Page History

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

Optional

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

• Optional

·       Total number of pregnancies including current

·       Minimum value will be 1

Para

Number

Numeric·       Mandatory

• Optional

·       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

• Optional

·       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

• Optional

·       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

• Optional

·       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

• Optional

·       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

• Optional

·       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.

Data Field

Field Type

Value/Options

Validation / Logic

Date of ANC Visit

Date

dd-mm-yyyy
(to be chosen from calendar)

• Mandatory
• Cannot exceed current date
• Default date should be null
• 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.
• And not greater than Date "42 weeks of Pregnancy"; i.e. maximum Date is 42 weeks from LMP Date

ANC Visit Number

Auto

• 1^st visit
• 2^nd visit
• 3^rd visit
• 4^th visit

• Mandatory
• Auto-populated based on the time when data entry happens as it should calculate the number of visit based on prior history but it should be editable.
• 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 28-36 weeks from LMP Date.
• Display ANC 4, if "ANC Date" is between 36 weeks up to EDD from LMP Date.

Gestational Age (Weeks)

Auto-calculated

Display as "X weeks Y days"

• Auto-calculated and mandatory
• Current date minus LMP date

Weight

Number

Number- kg

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

BP(Systolic)

Number

Numeric- mmHg

• Mandatory
• Accept numeric (integer) value only
• Values from 50 to 300
• Default value 0
• If value is < 90 or ≥140 mmHg → show alert for HRP (High Risk Pregnancy)

BP(Diastolic)

Number

Numeric- mmHg

• Mandatory
• Accept numeric (integer) value only
• Values from 30 to 200
• Default Value 0
• If value is < 60 or >= 90 mm Hg → show alert for HRP (High Risk Pregnancy)

Blood Sugar (Fasting)

Number

Numeric- mg/dl

• Mandatory
• Range 40-400 mg/dL
• Show alert if >95mg/dl

Urine Sugar

Dropdown

• Negative
• Trace
• +
• ++
• +++

• Mandatory
• If selected negative or trace, move to the next question without any alert.
• + or more → show alert for HRP (High Risk Pregnancy)

Fundal Height

Custom Number Picker

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

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

Fetal Heart Rate (FHR)

Number

BPM

• Optional
• Accept decimal numbers only, up to one decimal place
• Accept values up to 3 digits
• Allow range minimum 40.0 to maximum 200.0 bpm
• If FHR<110 bpm→ show alert for bradycardia
• If FHR>160 bpm→ show alert for tachycardia
• If <110 or >160 → show alert for HRP (High Risk Pregnancy)

Urine Albumin

Dropdown

• Negative
• Trace
• +
• ++
• +++

• Mandatory
• If selected negative or trace, move to the next question without any alert.
• + or more → show alert for HRP (High Risk Pregnancy)

Hb Level

Number

g/dL

• Mandatory
• If <7 → Severe Anemia → show alert for HRP (High Risk Pregnancy)

Date of TD dose 1

Date Picker

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

• Optional
• TD= Tetanus Diphtheria
• 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
  
  "TD dose 2" or '"Date of TT Booster Dose" is entered in the Last ANC Visit.

TD dose 2 given

Date Picker

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

• Enable only if TD dose 1 date is documented
• Accept date after 4 weeks from TD dose 1 given to date up to 36 weeks of LMP
• Enable this data field if "Date of TD 1^st Dose" is entered in the Last ANC Visit.
• 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
• 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.

TT booster dose given

Date Picker

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

• Mandatory
• Enable only if TT dose 2 given date is documented
• 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.

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

Calcium Given

Custom Number Picker

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

• Disable field up to 14 Weeks of Pregnancy.
• Default Value: to be null if no data is entered
• Accept value up to 400

Danger Signs

Multi-select

• Vaginal Bleeding
• Swelling of hands, feet or face
• Severe Headache
• Blurred Vision
• Convulsions/ seizures
• Severe abdominal pain
• Fever > 38°C
• Painful urination/ Burning
• Reduced fetal movement
• Vaginal fluid leakage
• Persistent vomiting
• Breathlessness/ chest pain
• None

• Mandatory
• Multiple selection should be possible
• If selected “None” then only single selection should be enabled. 
• On any selection→ show alert for HRP (High Risk Pregnancy)

Counselling Provided

Dropdown

• Yes
• No

• If "Yes"→ enable next question

Which counselling was provided?

