receives Rs. 100 per as an incentive. [FMR Code 3.1.1.2.8]; S.No. 28 \]></ac:plain-text-body></ac:structured-macro>
  to 31 in claim from
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="f1176a25-7378-4364-9bbb-ffb4551926ca"><ac:plain-text-body><![CDATA* If beneficiary receives the ANTRA injection 4th dose, ASHA receives Rs. 100 per as ani ncentive. [FMR Code 3.1.1.2.8]; S.No. 28 \]></ac:plain-text-body></ac:structured-macro>
  to 31 in claim from
• ASHAs receives Incentives of Rs 150 per patient if women chooses for PPIUCD insertion.(FMR Code 3.1.1.2.4)
• ASHAs receives Incentives of Rs 150 per patient if women chooses PAIUCD (FMR code 3.1.1.2.5) Top of Form
  
  
  
• ASHAs receives Incentives of Rs 1 per patient for Home Delivery Contraceptive-Condom
• ASHAs receives Incentives of Rs 1 per patient for Home Delivery Contraceptive-Oral pills
• ASHAs receives Incentives of Rs 2 per patient for Home Delivery Contraceptive-EC
• ASHAs receives Incentives of Rs 200 per patient /Per ASHA For motivating Female sterilization(MFR Code 1.2.2.1.a)
• ASHAs receives Incentives of Rs 300 per patient For motivating a woman for PPS(MFR Code 1.2.2.1.a)
• ASHAs receives Incentives of Rs 200 per patient For Motivating Minilap(MFR Code 1.2.2.1.a)
• ASHAs receives Incentives of Rs 300 per patient For motivating Male sterilization

Any Other Method

Edit Text Box

• Default Value Null

• Accept alphabets only
• Character limit 50

S. No

Name of data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Date of Registration

Calendar
Date Picker

• Is Mandatory
• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value Today's Date

• Not greater than Today's Date
• Accept date greater or equal to Date of beneficiary registration
• Don't allow date not less than 280 days from Today's Date
• Do not allow to update in edit or once submitted

2

RCH ID No. of Woman

Text Box

Default as 0

• 12-digit unique number
• Accept numeric (integer) value only
• Character limit up to 12

3

MCP Card No

Text Box

Default as 0

• 12-digit unique number
• Accept numeric (integer) value only
• Character limit up to 12

4

Name of Pregnant Women

Auto-populate

5

Name of Husband

Auto-populate

6

Current Age of Woman

Auto-populate

7

LMP Date

Calendar

Is Mandatory

• Accept date not less than 10 months 280 days from Today's Date
• Not greater than Today's Date
• And this LMP Date is editable
• For Edit LMP: any one of the conditions is applicable
• Allow to edit till 26 Weeks of Pregnancy
• Or till ANC-2 is not submitted
• Whichever is first

8

Weeks of Pregnancy at the time of PW Registration

Text Box

• Auto Calculated based on the LMP date and date of PW registration and convert to weeks
• Read only

9

EDD

Text Box

• Auto Calculated based on the LMP date
• Formula: LMP Date + 280 days

10

Blood Group

Spinner

Choose:

• A +ve
• B +ve
• AB +ve
• O +ve
• A -ve
• B -ve
• AB -ve
• O -ve

11

Weight of PW (Kg)

Number Picker

• Accept numeric (integer) value only
• Accept values from 30 to 200
• Weight of PW (Kg) at time of PW Registration

12

Hight of PW (Cm)

Number Picker

• Accept numeric (integer) value only
• Accept values from 50 to 200
• Hight of PW (cm) at time of PW Registration

13

VDRL/RPR Test result

Spinner

Choose:

• Reactive
• Non-Reactive
• Test Not Done

14

Date of VDRL/RPR Test done

Calendar

• Choose the date from the calendar
• Date Format: dd-mm-yyyy

• Accept date equal to or greater than Date of PW Registration.
• Accept Date of PW registration minus one year
• Not greater than Today's Date
• Disable if "Test Not Done"

15

HIV Test result

Spinner

Choose:

• Reactive
• Non-Reactive
• Test Not Done

16

Date of HIV Test done

Calendar

• Choose the date from the calendar
• Date Format: dd-mm-yyyy

• Accept date equal to or greater than Date of PW Registration.
• Not greater than Today's Date
• Disable if "Test Not Done"
• Accept Date of PW registration minus one year

17

HBsAg Test result

Spinner

Choose:

• Positive
• Negative
• Test Not Done

18

Date of HBsAg Test done

Calendar

• Choose the date from the calendar
• Date Format: dd-mm-yyyy

• Accept date equal to or greater than Date of PW Registration.
• Not greater than Today's Date
• Disable if "Test Not Done"
• Accept Date of PW registration minus one year

19

Past Illness

Multi select checkbox list

Is Mandatory
Choose:
None TB Diabetes Hypertension Heart Disease Epileptic STI/RTI Hepatites-B Asthama Any Other

• Default value is "None"
• If any other is selected "None" should unselect.

20

Any other

Textbox

• Accept alphabets only
• Character limit 50

• Enable if other is selected above
• Is Mandatory if other is selected above

21

Is this your 1st pregnancy?

