Informations:
Erreur:
ID
44012
Description
Form provided by Binyam Tilahun. Source: http://www.moh.gov.et/ (Ministry of Health, Ethiopia)
Lien
Mots-clés
Versions (3)
- 11/07/2016 11/07/2016 -
- 11/07/2016 11/07/2016 -
- 20/09/2021 20/09/2021 -
Téléchargé le
20 septembre 2021
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0
Modèle Commentaires :
Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.
Groupe Item commentaires pour :
Item commentaires pour :
Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.
Federal Ministry of Health Integrated Antenatal, Labor, Delivery, Newborn and Postnatal Care Card
Integrated Antenatal, Labor, Delivery, Newborn and Postnatal Care Card
Similar models
Integrated Antenatal, Labor, Delivery, Newborn and Postnatal Care Card
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Prenatal care registration number
Item
ANC Reg.No
integer
C0033052 (UMLS CUI [1,1])
C0421512 (UMLS CUI [1,2])
C0421512 (UMLS CUI [1,2])
Medical record number
Item
Medical record number
text
C1301894 (UMLS CUI [1])
Name
Item
Name of client
text
C0027365 (UMLS CUI [1])
Facility name
Item
Facility name
text
C0018704 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,2])
Address
Item
Address:Woreda
text
C0421449 (UMLS CUI [1])
Address
Item
Address: Kebelle
text
C0421449 (UMLS CUI [1])
Address
Item
Address: House number
integer
C0421449 (UMLS CUI [1])
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
Last menstrual period
Item
Last menstrual period
date
C0425932 (UMLS CUI [1])
Estimated date of delivery
Item
Estimated date of delivery
date
C1287845 (UMLS CUI [1])
Gravida
Item
Gravida
integer
C0750480 (UMLS CUI [1,1])
C0032961 (UMLS CUI [1,2])
C0032961 (UMLS CUI [1,2])
Para
Item
Para
integer
C0030563 (UMLS CUI [1])
Number of living children
Item
Number of living children
integer
C2229975 (UMLS CUI [1])
Marital status
Item
Marital status
text
C0024819 (UMLS CUI [1])
Stillbirth or neonatal loss
Item
Previous stillbirth or neonatal loss?
boolean
C0595939 (UMLS CUI [1,1])
C0410916 (UMLS CUI [1,2])
C0410916 (UMLS CUI [1,2])
Miscarriage
Item
History of 3 or more consecutive spontaneous abortions?
boolean
C0000786 (UMLS CUI [1])
Birth weight
Item
Birth weight of last baby < 2500g
boolean
C0005612 (UMLS CUI [1])
Birth weight
Item
Birth weight of last baby > 4000g
boolean
C0005612 (UMLS CUI [1])
Hospitalization pre-eclampsia/eclampsia
Item
Last pregnancy: hospital admission for hypertension or pre-eclampsia/eclampsia?
boolean
C0019993 (UMLS CUI [1,1])
C0032914 (UMLS CUI [1,2])
C0013537 (UMLS CUI [2])
C0032914 (UMLS CUI [1,2])
C0013537 (UMLS CUI [2])
Surgery on reproductive tract
Item
Previous surgery on reproductive tract?(Myomectomy, removal of septum, fistula repair, cone biopsy, CS, repaired rapture, cervical circlage)
boolean
C0700038 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
C0543467 (UMLS CUI [1,2])
Multiple Pregnancy
Item
Diagnosed or suspected multiple pregnancy?
boolean
C0032989 (UMLS CUI [1])
Age
Item
Age less than 16 years?
boolean
C0001779 (UMLS CUI [1])
Age
Item
Age more than 40 years
boolean
C0001779 (UMLS CUI [1])
Isoimmunization
Item
Isoimmunization Rh (-) in current or in previous pregnancy?
boolean
C0035404 (UMLS CUI [1])
Vaginal bleeding
Item
Vaginal bleeding
boolean
C2979982 (UMLS CUI [1])
Pelvic mass
Item
Pelvic mass
boolean
C0347944 (UMLS CUI [1])
Hypertension
Item
Diastolic blood pressure 90mm Hg or more at booking?