• Nutrition
• Birth Preparedness and Complication readiness
• Identification of danger signs
• Medication compliance (IFA/ Calcium/ other medications)
• Immunization
• Hygiene and Infection Prevention

• Mandatory if enabled
• Multiselect
• Should be enabled if above question is "Yes"
  
  
  

Next ANC Visit Date

Calendar

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

• Greater than Today's Date
• Should be < = EDD

Next Button

• Proceed to vital screen and prescription.

Data Field

Field Type

Value/Options

Validation / Logic

Name Details of the woman

Auto-populated

From pregnancy registration

• Auto populate
• Display only (non-editable)
• Should show: Name, Age, Case ID
• Should link to full ANC history

Date of Delivery

Date picker

dd/mm/yyyy

• Mandatory
• Cannot be future date
• Must be ≥ EDD minus 4 weeks (premature) and ≤ EDD plus 2 weeks (post-term)
• If >14 days from EDD → Show alert: "Post-term delivery"
• If <37 weeks gestation → Auto-flag as "Preterm delivery"

Time of Delivery

Time picker

HH:MM (12-hour format)

Optional 

Gestational Age at Delivery

Auto-calculated

Weeks + Days (e.g., 38w 5d)

• Auto-calculated from LMP/EDD
• Non editable
• Display only
• Based on the classification below show alert-
  
  
  
• <28 weeks: Extremely Preterm
• 28-32 weeks: Very Preterm
• 32-37 weeks: Moderate to Late Preterm
• 37-42 weeks: Term
• >42 weeks: Post-term

Place of Delivery

Dropdown (Single select)

• Sub-Centre
• Primary Health Centre (PHC)
• Community Health Centre (CHC)
• District Hospital (DH)
• Medical College Hospital
• Referral/Tertiary Hospital
• Private Hospital
• Home delivery
• On the way to facility

• Mandatory
• If "Home delivery" → Show alert: "Home delivery occurred. Provide counselling on risks. Ensure immediate PNC visit."
• If "Private Hospital" → Enable field for hospital name
• If "Home delivery" or "On the way" → Show alert for urgent PNC home visit within 24 hours

If Private Hospital, specify name

Text field

text

• Enable only if place of delivery = "Private Hospital"
• Optional
• Free text (100 char limit) -

Delivery conducted by

Dropdown

• Doctor (MBBS/Specialist)
• Nurse/ANM
• CHO
• Skilled Birth Attendant (SBA)
• Dai/TBA (Traditional Birth Attendant)
• Family member
• Self/Unassisted

• Mandatory
• Single selection
• If "Dai/TBA", "Family member", or "Self" → Show alert: "Unskilled delivery. High-risk PNC needed."

Mode of Delivery

Dropdown

• Normal Vaginal Delivery (NVD)
• Vacuum/ Forceps Assisted
• Lower Segment Cesarean Section (LSCS)
• Emergency LSCS
• Vaginal Birth After Cesarean (VBAC)Mandatory

• Single selection
• If LSCS/ emergency LSCS/ Assisted→ Enable "Indication for LSCS" field

Indication for LSCS/Emergency LSCS/Assisted

Multi-select checkbox

• Fetal distress
• Cephalopelvic disproportion (CPD)
• Previous LSCS
• Malpresentation (Breech/Transverse)
• Prolonged/Obstructed labor
• Antepartum hemorrhage (APH)
• Pre-eclampsia/Eclampsia
• Cord prolapse
• Failed induction
• Multiple pregnancies
• Maternal request
• Other (specify)

• Enable only if Mode of Delivery = LSCS/Assisted
• Mandatory if enabled
• Multiple selections allowed
• If "Other" → Enable text field (200 char)

Mother's Condition Immediately Post-Delivery

Radio button

• Healthy/ Stable
• Complication (specify)
• Critical/ICU admission
• Maternal Death

• Mandatory
• If selected "Complications" or "Critical" → Enable maternal complications field.
• If "Maternal Death" → open maternal death audit form
• If "Maternal Death" → Show alert "Inform District Nodal Officer" automatically