Spinner

Mandatory Choose: Yes No

• If "Yes" is selected, then disable below all fields from S. No. 22
• If "No" is selected, then enable below all fields from S. No. 22

22

Total no. of previous Pregnancy

Number Picker

• Accept numeric
• Accepts values from 0 to 15

23

Any complications in Last Pregnancy

Spinner

Choose:

• None
• Convulsions
• APH
• Pregnancy Induced Hypertension (PIH)
• Repeated Abortion
• Stillbirth
• Congenital Anomaly
• Caesarean Section
• Blood Transfusion
• Twins
• Obstructed Labour
• PPH
• Any Other

• Enable if "No" is selected in "Is this your 1st pregnancy?"
• Default value is "None"
• If "Any other" is selected enable below field 'Any other Complication' and is mandatory

24

Any other Complication

Text Box

• Accept alphabets only
• Character limit 50

25

Is Identified as HRP cases?

Radio button

Choose:

• Yes
• No

If "Yes" is selected, enable below field "Who had identified HRP?" and is Mandatory

• If "Yes" then
• Add the Woman name in the "HRP List"
• Display the name in the PMSMA list
• Highlight the Pregnant Women in Red colour in the Pregnant Women List
• Then flag as HRP Case and show in scheduler till Delivery

26

Who had identified as HRP?

Spinner

Is conditionally Mandatory
Choose:

• ANM
• CHO
• PHC – MO
• Specialist at Higher Facility

• Enable only if "Yes" is selected above,
• If "Yes" is selected above, then it is Mandatory

ANC Visit

Photo

Name:

w/o:

Age:

Phone No.

MCP No.

RCH Id:

LMP

EDD

S.No.

Name of data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

ANC Date

Date Picker

• Is Mandatory
• Choose the date from the calendar
• Format: dd-mm-yyyy

• Accept Date after 5 weeks from LMP Date
• Date less than 4 weeks from Last ANC Date must not be allowed.
• Accept date greater than Last ANC Date.
• Not greater than Today's Date

2

Weeks of Pregnancy

Text Box

• Auto calculated
• Auto Calculate from LMP date to till current ANC Date and convert to weeks
• Read only
• Incentive Logic:

ASHA incentive of Rs 50 gets added for 1^st time registration of beneficiary ,when the "Weeks of Pregnancy"field Autopopulates between 1 to 12 weeks. (FMR-3.1.1.1.13)

3

ANC Period

Spinner

Choose:

• ANC 1
• ANC 2
• ANC 3
• ANC 4

• Should be editable, based on User choice
• Default Value is auto select based on below conditions
• Display ANC 1, if "ANC Date" is within 12 weeks from LMP Date.
• Display ANC 2, if "ANC Date" is between 14- 26 weeks from LMP Date.
• Display ANC 3, if "ANC Date" is between 28-32 weeks from LMP Date.
• Display ANC 4, if "ANC Date" is between 36 weeks up to EDD from LMP Date.
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="d18bd311-8d6e-4892-adbe-2428ce490285"><ac:plain-text-body><![CDATA[*
• Incentive Logic:

ASHA incentive of Rs 100 gets added when ANC Period is choosen With ANC1 ,ANC2 , ANC3 and ANC4 is completed for a beneficiary [FMR code-3.1.1.1.13]

]]></ac:plain-text-body></ac:structured-macro>

4

Abortion If Any

Radio Group

Choose:

• No
• Yes

• Open "Abortion Date", "Abortion Type" and "Facility" data field on selection of Yes option and are mandatory.
• Default Value is "No"
• If "Yes", then Woman should be again moved to Eligible couple Tracking section
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="9ed7616d-0203-448a-986f-f67a010f24bb"><ac:plain-text-body><![CDATA[*
• Incentive Logic:

If Abortion is marked as "Yes" then ASHA incentives of Rs 150 to be added [FMR Code:3.1.1.1.13]

]]></ac:plain-text-body></ac:structured-macro>

5

Abortion Type

Spinner

Choose:

• Induced
• Spontaneous
  Default value – 0

• If Abortion is "Yes"this field is Mandatory
• Incentive Logic:

InIf Induced option is chosen, then Enable below "Facility" data field 
<ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="69421c41-5899-4877-b8c4-beed8e66c039"><ac:plain-text-body><![CDATA[* 'Abortion Type' = "Induced", then ASHA receives Rs. 150 as an incentive. [FMR Code: 3.1.1.1.13]; S. No. 15 in claim form

]]></ac:plain-text-body></ac:structured-macro>

6

Facility

Spinner

Choose:

• Govt. Hospital
• Pvt. Hospital
  Default Value 0

If Abortion is "Yes"this field is Mandatory

7

Abortion Date

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• If Abortion is "Yes"this field is Mandatory
• Accept date between 5 weeks to 20 weeks from LMP Date
• Not greater than Today's Date
• Disable the ANC detail Fields "Weight of PW (Kg)", "BP of PW (mm Hg) – Systolic/Diastolic"," Pulse Rate", "HB (gm/dl)", "Fundal Height / Size of the Uterus (in weeks)"," Urine Albumin"," Random Blood Sugar Test"," Date of Td / TT (1^st Dose)", "Date of Td / TT (2^nd Dose)", "Date of Td / TT (Booster Dose)","No. of Folic Acid Tabs given"," Any High Risk conditions"," High Risk conditions"," Referral Facility", Is HRP Confirmed?"," Who had identified as HRP?"," Maternal Death"," Probable Cause of Death" ,"Other Death Cause" "Death Date", "Has the pregnant woman delivered?"," Next ANC Visit Date"

