ANNEXURE-I Women Death First Information ... - Nrhmharyana.org

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1.Delay in Seeking CareNot aware of danger signsProblem not identified/ identified and neglectedDelay in decision makingNo birth prepararednessBeliefs and customsAny other/specifyFill in appropriate cause of Delay 12.Delay in reaching first level health facilityDelay in getting transportDelay in mobilizing fundsNot reaching appropriate facility in timeDifficult terrainAny other/specifyFill in appropriate cause of Delay 2
ADMISSION AT INSTITUTION WHERE DEATH OCCURREDType of facility where died:PHC24x7PHCSDH/RURALHOSPITAL/CHCDISTRICTHOSPITALMEDICALCOLLEGE/TERTIARYHOSPITALPRIVATEHOSPITALPVTCLINICOTHERDiagnosis at admission:AbortionEctopicpregnancyNot in labour In labour PostpartumDiagnosis when died:AbortionEctopicpregnancyNot in labour In labour PostpartumDuration from onset of complication to admission: □□ Hrs □□ minsCondition on Admission: □Stable □ Unconscious □ Serious □Brought deadReferral from another centre? □ Yes □ No□Don’t knowIf yes, how many centres? □□ Specify type4. Antenatal CareDid she receive ANC? Yes□ No □ Don’t know □
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Page 17: ANNEXURE IIIName of the BlockPHC/Di
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ANNEXURE-I Women Death First Information ... - Nrhmharyana.org

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