Maternal Complications

Multi-select checkbox

• Post-Partum Hemorrhage (PPH)
• Retained placenta
• Perineal tear (1st/2nd degree)
• Perineal tear (3rd/4th degree)
• Uterine rupture
• Sepsis/ Infection
• Pre-eclampsia/Eclampsia
• Blood transfusion required
• Hysterectomy performed
• Anesthesia complication
• Other

• Mandatory if enabled
• Enable if Mother's Condition Immediately Post-Delivery= "Complications" or "Critical"
• Multiple selections allowed
• If "PPH" or "Uterine rupture" → show alert for PNC monitoring
• If "Hysterectomy" → Automatic family planning counseling adjustment (permanent method done) or take in eligible couple tracking form
• Make it editable, for cases if any further complications occur in future.

Mother currently admitted?

Radio button

• Yes (Still in hospital)
• No (Discharged)

• If "No" → Enable discharge date field

Date of Discharge

Date picker

DD/MM/YYYY

• To be enabled if Mother currently admitted? = "No"
• Mandatory if discharged
• Cannot be before delivery date
• Should be used to calculate first PNC home visit timing

Next Button

• Proceed to vital screen and prescription.

S.No.

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Name

Auto-populated

From delivery outcome

• Auto-populate form Delivery outcome
• Display only
• Links to ANC & Delivery history
• Non-editable.

2

Date of Delivery

Auto-populated

From delivery outcome

• Auto-populate form Delivery outcome
• Non editable

3

PNC Visit

Spinner

• 1st Day
• 3rd Day
• 7th Day
• 14th Day
• 21st Day
• 28th Day
• 42nd Day/ 6th Week

• Mandatory
• Single selection
• If any 'Visit Day' or previous visit is submitted, then don't show that 'Visit Day' in the spinner for next visit. eg- if last PNC visit was done on 3^rd day, remove options 1^st and 3^rd day when next PNC visit is conducted.
• Selection should be incremental i.e. 1,3,7,14,21,28,42 days

4

PNC Visit Date

Calendar picker

• Format: dd-mm-yyyy

• Auto-populate this due date by calculating using below logic
• After selecting above 'PNC Visit' and calculate this date from 'date of Delivery'
• Not greater than Today's Date
• Not less than Date of Delivery
• Date of 'next visit' should be incremental
• Date of 'next visit' should not be less than 'previous visit' date (always should be greater than 'previous visit' date)
  
  
  

1. 1st Day - Accept date equal to Date of Delivery
2. 3rd Day – date should be equal to 3^rd day after delivery
3. 7th Day – date should be between Delivery + 7 (-3 and +3 ) in days
4. 14th Day - date should be between Delivery + 14 (-3 and +3) in days.
5. 21st Day - date should be between Delivery + 21 (-3 and +3 ) in days.
6. 28th Day - date should be between Delivery + 28 (-3 and +3 ) in days
7. 42nd Day - date should be between Delivery + 42 (-3 and +3 ) in days

5

Maternal Death

Radio Button

• Yes
• No

• Mandatory
• Default value is "No"
• If "Yes" is selected, enable Q.6 to Q.10 and close the case by directly going to the submit option.
• If "No" is selected, disable Q.6 to Q.10 and enable from Q.11 onwards
• If "Yes" is selected, enable below three fields and mark it mandatory
  
  1. Probable Cause of Death
  2. Date of Death
  3. Place of Death
• If "Yes" is selected, update 'Beneficiary Status' = "Death" in the Beneficiary record, with "Death Date", "Place of Death" and "Reason for Death" in Beneficiary table and sync to AMRIT
• If "Yes" is selected, then disable below fields from S. No. 11 to 20 (are Not applicable)

6

Date of Death

Date Picker

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

• Mandatory if enabled
• Enable if 'Maternal Death' = "Yes"
• Not greater than Today's Date
• Not less than Delivery Date

7

Cause of maternal death

Spinner

• Eclampsia
• Hemorrhage (PPH)
• Anaemia
• High fever
• Sepsis
• Accident
• Other

