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

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Whether any necessity felt by the committee to seekthe testimony of the family members of the deceased(Yes/No)?If yes, whether testimony sought?If yes, the details of the persons interrogated:What additional information about the death of thewoman emerged during such interrogation?Comment how far the committee is satisfied with the report of CBMDRComment how far the committee is satisfied with the report of the MO InchargeCAUSE OF DEATH :(In the opinion of the committee)Probable direct obstetric (underlying) cause of death: Specify:Indirect Obstetric cause of death: Specify::
Other Contributory (or antecedent) cause/s: SpecifyIN YOUR OPINION WERE ANY OF THESE FACTORS PRESENT?System Example Y N ? SpecifyPersonal/FamilyLogistical ProblemsFacilitiesDelay in woman seeking helpRefusal of treatment or admissionRefusal of admission in facilityLack of transport from home to health carefacilityLack of transport between health carefacilitiesHealth service - Health servicecommunication breakdownLack of facilities, equipment orconsumablesLack of bloodLack of OT availabilityHealth personnelproblemsLack of human resourcesLack of AnesthetistLack of SurgeonsLack of expertise, training or education
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Page 17 and 18: ANNEXURE IIIName of the BlockPHC/Di
Page 19 and 20: ADMISSION AT INSTITUTION WHERE DEAT
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Page 24 and 25: Other Contributory (or antecedent)
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ANNEXURE-I Women Death First Information ... - Nrhmharyana.org

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