boolean
C0565599 (UMLS CUI [1])
Diabetes mellitus
Item
Diabetes mellitus
boolean
C0011849 (UMLS CUI [1])
Renal disease
Item
Renal disease
boolean
C0022658 (UMLS CUI [1])
Cardiac disease
Item
Cardiac disease
boolean
C0018799 (UMLS CUI [1])
Chronic hypertension
Item
Chronic hypertension
boolean
C0745114 (UMLS CUI [1])
Substance use disorder
Item
Known 'substance' abuse (including heavy alcohol drinking, Smoking)?
boolean
C0038586 (UMLS CUI [1])
Comorbidity
Item
Any other severe medical disease or condition TB, HIV, Ca, DVT..?
boolean
C0009488 (UMLS CUI [1])
Eligibility
Item
A "Yes" to any ONE of the above questions (i.e. ONE shaded box marked with a cross) means that the woman is not eligible for the basic component of the new antenatal care mode and require more close follow up or referral to specialty care.If she needs more frequest ANC visits use and attach additional recoridng sheets
text
C0013893 (UMLS CUI [1])
Item Group
Initial Evaluation plus Promotive and Preventive Care
General exam
Item
General exam
text
C0031809 (UMLS CUI [1])
Pallor
Item
Pallor
boolean
C0030232 (UMLS CUI [1])
Jaundice
Item
Jaundice
boolean
C0022346 (UMLS CUI [1])
Chest abnormalities
Item
Chest abnormalities
boolean
C0497258 (UMLS CUI [1])
Heart abnormalities
Item
Heart abnormalities
boolean
C0018799 (UMLS CUI [1])
Gynecological exam Vulvar ulcer
Item
Vulvar ulcer
boolean
C0200044 (UMLS CUI [1,1])
C0156339 (UMLS CUI [1,2])
C0156339 (UMLS CUI [1,2])
Gynecological exam Vaginal discharge
Item
Vaginal discharge
boolean
C0200044 (UMLS CUI [1,1])
C0227791 (UMLS CUI [1,2])
C0227791 (UMLS CUI [1,2])
Gynecological exam Pelvic Mass
Item
Pelvic Mass
boolean
C0200044 (UMLS CUI [1,1])
C0347944 (UMLS CUI [1,2])
C0347944 (UMLS CUI [1,2])
Gynecological exam Cervical Lesion
Item
Cervical Lesion
boolean
C0200044 (UMLS CUI [1,1])
C0235656 (UMLS CUI [1,2])
C0235656 (UMLS CUI [1,2])
Gynecological exam Uterine size
Item
Uterine size (Wks)
float
C0200044 (UMLS CUI [1,1])
C2188911 (UMLS CUI [1,2])
C2188911 (UMLS CUI [1,2])
Danger signs
Item
Danger signs in pregnancy & delivery advised
boolean
C0512307 (UMLS CUI [1])
Birth Preparedness
Item
Birth Preparedness advised
boolean
C0514464 (UMLS CUI [1])
HIV test accepted
Item
Mother: HIV test accepted
boolean
C1321876 (UMLS CUI [1])
CL Item
R (1)
CL Item
NR (2)
CL Item
I (3)
HIV test result counseling
Item
HIV test result received with post test counseling
boolean
C1321876 (UMLS CUI [1,1])
C1274040 (UMLS CUI [1,2])
C0010210 (UMLS CUI [1,3])
C1274040 (UMLS CUI [1,2])
C0010210 (UMLS CUI [1,3])
Counseling Infant feeding
Item
Counseled on Infant feeding
boolean
C0010210 (UMLS CUI [1,1])
C0420979 (UMLS CUI [1,2])
C0420979 (UMLS CUI [1,2])
Referral
Item
Referred for care, treatment and support
boolean
C0034927 (UMLS CUI [1])
CL Item
R (1)
CL Item
NR (2)
CL Item
I (3)
CL Item
1st visit (better before 16 weeks) (1)
CL Item
2nd visit (better 24 - 28 wks) (2)
CL Item
3rd visit (better 30 -32 wks) (3)
CL Item