• Mandatory if enabled
• Enable if 'Maternal Death' = "Yes"
• Open "Other Death Cause" Text Box on selection of "Any Other" option and is mandatory.
• If "Accident" is selected mark it as "Non-maternal death"

8

Other

Text

• Enable only if "cause of maternal death" = "Other"
• Accept alphabets only
• Character limit 50

9

Place of Death

Spinner

• Home
• Subcenter
• PHC
• CHC
• District Hospital
• Medical College Hospital
• Private Hospital
• In Transit
• Other

• Mandatory if enabled.
• Enable if 'Maternal Death' = "Yes"
• If 'Place of Death' is selected as "Other" then enable next field, otherwise don't.

10

Other Place of Death

Textbox

• Mandatory if enabled.
• Enable If 'Place of Death' = "Other"
• Accept alphabets only
• Character limit 50

11

Maternal Symptoms

Dropdown

• Excessive bleeding
• Foul-smelling discharge
• Fever
• Severe abdominal pain
• Breast pain
• Painful urination
• Severe headache
• Dizziness
• Difficulty breathing
• Swelling
• Wound pain
• Mood changes
• None
• Other

• Mandatory.
• Multiple selection
• If 2 or more symptoms selected → show alert for referral to facility
• If "other" is selected enable next field, otherwise don't.

12

Other maternal symptoms

Text

• To be enabled if "Maternal Symptoms" = "Other"
• Accept alphabets only
• Character limit 50

13

Pallor (Anemia check)

Dropdown

• None
• Mild
• Moderate
• Severe

• Optional
• If pallor= "Severe" → show alert for referral to facility

14

Vaginal Bleeding

Dropdown

• Normal
• Heavy bleeding
• Foul-smelling discharge
• Scanty
• Stopped

• Optional
• Heavy bleeding or foul smell → show alert for referral to facility

15

Family planning method used by the couple after delivery to avoid pregnancy?

Spinner

Choose:

• Post partum iucd (PPIUCD)
• Condom
• Male sterilization
• Female sterilization
• Post partum sterilization (PPS)
• Minilap
• None
• Other

• Default value is select
• If "Other" is selected then enable " Other contraception method " Text Box below and is mandatory.
• If 'Method of Contraception' = "MALE STERILIZATION" or "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap", then from next PNC visits fields 'Any Method of Postpartum Contraception (PPC)', 'Method of Contraception' and 'Date of Sterilisation' should be disables and show last visit details.
• If 'Method of Contraception' is "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap" is selected, then update 'Status of Women' to "Permanently Sterilized" after submission of 42nd Day PNC visit or after 60 Days from Date of Delivery

16

Other contraception method

Text Box

• Mandatory if enabled
• Accept alphabets, numeric and special character
• Character limit 50

17

Date of Sterilization

Calendar

dd-mm-yyyy

• Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" or "POST PARTUM STERILIZATION (PPS)"
• Mandatory
• Not greater than Today's Date
• Accept date not less than Date of Delivery

18

No. of IFA Tablets given

Custom Number Picker

• Default value 0
• IFA supplementation- 180 days postpartum recommended
• Accept numeric (integer) value only
• Accept value greater than 0
• Accept value up to 400

19

Calcium supplementation

Custom Number Picker

• Must accept numeric (integer) value only
• Default Value 0
• Default Value: to be null if no data is entered
• Accept value up to 400

20

Next Button

• Proceed to vital screen and prescription.

S. No.

Data Field

Field Type

Value/Options

Validation / Logic

1

Number of neonates

Dropdown

• Single (1)
• Twins (2)
• Triplets (3)
• Quadruplets+ (4+)

• Mandatory
• If >1 → Duplicate baby outcome section for each baby
• Multiple births flagged for special PNC attention
• This module should be filled separately for each live neonate and generate unique ID for each neonate linked to the same Delivery ID

2

Outcome at Birth

Radio button

• Live Birth
• Still Birth (Macerated)
• Still Birth (Fresh)
• Died during delivery

• Mandatory
• If stillbirth/died → open stillbirth audit form and disable remaining fields
• If stillbirth/ died → Skip growth parameters, go to complications section
  
  
  

3

Sex

Radio button

• Male
• Female
• Ambiguous

• Mandatory
• If "Ambiguous" → Show alert for pediatric specialist referral

4

Cried immediately after birth?

