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

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 □