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UPHMIS reporting format
District Hospital
State Month-
District
Block
Category Urban/Rural Public/Private Delivery points – Yes/No
CHC Name Delivery point (if yes ) – L1/L2/L3)
Section A Human Resource Number
reported for the month
A1 HR Regular
A 1.1.1 Number of total class IV employees working at facility
A1.1.2 Number of Doctors Level 1 working at facility
A1.1.3 Number of Doctors Level 2 working at facility
A1.2.1 Number of Doctors Level 3 working at facility
A1.2.2 Number of Doctors Level 4 working at facility
A1.2.3 Number of Doctors Level 5 & above working at facility
A1.2.4 Number of Physician working at facility
A1.2.5 Number of Paediatrician working at facility
A1.3.1 Number of Radiologist working at facility
A1.3.2 Number of Gynaecologist & Obstetrics working at facility
A1.3.3 Number of Anaesthetists working at facility
A1.3.4 Number of Pathologist working at facility
A1.3.5 Number of General Surgeon working at facility
A1.3.6 Number of Staff Nurse working at facility
A1.3.7 Number of Administrative Staff (UDC,LDC) working at facility
A1.3.8 Number of Accounts Staff working at facility
A1.3.9 Number of Ward boy working at facility
A1.3.10 Number of Chest & TB Specialist working at facility
A1.3.11 Number of Skin & VD Specialist working at facility
A1.3.12 Number of Ortho Surgeon working at facility
A1.3.13 Number of ENT Surgeon working at facility
A1.3.14 Number of Dental Surgeon working at facility
A1.3.15 Number of total Surgeon working at facility
A1.3.16 Number of EMO (Emergency Medical Officer) working at facility
A1.3.17 Number of Other Specialist working at facility
A1.3.18 Number of X-ray Technician working at facility
A1.3.19 Number of optometrist working at facility
A1.3.20 Number of Physiotherapist working at facility
A1.3.21 Number of Medical staff received salary through PIS on time
A1.3.22 Number of Paramedical staff received salary through PIS on time
A2 HR (Contractual/Re-appointed)
A2.1 Number of Contractual Medical officer working at facility
A2.2 Number of Paramedical staff working at facility
A2.3 Number of Program Management/Administrative staff working at facility
A2.4 Number of Paediatricians working at facility
A2.5 Number of Anaesthetist working at facility
A2.6 Number of Gynaecologists working at facility
A2.7 Number of Surgeons working at facility
A2.8 Number of FP counsellors working at facility
A2.9 Number of ARSH counsellors working at facility
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A2.10 Number of Medical Officer AYUSH working at facility (Male)
A2.11 Number of Medical Officer AYUSH working at facility(Female)
Section B Training
B1.1 Number of EMOC trained Doctors working at facility
B1.2 Number of BEMOC trained Doctors working at facility
B1.3 Number of PPIUCD trained Doctors working at facility
B1.4 Number of LSAS trained Doctors working at facility
B1.5 Number of F-IMNCI trained Doctors working at facility
B1.6 Number of F-IMNCI trained Staff Nurses working at facility
B1.7 Number of Paramedical/ANMs trained in SBA working at facility
B1.8 No. of PPIUCD trained Paramedical staff working at facility
B1.9 No. of IUCD trained Paramedical staff working at facility
B1.10 No. of IUCD trained AYUSH - LMO working at facility
B1.11 No. of PPIUCD trained AYUSH-LMO working at facility
B1.12 No. of Laparoscopic trained doctors working at facility
B1.13 No. of Mini Lap trained doctors working at facility
B1.14 No. of Counsellors trained on Family Planning working at facility
B1.15 No. of ARSH Counsellors trained and working at facility
B1.16 Number of NSSK trained doctors working at facility
B1.17 Number of NSSK trained paramedical working at facility
Section C Availability of RMNCH+A drugs, supplies and equipment as per 5x5 matrix
# closing balance of last month
C1.1 Reproductive Health
C1.1.1 IUCD 375
C1.1.2 IUCD 380A
C1.1.3 OCP
C1.1.4 ECP
C1.1.5 Condoms
C1.1.6 Mifepristone + Misoprostol (MMA)
C1.1.7 MVA Kit/EVA
C1.1.8 IUCD Kit
C1.1.9 NSV Kit
C1.1.10 Laparoscopic sterilization kit
C1.1.11 MiniLap kit
C2.1 Maternal Health
C2.1.1 Inj. Oxytocin
C2.1.2 Tab Misoprostol
C2.1.3 Tab Alpha methyldopa
C2.1.4 Tab Labelatol
C2.1.5 Tab Nifedipine
C2.1.6 Inj. Magnesium Sulfate
C2.1.7 Inj. Tetanus Toxoid
C2.1.8 Sterile pads
C2.1.9 Tab Iron Folic Acid (IFA) FA
C2.1.10 Haemoglobinometer
C2.1.11 Urine albumin kit
C2.1.12 Blood grouping typing (Yes/No)
C2.1.13 HIV screening (Yes/No)
C2.1.14 Hepatitis B screening (Yes/No)
C2.1.15 Partograph (Yes/No)
C2.1.16 Protocols displayed in LR (Yes/No)
C2.1.17 IV Fluids
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C2.1.18 Inj Dexamethasone
C3.1 New Born Health
C3.1.1 Inj. Vit K1 (1 mg/ml)
C3.1.2 Mucus Extractor
C3.1.3 Bag and mask (240 ml) with both pre & term mask (size 0,1)
C3.1.4 Clean linen/towels for receiving new born
C3.1.5 Sterile cord cutting equipment
C3.1.6 Designated Newborn care Corner (Yes/No)
C3.1.7 Functional Radiant Warmer (Yes/No)
C4.1 Child Health
C4.1.1 ORS
C4.1.2 Zinc DT (20mg)
C4.1.3 Syp Salbutamol
C4.1.4 Salbutamol Nebulizing Solution
C4.1.5 Syrup Albendazole
C4.1.6 Inj. Gentamicin
C4.1.7 Tab Amoxicillin DT (125 mg)
C4.1.8 Tab Amoxicillin DT (250 mg)
C4.1.9 Amoxicillin syrup
C4.1.10 Inj. Ceftriaxone or Cefotaxime
C4.1.11 Tab Doxycycline
C4.1.12 Inj. Ampicillin
C4.1.13 Inj. Amikacin
C5.1 Adolescent Health
C5.1.1 Tab Dicyclomine
C5.1.2 Weekly iron folic acid supplementation
C5.1.3 Tab Albendazole
C6.1 Vaccines
C6.1.1 BCG
C6.1.2 OPV
C6.1.3 Hep B
C6.1.4 DPT
C6.1.5 Measles
C6.1.6 Syrup Vit. A
C6.1.7 JE Vaccine (where Applicable)
C6.1.8 IPV
C6.1.9 Pentavalent
C.2 Functional operators and logistics (Yes/No)
C6.2.1 Weighing Machine (Adult)
C6.2.2 Weighing Machine (Infant)
C6.2.3 Hub cutter with needle destroyer
C6.2.4 Refrigerator
C6.2.5 RTI/STI Kit