Radio button

• Immediate cry
• Cried after resuscitation
• Not applicable (Stillbirth)

• To be enabled if Q.2 = "Live Birth"
• Mandatory
• If "cried after resuscitation" enable "type of resuscitation" field.
  
  
  

5

Type of resuscitation

Dropdown

• Stimulation
• Suctioning
• Bag and mask ventilation
• Oxygen
• Intubation
• Chest compressions
• Medications

• Mandatory if enabledOptional
• To be enabled if Q.4 = "cried after resuscitation"
• Multiple selections allowed

6

Birth Weight

Number

Capture in grams

• Mandatory
• Validation:
• Must be between 500-6000g
• If <2500g → show alert for "Low Birth Weight (LBW)"
• If <1500g → show alert for "Very Low Birth Weight (VLBW)"
• If <1000g → show alert for "Extremely Low Birth Weight (ELBW)"
• If >4000g → show alert for "Macrosomia" (flag for maternal GDM screening)

7

Any congenital anomaly detected?

Radio button

• Yes
• No
• Suspected (under evaluation)

• Optional
• If "Yes" or "Suspected" → Enable type of congenital anomaly field

8

Type of congenital anomaly

Dropdown

• Neural tube defect (Spina bifida/Anencephaly)
• Cleft lip/palate
• Club foot
• Down syndrome (suspected)
• Congenital heart defect (suspected)
• Limb defects
• Abdominal wall defect
• Genital abnormality
• Other

• Mandatory if enabled
• To be enabled if Q7. = "Yes" or "Suspected"
• Multiple selections to be allowed
• Enable text field for "Other" specification

9

Other

Textbox

Free text (300 character limit)

• Mandatory if enabled
• To be enabled if type of congenital anomaly= "Other"

10

Newborn Complications

Dropdown

• Birth asphyxia
• Respiratory distress
• Neonatal jaundice (visible at birth)
• Sepsis (suspected)
• Hypothermia
• Hypoglycemia
• Bleeding
• Convulsions
• None

• Multiple selections allowed
• Any complication → show alert for immediate pediatric/ specialist review

11

Current Status of Baby

Radio button

• Healthy and with mother
• Admitted (SNCU/NICU)
• Admitted (General ward)
• Died

• Mandatory
• If "Died" → open neonatal death audit form
• If "Died" enable Q.12 and disable Q.14 to Q.18
• If admitted → show alert for PNC counseling
• If "Healthy and with mother" enable directly Q. 14

12

If baby died, cause of death

Multi-select checkbox

• Birth asphyxia
• Prematurity
• Low birth weight complications
• Sepsis
• Congenital anomaly
• Respiratory distress
• Unknown
• Other (specify)

• Enabled if Current Status of Baby
  
  = "Died"
• Mandatory if enabled
• Multiple causes can contribute
• Enable text field for "Other" specification

13

Other

Textbox

Free text (300 character limit)

• To be enabled if cause of death of baby= "Other"

14

Birth dose vaccines given?

Dropdown

• BCG
• Hepatitis B (Birth dose)
• OPV-0
• None

• Mandatory
• Multiple selections allowed
• If "None" → enable Q.15 to capture the reason for not giving birth dose vaccines

15

Reason for not giving birth dose vaccines

Text field

Free text (200 char)

• Mandatory if enabled
• To be enabled if Q14 = "None"
• Common reasons: Baby unstable, SNCU admission, vaccine unavailable

16

Vitamin K injection given?

Radio button

• Yes
• No

• Mandatory
• If "No" → Enable Q.17 to capture reason for not giving Vitamin K injection

17

Reason for not giving Vitamin K injection

Text field

Free text (200 char)

• To be enabled if Q16 = "No"
• Mandatory if enabled
• Common reasons: Baby unstable, SNCU admission, vaccine unavailable

18

Birth Certificate issued?

Radio button

• Yes
• In process
• No (Not applied)

• Mandatory
• If "No (Not applied)" → show alert to provide information to family stating that birth registration is a legal requirement

19

Next Button

• Proceed to vital screen and prescription.