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CHILD IMMUNISATION TRACKING (FOR EACH CHILD) S.

NO 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 FLOW CHART Location Details Child ID (18 Digits) Name Mother Name Address Gram Panchayat/Village Caste Phone No whom Phone Number Age (Years) Date of Birth Bloog Group Health Provider Details Name of ANM Phone No of ANM Name of ASHA Phone No of ASHA Immunisation Details BGG Date OPVO Date HepatitisB1_Date DPT1_Dt OPV1_Date DPT2_Date HepatitisB2_Dt OPV2_Date HepatitisB3_Date DPT3_Date OPV3_Date HepatitisB4_Date Measles_Date VitA Dose1 Date MR Date DPTBooster Date OPVBooster Date VitA Dose2 Date VitA_Dose3 Date JE Vaccine_Dt VitA_Dose4_Dt DT5_Date TT10_Dt TT16 Date CLD_REG_DATE Sex

xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx xxxxxxxxxxxxx at birth as early as possible till one year of age at birth as early as possible till onefirst year15 ofdayz age at birth as early as possible till onewithin year of 24hrs age 6weeks at 6weeks 10 weeks 6 weeks 10 weeks 10 weeks 14 weeks 14 weeks 14 weeks at completed 9 months to 12 months at 9months completed to 12months 16-24 months 16-24 months 18months 6months of 2nd dose 16-24months 6months of 3rd dose 5-6years 10years 16years

27 28 29 30 31 1 2 3 4 5 6

VitA_Dose5_Dt VitA_Dose6_Dt VitA_Dose7_Dt VitA_Dose8_Dt VitA_Dose9_Dt Remarks Call Answered Yes/No Remarks Correct Self Phone No Yes/No Call Back - HH &MM Submit

6months of 4th dose 6months of 5th dose 6months of 6th dose 6months of 7th dose 6months of 8th dose

PREGNANT WOMAN TRACKING S. NO FLOW CHART Location Details 1 Mother ID 18 Digits 2 Name 3 Husband's Name 4 Address 5 Gram Panchyat/Village 6 Caste SC/ST/Others 7 Phone Number of Whom 8 Phone Number 9 JSY Beneficiary - Yes/No 10 Date of Birth (D/M/Y) 11 Age (Years) 12 Status Health Provider Details 1 Name of ANM 2 Phone No of ANM 3 Name of ASHA 4 Phone No of ASHA 5 Linked fecility for delivery 6 Name of Linked fecility for delivery ANC Details - Date to be specified (D/M/Y) - D 1 LMP - (D/M/Y) 2 1st ANC(Including Registration) - (D/M/Y) 3 2nd ANC - (D/M/Y) 4 3rd ANC - (D/M/Y) 5 4th ANC - (D/M/Y) 6 Tt1 (D/M/Y) 7 Tt2 (D/M/Y) 8 TT Booster Date 9 100 IFA Given Date 10 Anaemia (HB Level) 11 Complication 12 RTI/STI - (Yes/No) Pregnancy Outcome - EDD 1 Abortion 2 Date of Delivery 3 Deliery Type 4 Complication 5 Place of Delivery 6 Type 7 Date of Discharge 8 JSY Beneficiary PNC Details 1 PNC Home visit

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when is ur last period ,did u conformied the pregnancy,how many we upto 12 weeks is 1st anc visit ,did u registered any where,did u under 14-22 weeks,3rd anc visit date?,tt dose taken,blood test done , 24-32 weeks,all investigations done,any problems,do u know ur edd,d 36-till delivery,did u know ur edd,all investigations done,any problem as soon as pregnancy is conformed and after 1st anc check up given 4 to 8 weeks after first tt dose. if received 2 tt dose in pregnancy with in the last 3years iron folic acid tablets taken or not,one tablet for a day for 3months or <11mg hypoprotenimeia,triedness,fatigue,fits/convulsions.giddiness. reproductive tract infection/sexually trasmitted infections-hiv?

any abortions ,how ,which month,previous abortions which date was delivery done institutional or home blood loss,abortions,any infections,low blood presure or high blood p hospital or home normal or caesarean how many days after delivery she was discharged any benefits she got from jsy,free health benefits used first visit immediate after delivery,2nd visit on 3rd day after delivery

2 3 4 1 2 3 4 5 6 7 8 1 2 3 4 5

PNC Complications Post Partum complication Method PNC Check up Infant Details ( Number of Outcomes) Chld 1 Name Chld 1 Sex Chld 1 Weight (kg) Breastfeeding (Within 1 Hr) Chld 2 Name Chld 2 Sex Chld 2 Weight (kg) Breastfeeding (Within 1 Hr) Call Answered Yes/No Remarks Correct Self Phone No Yes/No Call Back - HH &MM Submit

child haelth issues or mother excessive bleeding or any other issues when blood loss >500ml,cuts or lacerations,retained placental fragme as per home visit name of child male/female how much weight usually 2-3kgs sholud be done xxxx male/female 2-3kgs should be done

he pregnancy,how many weeks now any idea? ered any where,did u underwent all investigations, do u know 2nd anc date,did u take tt dose. ken,blood test done , other investigation?any complications or any issues iron folic tablets taken roblems,do u know ur edd,did u take tt dose. igations done,any problems, do u know govt health benefits,didtook u tt dose. ter 1st anc check up

he last 3years let for a day for 3months or two tablets a day if anaemic(<11mg)

nvulsions.giddiness. mitted infections-hiv?

iv,shyphilis,uti,gonnereah,hepatitis

ood presure or high blood pressure,any fits

enefits used 3rd visit on 7th day after fter delivery.4th birth 4thvisit visit after 6 weeks after birth and rest as per reqirement

t on 3rd day after delivery birth

eeding or any other issues s,retained placental fragments,uterine atony

and rest as per reqirement