C6.2.6 Bleaching Powder
C6.2.7 Oxygen Cylinder functional
C6.2.8 BP apparatus with stethoscope
C6.2.9 Thermometer
C6.2.10 PPIUCD Forceps
C6.2.11 Fetoscope/Doppler
C6.2.12 Autoclave/Boiler
C6.2.13 Running water
C6.2.14 Soap
C6.2.15 Colour coded bins and bags
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C6.2.16 Electricity Power back-up – generator
C6.2.17 Electricity Power back-up – Invertors
C6.2.18 Labor room with attached toilet
C6.2.19 Cold Box
C6.2.20 ILR
C6.2.21 Deep Freezer
C6.2.22 MCP cards) in DPs
C7.1 Other Functional Equipment at facility (Yes/No)
C7.1.1 X-ray Machines
C7.1.2 USG Machines
C7.1.3 CT scan Machines
C7.1.4 MRI Machine
C7.1.5 TMT machines
C7.1.6 ECG Machine
C7.1.7 Dialysis machine
C7.1.8 Boyles trolleys
C7.1.9 Pulse oximeter
C7.1.10 Semi auto Analyser
C7.1.11 Blood bank Refrigerator
C7.1.12 Computers
C7.1.13 Generator
Section D Performance Indicator
D1 Hospital
D1.1 OPD – Old cases only
Number of Beds Available
D1.2 Number of X-ray investigations at facility
D1.3 Number of USG investigations at facility
D1.4 Number of CT scan investigations at facility
D1.5 Number of Plasters at facility
D1.6 Number of Post-mortem at day in facility
D1.7 Number of Post-mortem at night in facility
D1.8 Number of Medico Legal cases at facility
D1.9 Number of ECG at facility
D1.10 Number of Dialysis at facility
D1.11 Number of EMG at facility
D1.12 Number Endoscopy at facility
D1.13 Number Cystoscopy at facility
D1.14 Number of Death due to JE at facility
D1.15 Number of Death due to AES at facility
D1.16 Number of surgeons not conducted any surgeries during the month
D2 Maternal Health
D2.1 Number of Pregnant Women hb test conducted
D2.1. A Of which Number of Pregnant Women severely anaemic
D2.3 Number of Pregnant Women delivered before 37 weeks of Pregnancy
D2.4 Number of Pregnant Women received corticosteroid before delivery
D2.5 Number of Pregnant Women with APH/PPH
D2.6 Number of Pregnant Women with sepsis
D2.7 Number of Pregnant Women with other complication
D2.8 Number of Pregnant Women referred to higher/other facility
D2.9 Number of facility based Maternal Death Review conducted
D2.10 Number of community based Maternal Death Review conducted
D3 New-born Health
D3.1 Number of new born with complication due to preterm delivery
D3.2 Number of new born resisted during birth
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D3.3 Number of new born with birth anomalies
D3.4 Number of new born with complication due to sepsis
D3.5 Number of new born with birth asphyxia
D3.6 Number of new born with other complications
D3.7 Number of new born referred to higher/other facility
D4 Child Health
1 Number of children diagnosed with diarrhoea in OPD
2 Number of children admitted with diarrhoea
3 Number of children (2month-5 year) with diarrhoea who were referred
4 Number of children diagnosed with pneumonia in OPD
5 Number of children admitted with pneumonia
6 Number of children (2month-5 year) with pneumonia who were referred
D4 Family Planning
D4.1 Number of camps planned for FP services (FDOS)
D4.2 Number of camps held for FP services (FDOS)
D4.3 Number of acceptors of FP service (LAP+ML+NSV+IUCD)
D4.4 Number of clinic/fixed days planned for FP services (FDS)
D4.5 Number of camps held for FP services (FDS)
D4.6 Number of acceptors of FP service (LAP+ML+NSV+IUCD)
D4.7 Number of Any follow-up made after male sterilization
D4.8 Number of Any follow-up made after female sterilization
D4.9 Number of Cases with complications due to IUCD
D4.10 Number of Any follow-up made after IUCD
D4.11 Number of Any follow-up made after PPIUCD
D4.12 Number of beneficiaries presented with complete Basket of Choice
D4.13 Number of beneficiaries received counselling for FP
D4.14 Number of Cases with complications due to PPIUCD
D5 NRC
D5.1 Is NRC established and operational in facility?
D5.2 Number of beds available in NRC
D5.3 Number of children admitted
D5.4 Number of children completed 14 days of stay in the facility
D5.5 Number of children discharged after recovery
D5.6 Number of children followed-up at least 4 times after discharged
D6 JSSK
D6.1 Number of PW under JSSK received drugs and Consumables
D6.2 Number of PW under JSSK received diet
D6.3 Number of PW under JSSK received Blood Transfusion
D6.4 Number of PW under JSSK received diagnostic services
D6.5 Number of PW under JSSK transported from home to hospital
D6.6 Number of PW under JSSK transported from lower to higher hospitals(IFT)
D6.7 Number of Beneficiaries under JSSK received Drop back
D6.8 No of newborn received free treatment under JSSK
D6.9 Number of newborn under JSSK transported from home to hospital
D6.10 Number of newborn under JSSK received Drop back
D6.11 Number of complain received
D6.12 No of complain resolved
D8 AFHS Clinic
D8.1 Target of AFHS clinic
D8.2 Number of AFHS clinic establish up to the month
D8.3 Number of AFHS counsellor recruited up to the month
D8.4 Total number of client registered during the month
D8.5 Number of school children (5 to 10 years) who received 4/5 IFA small
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tablets
D8.6 Number of school children (5 to 10 years) who received <4/5 IFA small tablets
D8.7 Number of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.8 Number of school children (10 to 19 years) who received <4/5 IFA small tablets
D8.9 Number of out of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.10 Number of out of school children (10 to 19 years) who received <4/5 IFA small tablets
Section E Process Indicator
E1 Number of misbehaviour incidents by patients & relatives
E2 Number of employees reported absent during inspections
E3 District Hospital has constituted HMIS/MCTS validation committee? (Yes/No)
E4 Date of District Hospital HMIS/MCTS validation committee meeting?