8

Weight of PW (Kg)

Custom Number Picker

• Accept numeric (integer) value only
• Values from 30 to 200

9

BP of PW (mm Hg) – Systolic

Edit Text Box

• Accept numeric (integer) value only
• Values from 50 to 300
• Default value 0

• Default Value: to be null if no data is entered
• Mandatory if "BP Diastolic (mm Hg)" filled.
• Systolic: < 90 or >= 140 is HRP Case

10

BP of PW (mm Hg) - Diastolic

Edit Text Box

• Accept numeric (integer) value only
• Values from 30 to 200
• Default Value 0

• Default Value: to be null if no data is entered.
• Mandatory if "BP Systolic (mm Hg)" filled.
• Systolic should be greater than Diastolic
• Diastolic: < 60 or >= 90 is HRP Case

11

Pulse Rate

Edit Text Box

• Accept numeric (integer) value only
• Accept values upto 3 digits
• Do not allow decimals

12

HB (gm/dl)

Custom Number Picker

• Accept numeric (integer) value up to one decimal place only
• Values from 2.0 to 15.0

• Default Value: to be null if no data is entered
• Severe Anemia (Hemoglobin is less than 7 gm/dl)

13

Fundal Height / Size of the Uterus (in weeks)

Custom Number Picker

• Must accept numeric (integer) value only
• Character limit 2
  Default value null

• Disable field up to 12 Weeks of Pregnancy.
• Accept numeric (integer) value only
• Accept values upto 2 digits
• Do not allow decimals

14

Urine Albumin

Radio Group

Choose:

• Absent
• Present

Default Value - null

15

Random Blood Sugar Test

Radio Group

Choose:

• Not Done
• Done

• . Default Value - null

16

Date of Td / TT (1^st Dose)

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Accept date between 5 weeks from LMP Date up to 36 Week of LMP
• Not greater than Today's Date
• Default Value: to be null if no data is entered.
• Disable this data field if "Date of TD Booster Dose" is entered in the Last ANC Visit.

17

Date of Td / TT (2^nd Dose)

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Accept date after 4 weeks from TD 1 Date up to 36 weeks of LMP
• If Td1 (1^st dose) is given then display the Given Date
• If Td2 (1^st dose) is given then display the Given Date
• If "TD 2^nd Dose" is given in the Last ANC Visit, then display a message "All TD doses are given"
• Not greater than Today's Date
• Default Value: to be null if no data is entered.
• Enable this data field if "Date of TD 1^st Dose" is entered in the Last ANC Visit.
• Disable this data field if "Date of TD Booster Dose" is entered in the Last ANC Visit.
• If "TD 2^nd Dose" is given in the Last ANC Visit, then message as "All TD doses have been given" must appear alongside the data field.

18

Date of Td / TT (Booster Dose)

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Accept date between 5 weeks from LMP Date up to up to 36 Week of LMP
• Not greater than Today's Date
• Default Value: to be null if no data is entered.
• Disable this data field if "Date of TD 1^st Dose" is entered in the Last ANC Visit.
• If "Date of TD Booster Dose" is entered in the Last ANC Visit, then message as "All TD doses have been given" must appear alongside the data field.

19

No. of Folic Acid Tabs given

Custom Number Picker

• Must accept numeric (integer) value only
• Default Value 0

• Disable field if Weeks of Pregnancy is greater than 12 weeks
• Accept value up to 60 No

20

No. of IFA tabs given

Custom Number Picker

• Must accept numeric (integer) value only
• Default Value 0

• Disable field up to 12 Weeks of Pregnancy.
• Default Value: to be null if no data is entered
• Accept value up to 400 No

21

Any High Risk conditions

Radio Button

• Options as
  Yes / No

• If "Yes" is selected, then enable "High Risk conditions" drop down below
• If "Yes", then flag this Woman as HRP Case and show in the scheduler till Delivery

22

High Risk conditions

Drop Down List

Choose:

• NONE
• HIGH BP (SYSTOLIC >=140 AND OR DIASTOLIC >=90 mmHg)
• CONVULSIONS
• VAGINAL BLEEDING
• FOUL SMELLING
  
  DISCHARGE
• SEVERE ANAEMIA (HB <7 gm/dl)
• DIABETES
• TWINS
• OTHER

• If "OTHER" is selected, then enable "Any Other High Risk conditions" Text Box below and is mandatory.
• Default value is "NONE"

23

Any other High Risk conditions

Text Box

• Accept alphabets only
• Character limit 50

24

Referral Facility

Spinner

Choose:

• Primary Health Centre
• Community Health Centre
• District Hospital
• Other Private Hospital

25

Is HRP Confirmed?

Radio Button

Choose:
No
Yes

• If "Is HRP Confirmed?" = "Yes" then
• Add the Woman name in the "HRP List"
• Display the name in the PMSMA list
• Highlight the Pregnant Women in Red colour in the Pregnant Women List
• Then flag as HRP Case and show in scheduler till Delivery

26

Who had identified as HRP?