4th visit (better 36-40wks) (4)
Visit date
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Gestational age
Item
Gestational age
text
C0017504 (UMLS CUI [1])
Blood pressure
Item
Blood pressure
integer
C0005823 (UMLS CUI [1])
Weight
Item
Body weight
float
C0005910 (UMLS CUI [1])
Pallor
Item
Pallor
text
C0030232 (UMLS CUI [1])
Uterine height
Item
Uterine height (Wks)
text
C0426012 (UMLS CUI [1])
Fetal heart beat
Item
Fetal heart beat
text
C0412564 (UMLS CUI [1])
Fetal Presentation
Item
Fetal Presentation
text
C0022869 (UMLS CUI [1])
Urine test
Item
Urine test for infection
text
C0462970 (UMLS CUI [1])
Urine test
Item
Urine test for protein
text
C0462970 (UMLS CUI [1])
Syphilis test
Item
Rapid syphilis test
text
C0973034 (UMLS CUI [1])
Hemoglobin
Item
Hemoglobin
text
C0019046 (UMLS CUI [1])
Blood group
Item
Blood group
text
C0005810 (UMLS CUI [1])
Rhesus factor
Item
Rhesus factor
text
C0427641 (UMLS CUI [1])
TT
Item
TT
text
C0305062 (UMLS CUI [1,1])
C1115464 (UMLS CUI [1,2])
C1115464 (UMLS CUI [1,2])
Iron/Folic acid
Item
Iron/Folic acid
text
C0357067 (UMLS CUI [1])
Mebendazole
Item
Mebendazole
text
C0025023 (UMLS CUI [1])
Use of ITN
Item
Use of ITN
text
C2717999 (UMLS CUI [1])
ARV Prophylaxis
Item
ARV Px type
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
Remarks
Item
Remarks
text
C0947611 (UMLS CUI [1])
Danger signs
Item
Danger signs identified and Investigation
text
C2164151 (UMLS CUI [1])
Action, Advice, counseling
Item
Action, Advice, counseling
text
C0441472 (UMLS CUI [1])
C0150600 (UMLS CUI [2])
C0010210 (UMLS CUI [3])
C0150600 (UMLS CUI [2])
C0010210 (UMLS CUI [3])
Appointment
Item
Appointment for next follow-up
text
C0586344 (UMLS CUI [1])
Name and signature
Item
Name and Sign of Health care Provider
text
C0027365 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
C1519316 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
Name
Item
Name
text
C0027365 (UMLS CUI [1])
Gravida
Item
Gravida
integer
C0422807 (UMLS CUI [1])
Parity
Item
Para
integer
C0030563 (UMLS CUI [1])
Medical Record Number
Item
Medical Record Number
text
C1301894 (UMLS CUI [1])
Admission date
Item
Admission Date
date
C1302393 (UMLS CUI [1])
Time of admission
Item
Time of admission
time
C3854259 (UMLS CUI [1])
Ruptured membranes
Item
Ruptured membranes
integer
C0948106 (UMLS CUI [1])
Fetal heart rate
Item
Fetal heart rate
integer
C0018811 (UMLS CUI [1])
Amniotic fluid
Item
Amniotic fluid
text
C0002638 (UMLS CUI [1])
Moulding
Item
Moulding
text
C0426103 (UMLS CUI [1])
Cervix
Item
Cervix uteri cm per hour
text
C0007874 (UMLS CUI [1])
Descent of head
Item
Descent of head per hour
text
C0437201 (UMLS CUI [1])
Contractions
Item
Contractions per 10 min
integer
C0042130 (UMLS CUI [1])
Oxytocin
Item
Oxytocin in drops per minute
integer
C0030095 (UMLS CUI [1])
Oxytocin
Item
Oxytocin in U/l
integer
C0030095 (UMLS CUI [1])
Drugs
Item
Drugs given
text
C0013227 (UMLS CUI [1])
IV fluids
Item
IV fluids given
text
C1289919 (UMLS CUI [1])