E5 Is the Agency hired for bio medical waste management at facility? (Yes/No)
E6 Contract rate per bed (in Rs.)
E7 No of times bio medical waste lifted by agency during the month
E8 Number of Indents made as per Rate Contract at facility
E9 Value (Rs.) of Purchase Orders placed as per Rate Contract
E10 Number of Indent made as per rate contract against which supply not received at facility
E11 Number of Indents made for Local Purchase at facility
E12 Value(Rs.) of Purchase Orders placed as per Local Purchase
E13 Date of Purchase Committee meeting
E14 Date of Physical verification of stock
E15 Number of drugs expired during the month
E20 Grievance redressal cell functional at facility (Yes/No)
E21 Citizen charter available at facility (Yes/No)
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UPHMIS reporting format
CMO office
State Month-
District
Office Name
Section A Training and availability # closing
balance of last month
A1 Training
A1.1 No of ASHA trained for induction training/up to 5 module
A1.2 No of ASHA completed module 6 & 7 training
A2 Availability drugs, supplies and equipment
A2.1 No of stock out as per EDL
A2.2 No of ASV received
A2.3 No of ARV received
A2.4 Total number of drug discarded due to expiry
A2.5 Indent received from CHC
A2.6 Indent received from PHC
Section B.1 Plan and Non Budget (Rs.lacs)
B1.1 Budget (Plan) – Total
B1.2 Budget (Non-Plan) – Total
B1.3 Salary (Budget Head - 01)
B1.4 DA (Budget Head - 03)
B1.5 Other Allowance (Budget Head - 06)
B1.6 Interring Relief (Budget Head - 38)
B1.7 Dearness Salary (Budget Head - 50)
B1.8 Office Expenditure (Budget Head - 08)
B1.9 Printing & Stationary (Budget Head - 11)
B1.10 Electricity Charges (Budget Head - 09)
B1.12 Water Charges (Budget Head - 10)
B1.13 Telephone Expenses (Budget Head - 13)
B1.14 Vehicle Maintenance & POL (Budget Head - 15)
B1.15 Rent & Taxes (Budget Head - 17)
B1.16 Major Civil Work (Budget Head - 24)
B1.17 Minor Civil Work (Budget Head - 25)
B1.18 Office Furniture & Equipment (Budget Head -12)
B1.19 Computer Hardware/Software (Budget Head - 46)
B1.20 Machinery, Equipment, Instruments(Budget Head -26)
B1.21 Repair & Maintenance (Budget Head -29)
B1.22 Drugs & Pharmaceuticals(Budget Head -39)
B1.23 Drug maintenance(Budget Head -40)
B1.24 Meals (Budget Head - 41)
B1.25 Other/Residual Expenses (Budget Head -42)
B1.26 Reagents & Consumables (Budget Head -43)
B. 2 National Health Mission (NHM) Budget Progress
B2.1 Fund available under RCH flexi pool (in Lakh)
B2.2 expenditure under RCH flexi pool (in Lakh)
B2.3 Fund available under Mission flexi pool (in Lakh)
B2.4 expenditure under Mission flexi pool (in Lakh)
B2.5 Fund available under RI (in Lakh)
B2.6 expenditure under RI (in Lakh)
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B2.7 Fund available under NUHM (in Lakh)
B2.8 expenditure under NUHM (in Lakh)
B1.9 Fund available under National Program (in Lakh)
B1.10 expenditure under National Program(in Lakh)
B1.12 Total No. of Works Sanctioned from 2012-13 under NHM
B1.13 Total No. of Works completed under NHM
B1.14 Total No. of Works in progress under NHM
B1.15 Total Project Cost for civil works (Rs. lakh)
B1.16 Expenditure (Rs. lakh)
B1.17 Total No. of Works in progress more than 75% ( other than NHM)
B1.18 Funds(Rs. lakh) released for civil works under state plan to construction agencies
B1.19 Funds (Rs. lakh) released for civil works under districts plan to construction agencies
Section C Process Indicator
E1 No of Genetic laboratories, counselling centres and Genetic clinics
E2 No of Ultra sounds clinics, mobile clinics & other bodies IVF centres, infertility cure centres
E3 Status of cancellation, suspend, investigated centres,
E4 Number of investigation by fake customers,
E5 Cases taken in judicial procedures, meeting of advisory committees,
E6 no of clinics renewed and action taken regarding public awareness
E7 Cases taken in judicial procedures, meeting of advisory committees,
E8 no of clinics renewed and action taken regarding public awareness
E9 No of raids against Quacks
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UPHMIS reporting format
Community Health Centre (CHC)
State Month
District
Block
Category Urban/Rural Public/Private Delivery point – Yes/No
CHC Name Delivery point (if yes ) – L1/L2/L3
Section A Human Resource Number reported for the month
A1 HR Regular
A 1.1.1 Number of total class IV employees working at facility
A1.1.2 Number of Doctors Level 1 working at facility
A1.1.3 Number of Doctors Level 2 working at facility
A1.2.1 Number of Doctors Level 3 working at facility
A1.2.2 Number of Doctors Level 4 working at facility
A1.2.3 Medical Superintendent (Yes/No)
A1.2.4 Number of Physician working at facility
A1.2.5 Number of Paediatrician working at facility
A1.3.1 Number of Radiologist working at facility
A1.3.2 Number of Gynaecologist & Obstetrics working at facility
A1.3.3 Number of Anaesthetists working at facility
A1.3.4 Number of Pathologist working at facility
A1.3.5 Number of General Surgeon working at facility
A1.3.6 Number of Staff Nurse working at facility