Spinner

Is conditionally Mandatory
Choose:

• ANM
• CHO
• PHC – MO
• Specialist at Higher Facility

• Enable only if "Yes" is selected above,
• If "Yes" is selected above, then it is Mandatory

27

Maternal Death

Radio Button

Choose:

• No
• Yes

• Default value is "No"
• If "Yes" is selected, then open "Death Date" and "Probable Cause of Death" data field below and are mandatory.
• If "Yes" is selected, then move this record 'MDSR' section

28

Probable Cause of Death

Spinner

• Choose from
  
  A. ECLAMPSIA
  B. HAEMORRHAGE
  C. HIGH FEVER
  D. ABORTION
  E. OTHER

• If "OTHER" is selected, then enable "Other Death Cause" Text Box and is mandatory.

29

Other Death Cause

Text Box

• Accept only alphabets
• Character limit 50

30

Death Date

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Not greater than Today's Date
• Should be less than EDD
• Greater than LMP date
• Greater than last visit date

31

Has the pregnant woman delivered?

Radio Button

Choose:

• Yes
• No

• Default value null
• Disable up to 22 weeks of pregnancy.
• If "Yes" is selected, then move record to 'Delivery Outcome' Section

32

Next ANC Visit Date

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Greater than Today's Date
• Should be < = EDD
• Greater than current visit date
  Show this PW on this Date in the To-do List

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Details of Pregnant women

1

MCTS Number/RCH Number (if Registration Number is not available)

Textbox

Auto populate 'RCH Number' form PW record

2

Does the beneficiary have an MCP card?

Radio button

Select:

• Yes
• No

If No is selected, MCP card is given

Radio button

Select:

• Yes
• No

3

Husband's Name

Textbox

Non-Mandatory

• Accept alphabets only
• Character limit 50
• All letter should be in caps

4

Address

Textbox

Non-Mandatory

• Accept numeric value, alphabets and special characters
• Character limit 100

5

Mobile number

Textbox

Auto populate from 'Beneficiary Registration'

• Accept numeric (integer) value only
• Accept 10 digits only
• Should not start from zero
• Should start with digit 7, 8 or 9
• All digits should not be same

6

Write the number of ANC's done before delivery

Textbox

Non-Mandatory

• Auto-Populate

Status of the Mother

7

Weight (Kg)

Textbox

Non-Mandatory

• Accept numbers only
• Values from 30 to 200
• Character limit 3

HRP Case, please visit the nearest HWC or call 104

8

Systolic Blood Pressure

Textbox

• Accept numbers only
• Character limit 3

9

Diastolic Blood Pressure

Textbox

10

Abdominal Check-up (Gestational Age in weeks)

Textbox

Calculate the difference between "Date of ANC" and "LMP Date" and display information in weeks

Fetal Status

11

Fetal heart rate per minute

Textbox

12

Twins pregnancy

Radio Button

Radio button:

• Yes
• No

Investigations

13

Urine Albumin

Textbox

14

Hemoglobin

Textbox

15

HIV

Textbox

16

VDRL

Textbox

17

HBSG (Hepatitis B)

Textbox

18

Malaria

Textbox

19

Was the HIV test done during ANC Checkup?

Radio Button

Radio button:

• Yes
• No

20

Swollen condition

Radio Button

Radio button:

• Yes
• No

21

Blood sugar test

Radio Button

Radio button:

• Yes
• No

22

Ultrasound

Radio Button

Radio button:

• Yes
• No

Intervention Details

23

Iron Folic Acid

Radio Button

Radio button:

• Yes
• No

24

Calcium supplementation

Radio Button

Radio button:

• Yes
• No

Tetanus Toxoid

Spinner

• First
• Second
• Booster

LMP

25

Last Menstrual Period

Calendar

• Last Menstrual Period (LMP)
• Auto populate form PW record

26

Expected Date of Delivery

Textbox

Is Mandatory

• Expected Date of Delivery (EDD)
• Auto populate form PW record

Identification of high-risk factors

27

Identification of high-risk symbols

Radio Button

Radio button:

• Yes
• No

If yes, select the reason given below

28

If yes, select reason given below and write

Textbox

29

Pregnant in high risk category treated

Radio Button

Radio button:

• Yes
• No

30

Pregnant in high risk category was referred

Radio Button

Radio button:

• Yes
• No

Advice

31

Preparation for birth and complications, nutrition and family planning

Radio Button

Radio button:

• Yes
• No

32

Signature of Medical Officer in charge

Textbox

33

Save

Button

Check all validation and Mandatory fields

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Date of Delivery

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Accept date 21 weeks from LMP Date
• Accept date greater or equal to Date of Last ANC Date.
• Accept date equal to or up to 25 days from EDD.
• Not greater than Today's Date

Time of Delivery

Time Picker

• Accept numeric (integer) values only.
• Format: hh-mm
• Default value is null

Place of Delivery

Spinner

• Choose from
  
  District Hospital – 5
  Community Health Centre – 2
  Primary Health Centre – 1
  Sub Centre – 24
  Other Public Facility – 19
  Accredited Private Hospital – 20
  Other Private Hospital – 21
  Home – 22
  Sub District Hospital – 4
  Medical College Hospital 17
  In Transit – 23

Incenvtive Logic:
<ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="02c1f99b-d53e-4d82-a22a-a0db6eddc970"><ac:plain-text-body><![CDATA[If this women is Identified as HRP and Place of delivery is other than "Home" and "In Transit" then ASHA receives an incentive of Rs 100 to be added [FMR Code 3.1.1.1.13]

]]></ac:plain-text-body></ac:structured-macro>

Type of Delivery

Drop Down List

Choose:

• Normal
• Caesarean
• Assisted

Complications during Delivery?

