Post-Natal Care Visits of Mother

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.
  
• If no data is entered. Open "Other Method" Text Box on selection of Any Other (Specify) option and is mandatory.
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="8a340a42-3500-416c-9280-06dcc0a943ac"><ac:plain-text-body><![CDATA3.1.1.2.4]; S.No. 35 in claim from \]></ac:plain-text-body></ac:structured-macro>
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="82924d86-6dba-4389-8ef9-4260136a5997"><ac:plain-text-body><![CDATA1.2.2.1.a]; S.No. 40 in claim from \]></ac:plain-text-body></ac:structured-macro>
  <ac:structured-macro ac:name="unmigrated-wiki-markup" ac:schema-version="1" ac:macro-id="5622ec3d-10b7-4f70-a672-13fbadbaa537"><ac:plain-text-body><![CDATA[* If 'Method of Contraception' = "PPS", then ASHA receives Rs. 300 as an incentive. [FMR Code: 1.2.2.1.a]; S.No. 41 in claim from

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

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