A1.3.7 Number of Administrative Staff (UDC,LDC) working at facility
A1.3.8 Number of Accounts Staff working at facility
A1.3.9 Number of Ward boy working at facility
A1.3.10 Number of Medical staff received salary through PIS on time
A1.3.11 Number of Paramedical staff received salary through PIS on time
A2 HR (Contractual/Re-appointed)
A2.1 Number of Contractual Medical officer working at facility
A2.2 Number of Paramedical staff working at facility
A2.3 Number of Program Management/Administrative staff working at facility
A2.4 Number of Paediatricians working at facility
A2.5 Number of Anaesthetist working at facility
A2.6 Number of Gynaecologists working at facility
A2.7 Number of Surgeons working at facility
A2.8 Number of FP counsellors working at facility
A2.9 Number of ARSH counsellors working at facility
A2.10.a Number of Medical Officer AYUSH-working at facility (Male)
A2.10.b Number of Medical Officer AYUSH working at facility (Female)
A2.11 Number of ASHA Sangini approved at facility
A2.12 Number of ASHA Sangini working at facility
Section B Training
B1.1 Number of EMOC trained Doctors working at facility
B1.2 Number of BEMOC trained Doctors working at facility
B1.3 Number of PPIUCD trained Doctors working at facility
B1.4 Number of LSAS trained Doctors working at facility
B1.5 Number of F-IMNCI trained Doctors working at facility
B1.6 Number of F-IMNCI trained Staff Nurses working at facility
B1.7 Number of Paramedical/ANMs trained in SBA working at facility
B1.8 No. of PPIUCD trained Paramedical staff working at facility
B1.9 No. of IUCD trained Paramedical staff working at facility
B1.10 No. of IUCD trained AYUSH - LMO working at facility
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B1.11 No. of PPIUCD trained AYUSH-LMO working at facility
B1.12 No. of Laparoscopic trained Doctors working at facility
B1.13 No. of Mini Lap trained Doctors working at facility
B1.14 No. of Counsellors trained on Family Planning working at facility
B1.15 No. of ARSH Counsellors trained and working at facility
B1.16 Number of ASHA Sangini trained
B.1.17 Number of NSSK trained doctors working at facility
B.1.18 Number of NSSK trained paramedical working at facility
Section C Availability of RMNCH+A drugs, supplies and equipment as per 5x5 matrix # closing balance of last month
C1.1 Reproductive Health
C1.1.1 IUCD 375
C1.1.2 IUCD 380A
C1.1.3 OCP
C1.1.4 ECP
C1.1.5 Condoms
C1.1.6 Mifepristone + Misoprostol (MMA)
C1.1.7 MVA Kit/EVA
C1.1.8 IUCD Kit
C1.1.9 NSV Kit
C1.1.10 Laparoscopic sterilization kit
C1.1.11 Mini Lap kit
C2.1 Maternal Health
C2.1.1 Inj. Oxytocin
C2.1.2 Tab Misoprostol
C2.1.3 Tab Alpha methyldopa
C2.1.4 Tab Labelatol
C2.1.5 Tab Nifedipine
C2.1.6 Inj. Magnesium Sulfate
C2.1.7 Inj. Tetanus Toxoid
C2.1.8 Sterile pads
C2.1.9 Tab IFA
C2.1.10 Haemoglobinometer
C2.1.11 Urine albumin kit
C2.1.12 Blood grouping typing (Yes/No)
C2.1.13 HIV screening (Yes/No)
C2.1.14 Hepatitis B screening (Yes/No)
C2.1.15 Partograph (Yes/No)
C2.1.16 Protocols displayed in LR (Yes/No)
C2.1.17 IV Fluids
C2.1.18 Inj Dexamethasone
C3.1 New Born Health
C3.1.1 Inj. Vit K1 (1 mg/ml)
C3.1.2 Mucus Extractor
C3.1.3 Bag and mask (240 ml) with both pre & term mask (size 0,1)
C3.1.4 Clean linen/towels for receiving new born
C3.1.5 Sterile cord cutting equipment
C3.1.6 Designated Newborn care Corner (Yes/No)
C3.1.7 Functional Radiant Warmer (Yes/No)
C4.1 Child Health
C4.1.1 ORS
C4.1.2 Tab Zinc DT (20mg)
C4.1.3 Syp Salbutamol
C4.1.4 Salbutamol Nebulizing Solution
C4.1.5 Syrup Albendazole
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C4.1.6 Inj. Gentamicin
C4.1.7 Tab Amoxicillin DT (125 mg)
C4.1.8 Tab Amoxicillin DT (250 mg)
C4.1.9 Amoxicillin syrup
C4.1.10 Inj. Ceftriaxone or Cefotaxime
C4.1.11 Tab Doxycycline
C4.1.12 Inj. Ampicillin
C4.1.13 Inj. Amikacin
C5.1 Adolescent Health
C5.1.1 Tab Dicyclomine
C5.1.2 Weekly iron folic acid supplementation
C5.1.3 Tablet Albendazole
C6.1 Vaccines
C6.1.1 BCG
C6.1.2 OPV
C6.1.3 Hep B
C6.1.4 DPT
C6.1.5 Measles
C6.1.6 Syrup Vit. A
C6.1.7 JE Vaccine (where relevant)
C6.1.8 IPV
C6.1.8 Pentavalent
C6.2 Functional operators and logistics (Yes/No)
C6.2.1 Weighing Machine (Adult)
C6.2.2 Weighing Machine (Infant)
C6.2.3 Hub cutter with needle destroyer
C6.2.4 Refrigerator
C6.2.5 RTI/STI Kit
C6.2.6 Bleaching Powder
C6.2.7 Oxygen Cylinder functional
C6.2.8 BP apparatus with stethoscope
C6.2.9 Thermometer
C6.2.10 PPIUCD Forceps
C6.2.11 Fetoscope /Doppler
C6.2.12 Autoclave/Boiler
C6.2.13 Running water
C6.2.14 Soap
C6.2.15 Colour coded bins and bags
C6.2.16 Electricity Power back-up – generator
C6.2.17 Electricity Power back-up – Invertors
C6.2.18 Labor room with attached toilet
C6.2.19 Cold Box
C6.2.20 ILR
C6.2.21 Deep Freezer
C6.2.22 MCP cards) in DPs
C7.1 Other Functional Equipment at facility (Yes/No)
C7.1.1 X-ray Machines
C7.1.2 USG Machines
C7.1.3 Boyles trolleys
C7.1.4 Pulse oximeter
C7.1.5 Semi auto Analyser
C7.1.6 Computers
C7.1.7 Generator
Section D Performance Indicator
D1 Hospital
D1.1 OPD – Old cases only
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D1.2 Number of Beds Available
