Personal information
Family Planning and Contraceptive Services
Registration date
date
New acceptor at registration
boolean
Repeat acceptor at registration
boolean
HIV test
boolean
HIV Test
boolean
HIV Test
integer
HIV counseling
boolean
TT vaccination status
boolean
Tick if one of following conditions present - Breastfeeding babb < 6 weeks old - Bleeding /spotting etween periods or after intercourse - Jaundice (abnormal yellow skin or eyes) - Smoke - Diabetes - Severe headache or blurred vision - Severe pain in calves, thighs or ehest, or swollen legs (edema) - High blood pressure (history of ) - Heart attack, strake or heart disease (history an - Breast cancer or suspicious (firm, contender , or fixed) lump in the breast - Taking drugs for epilepsy (phenytoin and barbiturates) or tuberculosis (rifampicin) - other
boolean
Tick if one of following conditions present - Client (or partner) has other sex partners - Sexually transmitted genital tract infections (GTI) within the last 3 months or other chronic STI (eg HBV, HIV/AIDS). - Pelvic infection (PID) or ectopic pregnancy (within the last 3 months) - Heavy menstrual bleeding (twice as much or twice as long as normal) - Severe menstrual cramping (dysmenorrhea) requiring analgesics and/or bed rest. - Bleeding/spottin between periods or after intercourse - Symptomatic va vular heart disease - other
boolean
Contraceptive methods permanent
integer
Visit number
integer
Visit Date
date
Contraceptive method
text
Remarks
text
Appointment
date
Total count