Radio Button

• Options as
  Yes / No

Delivery Complication

Spinner

• PPH
• RETAINED PLACENTA
• OBSTRUCTED DELIVERY
• PROLAPSED CORD
• TWINS PREGNANCY
• CONVULSIONS
• DEATH
• ANY OTHER (SPECIFY)
• DON'T KNOW

• Default value is select.
• If Death is chosen, then open "Other Delivery Complication" Text Box on selection of Any Other (Specify) option and is mandatory
• Open "Probable Death Cause" Text Box on selection of Death option and is mandatory.
• If "Death" is selected, then move this record 'MDSR' section

7

Probable Cause of Death

Spinner

Choose:

• Eclampcia
• Haemorrahge
• Obstructed Labour
• Prolonged Labour
• Other
• High Fever

• If "Other" is selected, then Open "Other Death Cause" Text Box and is mandatory.

8

Other Death Cause

Text Box

• Accept only alphabets and special character.
• Character limit 50

9

Other Delivery Complication

Text Box

• Accept only alphabets and special character.
• Character limit 50

10

Outcomes of Delivery

Custom Number Picker

• Accept numeric (integer) value only.
• Values from 0 – 6.

• Delivery Outcome is equal to sum of Live Births and Still Births.

11

Live Birth

Custom Number Picker

• Accept numeric (integer) value only
• Value from 0-6

• Accept value less than or equal to "Outcomes of Delivery"

12

Still Birth

Custom Number Picker

• Accept numeric (integer) value only
• Value from 0-6

• Accept value less than or equal to "Outcomes of Delivery"

13

Date of Discharge

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Not greater than Today's Date.
• Not less than Date of Delivery.

14

Discharge Time

Time Picker

• Accept numeric (integer) values only.
• Format: hh-mm
• Default value - null

15

Transferred to SNCU

Radio Button

Choose

• Yes
• No

• If "Yes" is selected then Open "Reason for Discharge"

16

Reason for Discharge

Dropdown

Choose

17

Is the Pregnant Woman a JSY Beneficiary?

Radio Button

Choose:
Yes / No

PNC Visit

Photo

Name:

w/o:

Age:

Phone No.

MCP No.

RCH Id:

Date of Delivery:

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

PNC Period

Spinner

Choose:
1st Day3rd Day7th Day14th Day21st Day28th Day42nd Day

• Default value is select.

PNC Visit Date

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy

• 1st Day - Accept date equal to Delivery Date or up to 1^st days from Delivery Date.
• 3rd Day – should be strictly given on 3^rd day after delivery
• 7th Day – Should be given between Delivery + 7 (-3 and +3 ) in days
• 14th Day - Should be given between Delivery + 14 (-3 and +3) in days.
• 21st Day - Should be given between Delivery + 21 (-3 and +3 ) in days.
• 28th Day - Should be given between Delivery + 28 (-3 and +3 ) in days
• 42nd Day Should be given between Delivery + 42 (-3 and +3 ) in days Not greater than Today's Date
• Not less than Date of Delivery

No. of IFA Tablets given

Custom Number Picker

• Default value 0

• Accept numeric (integer) value only
• Accept value greater than 0
• Accept value up to 400

Any Method of Contraception

Radio Button

• Options as
  Yes / No

• Open "PPC Method" data field on selection of Yes option.

Method of Contraception

Spinner

• Choose: POST PARTUM IUCD (PPIUCD) WITHIN 48 HRS OF DELIVERY
• CONDOM
• MALE STERILIZATION
• FEMALE STERILIZATION
• POST PARTUM STERILIZATION (PPS WITHIN 7 DAYS OF DELIVERY)
• ANY OTHER (SPECIFY)

• Default value is select.
• Incentive Logic : If no data is entered. Open "Other Method" Text Box on selection of Any Other (Specify) option and is mandatory. 
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6

Other PPC Method

Edit Text Box

• Accept alphabets, numeric and special character.
• Character limit 50

Mother Danger Sign

Drop Down List

Choose:

• NoneA. PPHB. FEVERC. SEPSISD. SEVERE ABDOMINAL PAINE. SEVERE HEADACHE OR BLURRED VISIONF. DIFFICULT BREATHING
• Z. Any Other

• Open "Other Danger Sign" Text Box on selection of Any Other (Specify) option and is mandatory.
• Default Value is "None"

8.1

Other Danger Sign

Edit Text Box

• Accept alphabets only
• Character limit up to 50

Referral Facility

Spinner

• Choose from
  Primary Health Centre - 1/Community Health Centre - 2/District Hospital - 5/Other Private Hospital - 21/Any Other (Specify) -99

Mother Death

Radio Button

Choose:

• Yes
• No

• Default value is "No"
• Open "Mother Death Date", "Mother Death Reason" and "Place of Death" data fields on selection of "Yes" option and are mandatory.
• If "Yes" is selected, then Disable next PNC Visits and Case is Closed

10.1

Date of Death

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Not greater than Today's Date
• Not less than Delivery Date

10.2

Probable Cause of Mother Death

Spinner

• Choose from
  
  A. ECLAMPSIA
  B. HAEMORRHAGE (PPH)
  C. ANAEMIA
  D. HIGH FEVER
  Z. Any Other

• Open "Other Death Cause" Text Box on selection of Any Other (Specify) option and is mandatory.