D1.3 Number of X-ray investigations at facility
D1.4 Number of USG investigations at facility
D1.5 Number of Plasters at facility
D1.7 Number of Death due to JE at facility
D1.8 Number of Death due to AES at facility
D1.9 Number of Indents made
D1.10 Number of Indents pending
D1.11 Date of Physical verification of stock
D1.12 Number of stock out including emergency medicine
D1.13 Number of drugs expired during the month
D1.14 Number of surgeons not conducted any surgeries during the month
D2 Maternal Health
D2.1 Number of Pregnant Women hb test conducted
D2.1. A Of which Number of Pregnant Women severely anaemic
D2.3 Number of Pregnant Women delivered before 37 weeks of Pregnancy
D2.4 Number of Pregnant Women received corticosteroid before delivery
D2.5 Number of Pregnant Women with APH/PPH
D2.6 Number of Pregnant Women with sepsis
D2.7 Number of Pregnant Women with other complication
D2.8 Number of Pregnant Women referred to higher/other facility
D2.9 Number of facility based Maternal Death Review conducted
D2.10 Number of community based Maternal Death Review conducted
D3 New born Health
D3.1 Number of new born with complication due to preterm delivery
D3.2 Number of new born resisted during birth
D3.3 Number of new born with birth anomalies
D3.4 Number of new born with complication due to sepsis
D3.5 Number of new born with birth asphyxia
D3.6 Number of new born with other complications
D3.7 Number of new born referred to higher/other facility
D4 Child Health
D 4.1 Number of children diagnosed with diarrhoea in OPD
D 4.2 Number of children admitted with diarrhoea
D 4.3 Number of children (2month-5 year) with diarrhoea who were referred
D 4.4 Number of children diagnosed with pneumonia in OPD
D 4.5 Number of children admitted with pneumonia
D 4.6 Number of children (2month-5 year) with pneumonia who were referred
D5 Family Planning
D5.1 Number of camps for FP services (FDOS)
D5.2 Number of camps held for FP services (FDOS)
D5.3 Number of acceptors of FP service (LAP+ML+NSV+IUCD)
D5.4 Number of clinic/fixed days for FP services (FDS)
D5.5 Number of camps held for FP services (FDS)
D5.6 Number of acceptors of FP service (LAP+ML+NSV+IUCD)
D5.7 Number of Any follow-up made after male sterilization
D5.8 Number of Any follow-up made after female sterilization
D5.9 Number of Cases with complications due to IUCD
D5.10 Number of Any follow-up made after IUCD
D5.11 Number of Any follow-up made after PPIUCD
D5.12 Number of beneficiaries presented with complete Basket of Choice
D5.13 Number of beneficiaries received counselling for FP
D5.14 Number of Cases with complications due to PPIUCD
D6 JSSK
D6.1 Number of PW under JSSK received drugs and Consumables
D6.2 Number of PW under JSSK received diet
Page 13
D6.3 Number of PW under JSSK received Blood Transfusion
D6.4 Number of PW under JSSK received diagnostic services
D6.5 Number of PW under JSSK transported from home to hospital
D6.6 Number of PW under JSSK transported from lower to higher hospitals(IFT)
D6.7 Number of PW under JSSK received Drop back
D6.8 No of newborn received free treatment under JSSK
D6.9 Number of newborn under JSSK transported from home to hospital
D6.10 Number of newborn under JSSK received Drop back
D6.11 Number of complain received
D6.12 No of complain resolved
D7 RBSK
D7.1 Number of regular team
D7.2 Number of school
D7.3 Number of School covered in the month
D7.4 Number of children investigated (Screening) in School
D7.5 Number of children referred for 4 Ds during the month
D7.6 Number of children treated against referred during the month
D7.7 Number of children treated on the spot during the month
D7.8 Number of AWC
D7.9 Number of AWC covered during the month
D7.10 Number of children investigated (screening) in AWC
D7.11 Number of children referred for 4 Ds during the month
D7.12 Number of children referred during the month
D7.13 Number of children treated on the spot during the month
D8 RKSK - Rastriya Kishori Swastha Karyakram
D8.1 Target of AFHS clinic up to CHC level
D8.2 Number of AFHS clinic establish up to the month
D8.3 Number of AFHS counsellor recruited up to the month
D8.4 Total number of client registered during the month
D8.5 Number of school children (5 to 10 years) who received 4/5 IFA small tablets
D8.6 Number of school children (5 to 10 years) who received <4/5 IFA small tablets
D8.7 Number of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.8 Number of school children (10 to 19 years) who received <4/5 IFA small tablets
D8.9 Number of out of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.10 Number of out of school children (10 to 19 years) who received <4/5 IFA small tablets
Section E Process Indicator
E1 Number of misbehaviour incidents by patients & relatives
E2 Number of employees reported absent during inspections
E3 Is the Agency hired for bio medical waste management at facility? (Y/No)
E4 Contract rate per bed (Rs.)
E5 No of times bio medical waste lifted by agency during the month
E6 Block has constituted HMIS/MCTS validation committee? (Y/N)
E7 Date of block HMIS/MCTS validation committee meeting?
