2. MODULES and FORMS

 

 

Please complete the table below:

Fill in the proposed modules and forms by replacing the samples seen in red, adding or subtracting rows as necessary

Module Name

Form Name

Mother

Registration

 

Check Up 1, 2, 3

 

Birth

 

Post Birth Check Up

Child

Registration

 

Immunizations

 

Weight/Height

 

Close


  1. DEFINITION CHART

Please fill in your proposed questions and their accompanying logic by replacing the samples seen in red. Please do this to include every form, adding additional rows for every additional question.

 

 

Module/Form

When will you ask?

 

 

Question

What you want to ask

 

Question Type

Free text, Number, Single Select, Multiple Select (Provide Choices)

Data Constraints

Display Logic

Pregnant Women:

-Registration

Name

Free Text

 

 

 

Age

Number

Must be between 12-70

 

 

Village

Free Text

 

(

 

 

 

Date of last menstrual period

Number (Date)

Must be in the past

 

 

Has had previous pregnancies?

Yes/No

 

 

-Check Up 1

Plan for Birth

Multiple Select:

-hospital, clinic, home, no plan

 

Only show in 3rd trimester

 

Who will help with home birth?

-Family member

-Midwife

-Traditional Birth Attendant

-No plan

 

Only if answered "home" from "Plan for Birth"