Pulse Rate
Item
Pulse
integer
C0232117 (UMLS CUI [1])
Blood pressure
Item
Blood pressure, systolic
integer
C0005823 (UMLS CUI [1])
Blood pressure
Item
Blood pressure, diastolic
integer
C0005823 (UMLS CUI [1])
Body Temperature
Item
Body Temperature
float
C0005903 (UMLS CUI [1])
Urine protein
Item
Urine protein
float
C0262923 (UMLS CUI [1])
Urine acetone
Item
Urine acetone
float
C0236440 (UMLS CUI [1])
Urine volume
Item
Urine volume
float
C1287298 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Time
Item
Time
time
C0040223 (UMLS CUI [1])
Spontaneous Vaginal Delivery
Item
Spontaneous Vaginal Delivery
boolean
C0269694 (UMLS CUI [1])
Cesarean section
Item
Cesarean section
boolean
C0007876 (UMLS CUI [1])
Vacuum extraction delivery
Item
Vacuum extraction delivery
boolean
C0042225 (UMLS CUI [1])
Forceps extraction delivery
Item
Forceps extraction delivery
boolean
C0869912 (UMLS CUI [1])
Episiotomy
Item
Episiotomy
boolean
C0014586 (UMLS CUI [1])
Item
Active management of third stage labor
integer
C0022873 (UMLS CUI [1,1])
C0150270 (UMLS CUI [1,2])
C0150270 (UMLS CUI [1,2])
CL Item
Ergometrine (1)
CL Item
Oxytocine (2)
CL Item
Misoprostol (3)
CL Item
Completed (1)
CL Item
Incomplete (2)
CL Item
CCT (3)
CL Item
MRP (4)
CL Item
1rst degree (1)
CL Item
2nd degree (2)
CL Item
3rd degree (3)
CL Item
Single (1)
CL Item
Multiple (2)
Newborn: life birth
Item
Newborn: life birth
boolean
C2584946 (UMLS CUI [1])
Apgar score
Item
Apgar score
integer
C0003533 (UMLS CUI [1])
CL Item
MAC (1)
CL Item
Fresh (2)
CL Item
Male (1)
CL Item
Female (2)
Birth weight
Item
Birth weight
float
C0005612 (UMLS CUI [1])
Length
Item
Infant length
integer
C1444754 (UMLS CUI [1])
Delivery preterm
Item
Delivery preterm
boolean
C0151526 (UMLS CUI [1])
Delivery to term
Item
Delivery to term
boolean
C0233089 (UMLS CUI [1])
BCG Date
Item
BCG Date
date
C0004886 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
BCG (1)
CL Item
Polio 0 (2)
CL Item
Vit K (3)
CL Item
TTC (4)
Bonding
Item
Baby-Mother Bonding
boolean
C0237497 (UMLS CUI [1])
CL Item
Eclampsia (1)
CL Item
APH (2)
CL Item
Ruptured uterus (repaired) (3)
CL Item
PPH (4)
CL Item
PROM/Sepsis (5)
CL Item
Obst/prolg labor (6)
CL Item
Eclampsia (1)
CL Item
APH (2)
CL Item
Ruptured uterus (hysterectomized) (3)
CL Item
PPH (4)
CL Item
PROM/Sepsis (5)
CL Item
Obst/prolg labor (6)
HIV testing and counseling
Item
HIV testing and counseling offered
boolean
C1321876 (UMLS CUI [1,1])
C0010210 (UMLS CUI [1,2])
C0010210 (UMLS CUI [1,2])
HIV Test
Item
HIV Test accepted
boolean
C1321876 (UMLS CUI [1])
CL Item
R (1)
CL Item
N (2)
CL Item
I (3)
ARV Prophylaxis
Item
Type of ARV prophylaxis provided to mother
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
ARV Prophylaxis
Item
Type of ARV prophylaxis provided to newborn
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
CL Item
EBF (1)
CL Item
RF (2)
Referred for care and support
Item
Mother and newborn referred for care and support
boolean