E8 Number of cluster meeting held in block
E9 Number of ASHA absent in cluster meeting
E10 No of ASHA due for incentives (submitted vouchers) in the reporting month by type of program
E11 No of facilities visited by validation committee for HMIS supportive supervision
E17 Date of Purchase Committee meeting
E18 Date of Physical verification of stock
E20 Grievance redressal cell functional at facility (Yes/No)
E21 Citizen charter available at facility (Yes/No)
Page 14
UPHMIS reporting format
Primary Health Centre
State Month-
District
Block
Category Urban/Rural Public/Private Delivery points – Yes/No
PHC Name Delivery point (if yes ) – L1/L2/L3)
Section A Human Resource Number reported for
the month
A1 HR Regular
A 1.1.1 Number of total class IV employees working at facility
A1.1.2 Number of Doctors Level 1 working at facility
A1.1.3 Number of Doctors Level 2 working at facility
A1.2.1 Number of Doctors Level 3 working at facility
A1.2.2 Number of Doctors Level 4 working at facility
A1.2.3 Medical Superintendent (Yes/No) (applicable for Block HQ)
A1.2.4 Number of Physician working at facility
A1.2.5 Number of Paediatrician working at facility
A1.3.1 Number of Radiologist working at facility
A1.3.2 Number of Gynaecologist & Obstetrics working at facility
A1.3.3 Number of Anaesthetists working at facility
A1.3.4 Number of Pathologist working at facility
A1.3.5 Number of General Surgeon working at facility
A1.3.6 Number of Staff Nurse working at facility
A1.3.7 Number of Administrative Staff (UDC,LDC) working at facility
A1.3.8 Number of Accounts Staff working at facility
A1.3.9 Number of Ward boy working at facility
A1.3.10 Number of Medical staff received salary through PIS on time
A1.3.11 Number of Paramedical staff received salary through PIS on time
A2 HR (Contractual/Re-appointed)
A2.1 Number of Contractual Medical officer working at facility
A2.2 Number of Paramedical staff working at facility
A2.3 Number of Program Management/Administrative staff working at facility
A2.4 Number of Paediatricians working at facility
A2.5 Number of Anaesthetist working at facility
A2.6 Number of Gynaecologists working at facility
A2.7 Number of Surgeons working at facility
A2.8.a Number of Medical Officer AYUSH- working at facility (Male)
A2.8.b Number of Medical Officer AYUSH working at facility (Female)
A2.9 Number of ASHA sangini approved in block
A2.10 Number of ASHA sangini working in block
Section B Training
B1.1 Number of EMOC trained Doctors working at facility
B1.2 Number of BEMOC trained Doctors working at facility
B1.3 Number of PPIUCD trained AYUSH Female- Doctors working at facility
B1.4 Number of LSAS trained Doctors working at facility
B1.5 Number of F-IMNCI trained Doctors working at facility
B1.6 Number of F-IMNCI trained Staff Nurses working at facility
B1.7 Number of Paramedical/ANMs trained in SBA working at facility
B1.8 No. of PPIUCD trained Paramedical staff working at facility
B1.9 No. of IUCD trained Paramedical staff working at facility
Page 15
B1.10 Number of IUCD trained AYUSH – Female Doctors working at facility
B1.11 Number of ASHA Sangini trained
B.1.12 Number of NSSK trained doctors working at facility
B.1.13 Number of NSSK trained paramedical working at facility
Section C Availability of RMNCH+A drugs, supplies and equipment as per 5x5 matrix
# closing balance of last month
C1.1 Reproductive Health
C1.1.1 IUCD 375
C1.1.2 IUCD 380A
C1.1.3 OCP
C1.1.4 ECP
C1.1.5 Condoms
C1.1.6 Mifepristone + Misoprostol (MMA)
C1.1.7 MVA Kit/EVA
C1.1.8 IUCD Kit
C2.1 Maternal Health
C2.1.1 Inj. Oxytocin
C2.1.2 Tab Misoprostol
C2.1.4 Tab Alpha methyldopa
C2.1.5 Tab Labelatol
C2.1.6 Tab Nifedipine
C2.1.7 Inj. Magnesium Sulfate
C2.1.8 Inj. Tetanus Toxoid
C2.1.9 Sterile pads
C2.1.10 Tab IFA
C2.1.11 Haemoglobinometer
C2.1.12 Urine albumin kit
C2.1.13 Blood grouping typing (Yes/No)
C2.1.14 HIV screening (Yes/No)
C2.1.15 Hepatitis B screening (Yes/No)
C2.1.16 Partograph (Yes/No)
C2.1.17 Protocols displayed in LR (Yes/No)
C2.1.18 IV Fluids
C2.1.19 Inj Dexamethasone
C3.1 New Born Health
C3.1.1 Inj. Vit K1 (1 mg/ml)
C3.1.2 Mucus Extractor
C3.1.3 Bag and mask (240 ml) with both pre & term mask (size 0,1)
C3.1.4 Clean linen/towels for receiving new born
C3.1.5 Sterile cord cutting equipment
C3.1.6 Designated Newborn care Corner (Yes/No)
C3.1.7 Functional Radiant Warmer (Yes/No)
C4.1 Child Health
C4.1.1 ORS
C4.1.2 Tab Zinc DT (20mg)
C4.1.3 Syp Salbutamol
C4.1.4 Salbutamol Nebulizing Solution
C4.1.5 Syrup Albendazole
C4.1.6 Inj. Gentamicin
C4.1.7 Tab Amoxicillin DT (125 mg)
C4.1.8 Tab Amoxicillin DT (250 mg)
C4.1.9 Amoxicillin syrup
C4.1.10 Inj. Ceftriaxone or Cefotaxime
C4.1.11 Tab Doxycycline (tablet)
C4.1.12 Inj. Ampicillin
Page 16
C4.1.13 Inj. Amikacin
C5.1 Adolescent Health
C5.1.1 Tab Dicyclomine
C5.1.2 Weekly iron folic acid supplementation
C5.1.3 Tablet Albendazole
C6.1 Vaccines
C6.1.1 BCG
C6.1.2 OPV
C6.1.3 Hep B
C6.1.4 DPT
C6.1.5 Measles
C6.1.6 Syrup Vit. A
C6.1.7 JE Vaccine (where relevant)
C6.1.8 IPV
C6.1.9 Pentavalent
C6.2 Functional operators and logistics (Yes/No)
C6.2.1 Weighing Machine (Adult)
C6.2.2 Weighing Machine (Infant)
C6.2.3 Hub cutter with needle destroyer
C6.2.4 Refrigerator
C6.2.5 RTI/STI Kit
C6.2.6 Bleaching Powder
C6.2.7 Oxygen Cylinder functional
C6.2.8 BP apparatus with stethoscope
C6.2.9 Thermometer
C6.2.10 PPIUCD Forceps
C6.2.11 Fetoscope/Doppler
C6.2.12 Autoclave/Boiler
