Module

Forms

Objectives

Frequency

Pregnancy

Pregnancy Registration

To register details of pregnant women in the village you work in.

Fill out once for every pregnant woman in the village

Pregnancy Checklist

To check if your client has received various mandatory medical services and care applicable through the course of her pregnancy

Fill out periodically based on each client’s trimester and services due to her. The purpose of the checklist is to ensure, service are provided to her in a timely manner. 

Pregnancy Counseling

To provide counseling on various pregnancy related practices that ensure a safe and healthy pregnancy

Fill out based on each client’s trimester position and recommended topics of counseling

Pregnancy Outcome

To fill out the outcome of a pregnancy

Fill out for every client on delivery

 

Pregnancy Registration Edit

 

To edit any details entered in the pregnancy registration form

Fill out only if you need to edit/change the details of the pregnant woman.

 

CommCare Application: CRS Revised Pregnancy Checklist (2.x)

Form Description

 

Module

Form

Objective

Frequency

Baby

Baby Registration

To register the details of a newborn

Fill out for every newborn post-delivery of your client

Baby Registration Edit

To edit any details entered in the baby registration form

Fill out only if you need to  edit/change the details of the newborn

 

 

 

 

 

 

 

 

 

 

Detailed Form Description

Module

Form

Objective

Frequency

Pregnancy

Pregnancy Registration

To register details of pregnant women in the village you work in.

Fill out once for every pregnant woman in the village

 

Navigation: Open CommCare Login 1. Pregnancy Module 1. Pregnancy Registration

This form is the first firm to be filled by Asha’s in the application and is meant to register the details of their client (pregnant mother). You can start registering a client by choosing the Pregnancy Module and then Pregnancy Registration form.

The Asha needs to fill out the following details:

  • Name of the Client
  • Age
  • Phone Number
  • Husbands Name
  • Village Name
  • Last Menstrual Period (LMP)
  • Number of Previous Pregnancies
  • Number of Living Children

Constraint

1. Entering the name of the client is must. The form will not move forward without a name

2.  LMP date can only be between 10 months and to the date of filling out the registration

Notes

1. On entering a valid LMP, the expected delivery date of your client will show up

2. Entering an accurate or close to accurate LMP is important as the rest of the information in the application depends upon the LMP

 

 

Module

Form

Objective

Frequency

Pregnancy Checklist

To check if your client has received various mandatory medical services and care applicable through the course of her pregnancy

Fill out periodically based on each client’s trimester and services due to her. The purpose of the checklist is to ensure, service are provided to her in a timely manner. 

Fill out periodically based on each client’s trimester and services due to her. The purpose of the checklist is to ensure, service are provided to her in a timely manner

 

Navigation: Open CommCare Login 1. Pregnancy Module 2. Pregnancy Checklist Case List Case Detail

This form is filled out to check if the client has receiving various mandatory medical services that ensure a safe pregnancy for the client. To start with the Checklist form, navigate through Pregnancy Module, Pregnancy Checklist and the Asha has to choose the appropriate client from a list of clients she has registered in the first step. On choosing the case, the next screen will pop up a case detail screen with basic information filled up during registration. This is to confirm that Asha is choosing the right client. The checklist form contains a series of questions that the Asha asks her client and the answer is a simple Yes or No that she chooses for each question. Some of the major questions that show up are

  • If the client has registered herself with the ANM within four months of pregnancy
  • Has the client completed her first ANC checkup (followed by second, third and fourth ANC checkups)
  • Has the client received Tetanus injections in the course of her earlier pregnancy
  • Has the client received her first and second Tetanus injection during the course of the her current pregnancy
  • If the client is taking Iron Tablets

 

Skip Logic 

1. On the ANC checkup questions, the logic on the ANC checkup questions is such that as long as the previous ANC checkup question = “yes” the next ANC checkup question will not appear.

2. If the client has had previous tetanus injections (previous tetanus = “yes”), only tetanus 1 question will show up. If previous tetanus = “no” then tetanus 2 question will appear if tetanus 1 = “yes”

3. The question on iron folic will show up only when the client is in her second trimester

Notes

ANC questions are structured such that there are 3 visits per trimester and the last visit is just before the pregnancy. Hence, the ANC checkup questions show up till the 4 th ANC question = “yes”. Whereas questions related to registration and tetanus disappear once the value = “yes” at any point in the form.