C0034927 (UMLS CUI [1,1])
C0032782 (UMLS CUI [1,2])
C0418955 (UMLS CUI [1,3])
C0032782 (UMLS CUI [1,2])
C0418955 (UMLS CUI [1,3])
Remarks
Item
Remarks
text
C0947611 (UMLS CUI [1])
Name of Obstetrician
Item
Delivered by
text
C0027365 (UMLS CUI [1,1])
C0334897 (UMLS CUI [1,2])
C0334897 (UMLS CUI [1,2])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
CL Item
1st visit (better at 6 hrs) (1)
CL Item
2nd (better at 6th day) (2)
CL Item
3rd visit (better at 6th wks) (3)
Date
Item
Date of postpartum visit
date
C0011008 (UMLS CUI [1])
Blood Pressure
Item
Blood Pressure
integer
C0005823 (UMLS CUI [1])
TPR
Item
TPR
text
C0849975 (UMLS CUI [1])
Temperature
Item
Temperature
float
C0039476 (UMLS CUI [1])
Uterus contracted
Item
Uterus contracted
text
C0567158 (UMLS CUI [1])
Postpartum hemorrhage
Item
Postpartum hemorrhage
text
C0032797 (UMLS CUI [1])
Urine leakage
Item
Urine leakage or dribbling
text
C0375553 (UMLS CUI [1])
Anemia
Item
Anemia
text
C0002871 (UMLS CUI [1])
Vaginal Discharge
Item
Vaginal Discharge after 4 weeks post delivery
text
Pelvic exam
Item
Pelvic exam (only if vaginal discharge)
text
C0200045 (UMLS CUI [1])
Breast exam
Item
Breast exam
text
C2347781 (UMLS CUI [1])
Vitamin A
Item
Vitamin A for mother
text
C0042839 (UMLS CUI [1])
Counseling on danger signs, ITN and EPI
Item
Counseling on danger signs, ITN and EPI
text
C0010210 (UMLS CUI [1,1])
C0512307 (UMLS CUI [1,2])
C2717999 (UMLS CUI [2])
C0545304 (UMLS CUI [3])
C0512307 (UMLS CUI [1,2])
C2717999 (UMLS CUI [2])
C0545304 (UMLS CUI [3])
Baby Breathing
Item
Baby Breathing
text
C0548003 (UMLS CUI [1])
Breastfeeding
Item
Baby breastfeeding
text
C0006147 (UMLS CUI [1])
Infant Weight
Item
Baby weight
integer
C0745274 (UMLS CUI [1])
Immunization
Item
Immunization
text
C0020971 (UMLS CUI [1])
HIV test
Item
HIV test done?
boolean
C1321876 (UMLS CUI [1])
CL Item
R (1)
CL Item
NR (2)
ARV Prophylaxis
Item
Type of ARV prophylaxis provided to mother
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
ARV Prophylaxis
Item
Type of ARV prophylaxis provided to newborn
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
CL Item
EBF (1)
CL Item
RF (2)
Referred for care and support
Item
Mother referred for care and support
text
C0034927 (UMLS CUI [1,1])
C0032782 (UMLS CUI [1,2])
C0418955 (UMLS CUI [1,3])
C0032782 (UMLS CUI [1,2])
C0418955 (UMLS CUI [1,3])
Referral for HIV infant care
Item
Newborn referred to chronic HIV infant care
text
C0034927 (UMLS CUI [1,1])
C0021272 (UMLS CUI [1,2])
C0019699 (UMLS CUI [1,3])
C0021272 (UMLS CUI [1,2])
C0019699 (UMLS CUI [1,3])
Counseling feeding practice
Item
FP Counseled & provided
text
C0010210 (UMLS CUI [1,1])
C0420979 (UMLS CUI [1,2])
C0420979 (UMLS CUI [1,2])
Remarks
Item
Remarks
text
C0947611 (UMLS CUI [1])
Action taken
Item
Action Taken
text
C1555295 (UMLS CUI [1])
Attendant name
Item
Attendant name
text
C0554205 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,2])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])