C6.2.13 Running water
C6.2.14 Soap
C6.2.15 Colour coded bins and bags
C6.2.16 Electricity Power back-up – generator
C6.2.17 Electricity Power back-up – Invertors
C6.2.18 Labor room with attached toilet
C6.2.19 Cold Box
C6.2.20 ILR
C6.2.21 Deep Freezer
C6.2.22 MCP cards) in DPs
C7.1 Other Functional Equipment at facility (Yes/No)
C7.1.1 Xray Machines
C7.1.2 USG Machines
C7.1.3 Boyles trolleys
C7.1.4 Pulse oximeter
C7.1.5 Semi auto Analyser
C7.1.6 Computers
C7.1.7 Generator
Section D Performance Indicator
D1 Hospital
D1.1 OPD – Old cases only
D1.2 Number of Beds Available
D1.3 Number of Xray investigations at facility
D1.4 Number of USG investigations at facility
D1.5 Number of Plasters at facility
D1.7 Number of Death due to JE at facility
D1.8 Number of Death due to AES at facility
Page 17
D1.9 Number of Indents made
D1.10 Number of Indents pending
D1.11 Date of Physical verification of stock
D1.12 Number of stock out including emergency medicine
D1.13 Number of drugs expired during the month
D1.14 Number of surgeons not conducted any surgeries during the month
D2 Maternal Health
D2.1 Number of Pregnant Women hb test conducted
D2.1. A Of which Number of Pregnant Women severely anaemic
D2.3 Number of Pregnant Women delivered before 37 weeks of Pregnancy
D2.4 Number of Pregnant Women received corticosteroid before delivery
D2.5 Number of Pregnant Women with APH/PPH
D2.6 Number of Pregnant Women with sepsis
D2.7 Number of Pregnant Women with other complication
D2.8 Number of Pregnant Women referred to higher/other facility
D2.9 Number of facility based Maternal Death Review conducted
D2.10 Number of community based Maternal Death Review conducted
D3 New born Health
D3.1 Number of new born with complication due to preterm delivery
D3.2 Number of new born resisted during birth
D3.3 Number of new born with birth anomalies
D3.4 Number of new born with complication due to sepsis
D3.5 Number of new born with birth asphyxia
D3.6 Number of new born with other complications
D3.7 Number of new born referred to higher/other facility
D4 Child Health
D4.1 Number of children diagnosed with diarrhoea in OPD
D4.2 Number of children admitted with diarrhoea
D4.2 Number of children (2month-5 year) with diarrhoea who were referred
D4.3 Number of children diagnosed with pneumonia in OPD
D4.4 Number of children admitted with pneumonia
D4.5 Number of children (2month-5 year) with pneumonia who were referred
D5 Family Planning
D5.1 Number of camps planned for FP services (FDOS)
D5.2 Number of camps held for FP services (FDOS)
D5.3 Number of acceptors of FP service (LAP+ML+NSV+IUCD)
D5.4 Number of Any follow-up made after male sterilization
D5.5 Number of Any follow-up made after female sterilization
D5.6 Number of Cases with complications due to IUCD
D5.7 Number of any follow-up made after IUCD
D5.8 Number of any follow-up made after PPIUCD
D5.9 Number of beneficiaries presented with complete Basket of Choice
D5.10 Number of beneficiaries received counselling for FP
D5.11 Number of complications from PPIUCD reported
D6 JSSK
D6.1 Number of Beneficiaries under JSSK received drugs and Consumables
D6.2 Number of Beneficiaries under JSSK received diet
D6.3 Number of Beneficiaries under JSSK received Blood Transfusion
D6.4 Number of Beneficiaries under JSSK received diagnostic services
D6.5 Number of Beneficiaries under JSSK transported from home to hospital
D6.6 Number of Beneficiaries under JSSK transported from lower to higher hospitals(IFT)
D6.7 Number of Beneficiaries under JSSK received Drop back
D6.8 No of newborn received free treatment under JSSK
Page 18
D6.9 Number of newborn under JSSK transported from home to hospital
D6.10 Number of newborn under JSSK received Drop back
D6.11 Number of complain received
D6.12 No of complain resolved
D7 RBSK
D7.1 Number of regular team
D7.2 Number of school
D7.3 Number of School covered in the month
D7.4 Number of children investigated (Screening) in School
D7.5 Number of children referred for 4 Ds during the month
D7.6 Number of children treated against referred during the month
D7.7 Number of children treated on the spot during the month
D7.8 Number of AWC
D7.9 Number of AWC covered during the month
D7.10 Number of children investigated (screening) in AWC
D7.11 Number of children referred for 4 Ds during the month
D7.12 Number of children referred during the month
D7.13 Number of children treated on the spot during the month
D8 RKSK - Rastriya Kishori Swastha Karyakram
D8.1 Number of school children (5 to 10 years) who received 4/5 IFA small tablets
D8.2 Number of school children (5 to 10 years) who received <4/5 IFA small tablets
D8.3 Number of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.4 Number of school children (10 to 19 years) who received <4/5 IFA small tablets
D8.5 Number of out of school children (10 to 19 years) who received 4/5 IFA small tablets
D8.6 Number of out of school children (10 to 19 years) who received <4/5 IFA small tablets
Section E Process Indicator
E1 Number of misbehaviour incidents by patients & relatives
E2 Number of employees reported absent during inspections
E3 Is the Agency hired for bio medical waste management at facility? (Y/No)
E4 Contract rate per bed (Rs.)
E5 No of times bio medical waste lifted by agency during the month
E6 Block has constituted HMIS/MCTS validation committee? (Y/N)
E7 Date of block HMIS/MCTS validation committee meeting?