10.3

Other Death Cause

Edit Text Box

• Accept alphabets only
• Character limit 50

10.4 

Place of Death

Radio Group

• Options as
  Home - 1 / Hospital - 2 / Transit – 3

Remarks

Text Box

• Accept alphabets, numeric and special characters
• Character limit 250

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Micro Birth Plan

1

Name of the PW

Auto-populate

2

Age

Auto-populate

3

Contact No. 1
Contact No. 2

Text Box

• Contact No. 1: This number should Auto-fill
• Contact No. 2: This should be free text and Non-Mandatory;
• Accept numeric (integer) value only
• Accept 10 digits only
• Should not start form zero
• Should start with digit 6, 7, 8 or 9
• Should Not accept all same digits

4

SC/HWC/TG Hosp

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letter should be in caps

5

Block

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letter should be in caps

6

Husband's Name

Auto-Populate

9

Nearest SC/HWC

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letter should be in caps

10

Nearest 24*7 PHC

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letter should be in caps

11

Nearest FRU

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letter should be in caps

12

Nearest USG centre

Text Box

• Accept alpha-numeric values
• Character limit 100
  All letters should be in caps

13

Blood Group

Spinner

Choose:

• A +ve
• B +ve
• AB +ve
• O +ve
• A -ve
• B -ve
• AB -ve
• O -ve

Auto Fill if available
OR
Select form Spinner

14

Blood donors identified

Text Box

• Accept alphabets only
• Character limit 50
  All letter should be in caps

15

Birth Companion

Text Box

• Accept alphabets only
• Character limit 50
  All letter should be in caps

16

Person who will take care of Children, if any when the PW is admitted for delivery

Text Box

• Accept alphabets only
• Character limit 50
  All letter should be in caps

17

Name and Contact number of VHSND/Community member for support during emergency

Text Box

• Accept alphabets only
• Character limit 100
  All letter should be in caps

18

Mode of transportation in case of labor Pain

Text Box

• Accept Alpha-numeric values
• Character limit 100
  All letter should be in caps

19

Submit

Button

Once submitted, change the Color of button "Micro Birth Plan" to Orange on the Card

Photo

Woman Name:

w/o:

Age:

Phone No.

MCP No.

RCH Id:

Date of Delivery:

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Name of Baby

• default Name is 'Baby of' <Mother Name>

Auto-populate, default Name is 'Baby of' <Mother Name>
Or
'Baby one of' <Mother Name>, 'Baby Two of' <Mother Name>,

2

Infant Term

Text Box

• Appears as
  Full Term - F/Preterm – P

• Display Full Term, if Delivery Date is between 37 completed weeks to less than 42 completed weeks w.r.t LMP Date.
• Display Preterm, if Delivery Date is less than 37 completed weeks w.r.t LMP Date.

3

Was Corticosteroid Inj. given?

Radio Button

• Options as
  
  Yes - Y/ No- N / Don't Know- NA
  Default - null

• Default value null

4

Sex of Infant

Radio Button

• Options as
  Male - M / Female - F

5

Baby Cried Immediately at Birth

Radio Button

• Options as
  
  Yes - Y / No – N
  Default - null

• Default value null
• Open "If No, Resuscitation Done" data field on selection of No option and is mandatory.

6

If No, Resuscitation Done

Radio Button

• Options as
  
  Yes- Y / No – N
  Default - 0

7

Referred to higher facility for further management

Radio Button

• Options as
  
  Yes - Y/ No- N/
  Not Applicable - NA

• Default Value: to be "Not Applicable" if no data is entered

8

Any birth defect seen at birth?

Radio Button

• Options as
  Yes / No

• Open "Any defect seen at birth" data field on selection of Yes option.

9

Defect seen at birth

Spinner

Choose:

• Cleft Lip / Cleft Palate
• Club Foot
• Down's Syndrome
• Hydrrocephalus
• Imperforate Anus
• Neural Tube Defect (Spinal Bifida)
• Other

• If "Other" is selected, Open "Other defect seen at birth"

10

Other defect seen at birth

Text Box

• Accept only alphabets and special character
• Character limit 50

11

Weight at Birth (kg)

Custom Number Picker

• Accept numeric (integer) value up to one decimal place only
• Values from 0.5 to 7.0

If Weight of Baby is Less than 2.5 kg, then treat as LBW Baby
Then flag as LBW Baby Case and show in scheduler till DOB + 42 days

12

Breast feeding started within one hour of birth

Radio Button

• Choose from
  Yes - Y/No - N

13

OPV0 Dose

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value is null

• Accept date between Delivery Date to 15 days from Delivery Date.
• Not greater than Today's Date

14

BCG Dose

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value is null

• Accept date between Delivery Date to 1 year from Delivery Date.
• Not greater than Today's Date

15

HEP B-0 Dose

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value is null

• Accept date between Delivery Date to 1 day after Delivery Date.
• Not greater than Today's Date

16

VITK Dose

Calendar

• Choose the date from the calendar
• Format: dd-mm-yyyy
• Default value is null

• Accept date between Delivery Date to 1 day after Delivery Date.
• Not greater than Today's Date

Photo

Mother Name:

w/o:

Age:

Phone No.

MCP No.

