ANNEXURE-I Women Death First Information ... - Nrhmharyana.org
ANNEXURE-I Women Death First Information ... - Nrhmharyana.org ANNEXURE-I Women Death First Information ... - Nrhmharyana.org
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ANNEXURE IIIName of the BlockPHC/District:MDR FORM TO BE FILLED BY THE MO INCHARGE OF PHC/CHC/SDH/DH(To be filled after the report of the CBMDR)(To be submitted along with the report of CBMDR to the Civil Surgeon)To be filled by the block medical officer for each maternal death in the block after investigationParticulars of the deceased Name: Age:Name of the husbandGravida/ParaVisitor/Resident/AddressTiming of Death Pregnancy During MTP Delivery Within 42 daysafter delivery orMTPReligion/Caste/CommunityPlace & Date of deathDate of investigation bycommunitybasedcommittee
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- Page 19 and 20: ADMISSION AT INSTITUTION WHERE DEAT
- Page 21 and 22: Comments on antenatal care - List a
- Page 24 and 25: Other Contributory (or antecedent)
- Page 26 and 27: Sr.NoName ofdeceasedAgeDateofdeathA
- Page 28 and 29: Whether any necessity felt by the c
- Page 30 and 31: Comments on potential avoidable fac
- Page 32: ANNEXURE-VISr.No.(To be filled by t
<strong>ANNEXURE</strong> IIIName of the BlockPHC/District:MDR FORM TO BE FILLED BY THE MO INCHARGE OF PHC/CHC/SDH/DH(To be filled after the report of the CBMDR)(To be submitted along with the report of CBMDR to the Civil Surgeon)To be filled by the block medical officer for each maternal death in the block after investigationParticulars of the deceased Name: Age:Name of the husbandGravida/ParaVisitor/Resident/AddressTiming of <strong>Death</strong> Pregnancy During MTP Delivery Within 42 daysafter delivery orMTPReligion/Caste/CommunityPlace & Date of deathDate of investigation bycommunitybasedcommittee
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