Page History

If Age is 15 to 49 years and 'Marital Status' = “Married”show only below options:

• Eligible Couple
• Pregnant Woman
• Postnatal Mother
• Permanently Sterilised

Display "Elderly Woman" only for individuals age 50 years and above.

Show only below options:

• Eligible Couple
• Pregnant Woman
• Postnatal Mother
• Permanently Sterilised

S No

Data Field

Field Type

Value/Options

Validation / Logic

RCH ID No. of Woman

Text Box

Default as 0

·       Auto-populate from beneficiary details, if id is available or enter here and update in the beneficiary record/ table

·       12-digit unique number

·       Accept numeric (integer) value only

·       Character limit up to 12

Is the pregnancy test conducted at facility?

Dropdown

·       Yes

·       No

·       If “yes” enable next question

·       If “No”- show alert to conduct UPT (urine pregnancy test)

Result of UPT

Dropdown

·       Positive

·       Negative

·       If positive → enable LMP and EDD fields

·       If negative → take the woman to Eligible couple tracking form

LMP

Date

DD/MM/YYYY

·       Mandatory if enabled

·       LMP is Last Menstrual Period

·       Cannot be future date

·       Should be within last 42 weeks

EDD

Auto-calculated

LMP+ 280 days

·       Mandatory if enabled

·       Cannot be past or current date, will always be in future.

·       Should be auto calculated

·       EDD is Expected Date of delivery

·       Based on Naegele’s rule (First day of LMP + 9 months + 7 days) i.e (LMP+280 days)

Blood Group

Spinner

Choose:

·       A +ve

·       B +ve

·       AB +ve

·       O +ve

·       A -ve

·       B -ve

·       AB -ve

·       O -ve

Gestational Age (Weeks)

Auto-calculated

Display as

"X weeks Y days"

·       Mandatory

·       Auto-calculated

·       Current date minus LMP date

Trimester

Auto-selection

·       First

·       Second

·       Third

·       Auto-calculated based on gestational age

·       Should be classified based on the gestational age in weeks above i.e.

Ø  First to be chosen if gestational age is in between 0-12 weeks

Ø  Second to be chosen if gestational age is in between 13-26 weeks

Ø  Third to be chosen if gestational age is in between 27-40 weeks

Gravida

Number

Numeric

·       Mandatory

·       Total number of pregnancies including current

·       Minimum value will be 1

Para

Number

Numeric

·       Mandatory

·       Cannot exceed gravida

·       Auto select “0” if Gravida is 1

·       Para is number of deliveries if the fetus reaches a viable gestational age of ≥ 20–24 weeks regardless of the fetus was born alive or stillborn

History of abortions

Number

·       Yes

·       No

·       Mandatory

·       Enable if gravida is more than 1 otherwise the field will be disabled

·       If Yes → show alert for HRP (High Risk Pregnancy)

History of previous LSCS

Radio

·       Yes

·       No

·       Mandatory

·       Enable if gravida is more than 1 otherwise the field will be disabled

·       If Yes → show alert for HRP (High Risk Pregnancy)

Any complications in previous pregnancy

Dropdown

·       Gestational Diabetes

·       Pre-eclampsia

·       Eclampsia

·       Hemorrhage

·       Preterm Birth

·       Stillbirth

·       None

·       Mandatory

·       Multiple selection

·       If selected “None” then only single selection should be enabled.

·       Show alert for HRP (High Risk Pregnancy) if any option is selected except none

·       Enable if gravida is more than 1 otherwise the field will be disabled

·       If Yes → show alert for HRP (High Risk Pregnancy)

Height (cm)

Number

Numeric Value

·       Mandatory

·       Range to be kept = 100-220 cm

·       Use for BMI calculation

·       If <145 cm → show alert for HRP (High Risk Pregnancy

Weight (Kgs)

Number

Decimal Value

·       Mandatory

·       Range 30-150 kg

·       Use for BMI calculation

BMI

Auto calculated and single selection

·       Under weight

·       Normal

·       Overweight

·       Obese

·       Single selection of the option

·       Auto-calculated using formula

       Weight/(Height/100) ²

·       Weight is in Kgs

·       Height is in cms

·       Display category according :

Ø  Underweight (<18.5)

Ø  Normal (18.5-24.9) Overweight (25-29.9)

Ø  Obese (≥30)

Pre-existing conditions

Multi-select

·       Hypertension

·       Diabetes Mellitus

·       Thyroid

·       Heart disease

·       Epilepsy

·       Tuberculosis

·       HIV

·       Sexually transmitted Infections

·       Severe Malnutrition

·       Kidney disease

·       Auto Immune disorders

·       Mandatory

·       Any selection → show alert for HRP (High Risk Pregnancy)

VDRL/RPR Test result

Spinner

Choose:

·       Reactive

·       Non-Reactive

·       Test Not Done

·       Mandatory

·       Reactive → show alert for HRP (High Risk Pregnancy)

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"

HIV Test result

Spinner

Choose:

·       Reactive

·       Non-Reactive

·       Test Not Done

·       Mandatory

·       Reactive → show alert for HRP (High Risk Pregnancy)

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

HBsAg Test result

Spinner

Choose:

·       Positive

·       Negative

·       Test Not Done

·       Mandatory

·       Reactive → show alert for HRP (High Risk Pregnancy)

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

High-Risk Conditions Present?

Auto selected

·       Yes

·       No

·        Auto-selection based on algorithm

·        HRP if any of the condition is present: age <18 yrs or >35 yrs, Height <145 cm, History of abortion, Previous LSCS, Any pre-existing condition selected

Next Button

·       Proceed to vital screen and prescription.

S No

Data Field

Field Type

Values / Options

Validation / Logic

Symptoms

·       Pain

·       Soreness

·       Cold

·       Itching

·       Hoarseness

·       Mandatory

·       Multiple selection

Swelling in the neck (thyroid)

·       Yes

·       No

·       Optional

·       If yes show alert for referral to specialist at the secondary level

Difficulty in swallowing

·       Yes

·       No

·       Optional

·       If yes show alert for referral to specialist at the secondary level

Tonsillitis

·       Yes

·       No

·       Optional

Pharyngitis

·       Yes

·       No

·       Optional

Laryngitis

·       Yes

·       No

·       Optional

Sinusitis

·       Yes

·       No

·       Optional

Cleft lip

·       Yes

·       No

·       Optional

·       If yes show alert for referral to specialist at the secondary level

Cleft palate

·       Yes

·       No

·       Optional

·       If yes show alert for referral to specialist at the secondary level

Next Button

·       Proceed to vital screen and prescription.