RCH Id:

Date of Delivery:

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Date of Registration

Date Picker

• Choose the date from the calendar
• Format: dd-mm-yyyy

• Not greater than Today's Date
• Date of Registration should be taken after or equal date of birth

Name of Child

Edit Text Box

Fetch from Infant registration

• default Name is 'Baby of' <Mother Name>
• Auto-populate, default Name is 'Baby of' <Mother Name>
  
  Or
  'Baby one of' <Mother Name>, 'Baby Two of' <Mother Name>,
  
  
• Editable
• Accept alphabets only
• Character limit 50

RCH ID No. of Child

Text Box

• 12 digit unique number
• Character limit up to 12
  *

Date of Birth

Auto-populate, from Infant details

Sex of Child

Radio Group

• Options as
  Male- M / Female - F

 Auto-populate, from Infant details

Mother's Name

Text Box

• Fetch from Delivery Outcome

• Auto-populate, from Infant details

Father's Name

Text Box

• Fetch from Delivery Outcome

• Auto-populate, from Infant details

Whose Mobile Number

Spinner

• Choose from Mother - W/Father -H/Others – O

Auto-populate, from Infant details

Mobile No.

Text Box

• Fetch from EC or PW Registration

• Auto-populate, from Infant details

RCH ID No. of Mother

Edit Text Box

• Auto-populate, from PW details

Birth Certificate No.

Text Box

• Default value should be Null

• Accept numeric value and special characters
• Character limit 50

Weight at Birth (kg)

Custom Number Picker

• Accept numeric (integer) values only, up to 1 decimal place.
• Values from 0.5 to 7.0

Place of Birth

Spinner

• Choose:
  
  District Hospital – 5
  Community Health Centre – 2
  Primary Health Centre – 1
  Sub Centre- 24
  Other Public Facility 19
  Accredited Private Hospital – 20
  Other Private Hospital – 21
  Home-22
  Sub District Hospital – 4
  Medical College Hospital – 17
  In Transit- 23

S. No

Name of the Data Field

Field Type

Value/options

Validation/ Logic/ Condition

Mother-Newborn Home Visit Card

1

ASHA's Name

Auto populate form ASHA's profile

2

Village Name

3

Health Subcenter Name

Textbox

4

Block Name

Textbox

5

Mother's Name

Textbox

Auto populate form beneficiary details of this Child's Mother

6

Father's Name

Textbox

Auto populate form beneficiary details of this Child's Mother

7

Date of Delivery

Calendar

Auto populate form Mother's delivery details

8

Place of Delivery

Spinner

Choose:

• Home
• Subcenter
• PHC
• CHC

Auto populate form Mother's delivery details

9

Baby Gender

Spinner

Choose:MaleFemaleTransgender

Auto populate form Infant Registration section

10

Type of Delivery

Spinner

Choose from:

• Normal
• Assisted
• Cesarean

Auto populate form Mother's delivery details

11

Still Birth

Radio Button

Choose:

• Yes
• No

If "Yes" is selected here, then disable below all fields from S. No. 12 and Table – 2, 3 & 4 are Not Applicable (disable)

12

Breast feeding Started

Spinner

Choose from:

• Within 1 Hour
• 1 – 4 Hour
• 4.1 Hours to 24 Hours
• After 24 Hours

13

Baby Discharged from SNCU

Radio

Choose from:

• Yes
• No

• If "Yes" is selected here, then enable "Date of Discharge" Field
• If "Yes" is selected here,
• Incentive Logic:

Add ASHA Incentive of Rs.250 per case for follow up of "SNCU discharge babies "As per ROP 2019-20 U/ FMR 3.1.1.1.4

14

Date of Discharge

Calendar

Mandatory

13

Date of Discharge of Institutional Delivery

Calendar

• Not greater than Today's Date
• Discharge Date should be taken after or equal date of Delivery

14

Discharge Date of Mother

Calendar

• Not greater than Today's Date
• Discharge Date should be taken after or equal date of Delivery

15

Discharge Date of Baby

Calendar

• Not greater than Today's Date
• Discharge Date should be taken after or equal date of Delivery

16

Birth Weight (Kg)

Custom Number Picker

• Accept numeric (integer) value up to one decimal place only
• Values from 0.5 to 7.0

17

Birth Registration

Spinner

Choose:YesNo

S. No

Name of the Data Field

Field Type

Value/options

Validation/ Logic/ Condition

Part – I

1

Date of Home Visit

Day1 (one hour after birth)

2

Is the Baby alive?

Radio Button

Choose:

• Yes
• No

If above field 'Still Birth' is "Yes", then select "No"
And, then note the Date, time and place of Death below
(In case of still birth/Newborn death, do not perform further examination of baby but complete the examination of the mother as per home visit form on day 1,3,7,14,21,28,42)
Show Alert:
Cause of Death to be reported to ANM/MPW/PHC for infant death review.

3

Date and Time of Death

Date and Time picker

• Show only above value is "No"
• Not greater than Today's Date
• Date should be taken after or equal date of Delivery

4

Place of Death

Choose:

• Home
• Subcenter
• PHC
• CHC
• Other

5

Other Place of Death

Textbox

Show only above value is "Other"

6

Is the baby preterm?

Radio Button

Choose:

• Yes
• No

7

How many weeks have been born
(Gestational Age)

Spinner

Is conditionally Mandatory
Choose:

• 24 – 34 Weeks
• 34 – 36 Weeks
• 36 – 38 Weeks

• Enable only if above value is "Yes"
• Is Mandatory, if "Yes" is selected above
  
  If Baby is born in less than 35 weeks
  Show Alert:
  Please pay attention at Baby

8

Date of First examination

Date and Time picker

• Not greater than Today's Date
• Date should be taken after or equal date of Delivery

9

Is the Mother alive?

Radio Button

Choose:

• Yes
• No

If "No", then note the Date, time and place of Death below.
(in case Mother is dead, do not perform further examination of mother but complete the examination of the baby as per home visit form on day 1,3,7,14,21,28,42)
Show Alert:
Report to ANM/PHC for Maternal Death review

10

Date and Time of Death

Date and Time picker

• Show only above value is "No"
• Not greater than Today's Date
• Date should be taken after or equal date of Delivery

11

Place of Death

Choose:

• Home
• Subcenter
• PHC
• CHC
• Other

12

Other Place of Death

Textbox

Show only above value is "Other"

13

Does Mother have any problems

Multi-select Spinner

Choose:

• Excessive Bleeding
• Unconscious
• Fits

If yes,
Show Alert:
Please refer immediately to Facility

14

What was given as the first feed to Baby after birth?

Spinner

Choose from:

• Mother Milk
• Water
• Honey
• Mishri water
• Goat Milk
• Other

15

Other

Textbox

Show only above value is "Other"

16

At what time was the baby first breastfed?

Time picker

Alpha-numeric including special characters

17

How did the baby take feed?

Spinner

Choose from:

• Forcefully
• Weakly
• Could not breastfeed but had to be fed with spoon
• Could neither breast-feed nor could take milk given by spoon

Does the mother have breastfeeding problem?

Radio Button

Choose:

• Yes
• No

Write the problem, if there is any problem in breast feeding, help the mother to overcome it

Textbox

Show only above value is "Yes"

S. No

Name of the Data Field

Field Type

Value/options

Validation/ Logic/ Condition

1

Part 2: Baby first health check-up

2

Date of Home Visit

Show DOB
Day 1 (within one hour after birth)

3

Temperature of the baby

Textbox

4

Baby Eyes condition

Spinner

Choose:

• Normal
• Swelling
• oozing pus

5

Is umbilical cord bleeding

Spinner

Choose:

• Yes
• No

6

If yes, either ASHA, ANM/MPW or TBA can tie again with a clean thread. Action taken?

Spinner

Choose:

• Yes
• No

7

Baby Weight

8

Weighing matches with the colour?

Spinner

Choose:

• Yes
• No

9

Color on scale

Spinner

Choose:

• Red
• Yellow
• Green

Enter the Baby physical condition

10

All limbs limp

Spinner

Choose:

• Yes
• No

11

Feeding less/stop

Spinner

Choose:

• Yes
• No

12

Cry weak/ stopped

Spinner

Choose:

• Yes
• No

13

Routine Newborn Care: whether the task was performed

Spinner

Choose:

• Yes
• No

14

Dry the baby

Spinner

15

Keep warm, do not bathe, wrap in cloth, keep closer to mother

Spinner

Choose:

• Yes
• No

16

Initiate exclusive breast feeding

Spinner

Choose:

• Yes
• No

17

Keep the cord clean and dry

Spinner

Choose:

• Yes
• No

18

Anything unusual in baby?

Spinner

Choose:

• Curved limbs
• cleft lip
• other

19

Other

Textbox

Show only above value is "Other"

S. No

Name of the Data Field

Field Type

Value/options

Validation/ Logic/ Condition

Ask and Examine

A. Ask Mother

1

Date of ASHA's visit

2

Is the baby alive?

Choose:

• Yes
• No

3

No. of times mothers takes a full meal in 24 hours

Custom Number Picker

• Default Value 0
• Accepts values from 0 to 6

If the mother does not eat full stomach or eat less than 4 times
Action taken by ASHA: show Alert:
Please advise Mother to meal at least 3 times a Day

4

Bleeding: how many pads are changed in a day

Custom Number Picker

• Default Value 0
• Accepts values from 0 to 20

If more than 5 pads:
Action taken by ASHA: show Alert:
Refer the Mother to the Facility.

5

During the winter season, is the baby kept warm? (Closer to the mother, dressed well and wrapped properly)

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
Advise the mother to do so, if not being done.

6

Is the baby being fed properly (whenever hungry or at least 7-8 times in 24 hours)

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
Advise the mother to do so, if not being done.

7

Is the baby crying incessantly or passing urine less than 6 times a day?

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
Advise mother to feed the baby after every 2 hours

8

Temperature of Mother

Textbox

• Accept Numeric value
• Character limit 3

Action taken by ASHA: show Alert:
Temperature up to 102°F (38.9°C) - treat with paracetamol, and if the temperature is above it, refer to hospital

9

Foul smelling discharge and fever more than 100°F (37.8°C).

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
If yes, refer the mother to a hospital

10

Is mother speaking abnormally or having fits?

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
If yes, refer the mother to a hospital

11

Mother has no milk since delivery or if perceives
breast milk to be less.

Spinner

Choose from:YesNo

Action taken by ASHA: show Alert:
Ask the mother to feed the baby more often and counsel her for proper attachment and positioning during breast feeding.

12

Cracked nipples/painful and /or engorged breast

Spinner