E8 Number of cluster meeting held in block
E9 Number of ASHA absent in cluster meeting
E10 No of ASHA due for incentives (submitted vouchers) in the reporting month by type of program
E11 No of facilities visited by validation committee for HMIS supportive supervision
E18 Date of Physical verification of stock
E19 Number of drugs expired during the month
E20 Grievance redressal cell functional at facility (Yes/No)
E21 Citizen charter available at facility (Yes/No)
Page 19
UPHMIS reporting format
Sub centre
State Month-
District
Block
Category Urban/Rural Public/Private
SC Name Govt building/Panchayat/ Rental building
Delivery point (Yes/No)
Delivery point (if yes ) – L1/L2/L3)
Section A Human Resource Number reported
for the month
A1 HR Regular
A 1.1.1 Number of LHV associated at facility
A1.1.2 No of regular ANM working at facility
A2 HR (Contractual)
A2.1 Number of ANM working at facility
A2.2 Number of ASHA positions Approved
A2.3 Number of ASHA associated at facility
Section B Training
B1.1 Number of ANM/LHV trained in SBA
B1.1b Number of ANM/LHV trained in PPIUCD
B1.1c Number of ANM/LHV trained in IUCD
B1.2a Number of ANM/LHV trained in NSSK
B1.2b No of ASHA trained for induction training/up to 5 module
B1.2c No of ASHA completed module 6 & 7 training
Section C Availability of RMNCH+A drugs, supplies and equipment as per 5x5 matrix # closing balance of last month
C1.1 Reproductive Health
C1.1.1 IUCD 375,380A
C1.1.2 OCP
C1.1.3 ECP
C1.1.4 Condoms
C1.1.5 Mifepristone + Misoprostol (MMA)
C2.1 Maternal Health
C2.1.1 Inj. Oxytocin
C2.1.2 Tab Misoprostol
C2.1.3 Tab Alpha methyldopa
C2.1.4 Tab Labelatol
C2.1.5 Tab Nifedipine
C2.1.6 Inj. Magnesium Sulfate
C2.1.7 Inj. Tetanus Toxoid
C2.1.8 Sterile pads
C2.1.9 IFA
C2.1.10 Pregnancy Test Kit
C2.1.11 Haemoglobinometer
C2.1.12 Urine albumin kit
C2.1.13 Partograph (applicable for DP) (Yes/No)
C2.1.14 Protocols displayed in LR (Yes/No)
C2.1.15 IV Fluids
C2.1.16 Inj Dexamethasone
C2.1.17 Tab – Paracetamol
C2.1.18 Tab –Calcium
anand.tripathi
Typewritten text
English version
Page 20
C3.1 New Born Health
C3.1.1 Inj. Vit K1 (1 mg/ml)
C3.1.2 Mucus Extractor
C3.1.3 Bag and mask (240 ml) with both pre & term mask (size 0,1)
C3.1.4 Clean linen/towels for receiving new born
C3.1.5 Sterile cord cutting equipment
C3.1.6 Designated Newborn care Corner (Yes/No)
C3.1.7 Functional Radiant Warmer (Yes/No)
C4.1 Child Health
C4.1.1 ORS
C4.1.2 Tab Zinc DT (20mg)
C4.1.3 Syp Salbutamol
C4.1.4 Salbutamol Nebulizing Solution
C4.1.5 Syrup Albendazole
C4.1.6 Syrup Vit. A
C4.1.7 Inj. Gentamicin
C4.1.8 Tab Amoxicillin DT (125 mg)
C4.1.9 Tab Amoxicillin DT (250 mg)
C4.1.10 Amoxicillin syrup
C5.1 Adolescent Health
C5.1.1 Tablet Albendazole
C6.1 Essential logistics
C6.1.1 Bleaching Powder (Yes/No)
C6.1.2 PPIUCD Forceps
C6.1.3 Fetoscope/Doppler
C6.1.4 Soap
C6.1.5 Colour coded bins and bags
C6.1.6 MCP cards) in DPs
C7.1 Other Functional Equipment at facility (Yes/No)
C7.1.1,a Weighing Machine – Infant
C7.1.1,b Weighing Machine – Adult
C7.1.2 Hub cutter with needle destroyer
C7.1.3 Oxygen Cylinder functional
C7.1.4 BP apparatus with stethoscope
C7.1.5 Thermometer
C7.1.6 Autoclave/Boiler
C7.1.7 Cold Box
C.7.1.8 IUCD Kit
C.7.1.9 MUAC Tape
C.7.1.10 Height scale
Section D Performance Indicator
D Maternal Health
D2.1 Number of Pregnant Women HB test conducted
D2.1. A Of which Number of Pregnant Women severely anaemic
D2.3 Number of Pregnant Women delivered before 37 weeks of Pregnancy
D2.4 Number of Pregnant Women received corticosteroid before delivery
D2.5 Number of Pregnant Women with APH/PPH
D2.6 Number of Pregnant Women with sepsis
D2.7 Number of Pregnant Women with other complication
D2.8 Number of Pregnant Women referred to higher/other facility
D3 New-born Health
D3.1 Number of new born with complication due to preterm delivery
D3.2 Number of new born resisted
D3.3 Number of new born with birth anomalies
D3.4 Number of new born with complication due to sepsis
Page 21
D3.5 Number of new born with birth asphyxia
D3.6 Number of new born with other complications
D3.7 Number of new born referred to higher/other facility
D4 Child Health
D4.1 Number of young infants diagnosed with sepsis by ANM
D4.2 Number of young infants given pre-referral dose
D4.3 Number of young infants who completed 7-day antibiotic treatment
D4.4 Number of young infants who were treated by ANM and survived
D4.1 Number of children (2month-5 year) diagnosed with diarrhoea by ASHA
D4.2 Number of children (2month-5 year) diagnosed with diarrhoea by ANM
D4.3 Number of children (2month-5 year) with diarrhoea who received both ORS+zinc
D4.4 Number of children (2month-5 year) with diarrhoea who were referred
D4.5 Number of ASHA with ORS & Zinc stock
D4.6 Number of children (2month-5 year) suspected with pneumonia by ASHA
D4.7 Number of children (2month-5 year) diagnosed with pneumonia by ANM
D4.8 Number of children (2month-5 year) with pneumonia who received amoxicillin
D4.9 Number of children (2month-5 year) with pneumonia who were referred
D4.10 Number of ASHA with amoxicillin supply
D5 Family Planning
D5.1 Number of Any follow-up made after male sterilization
D5.2 Number of Any follow-up made after female sterilization
D5.3 Number of Cases with complications due to IUCD
D5.4 Number of any follow-up made after IUCD
D5.5 Number of any follow-up made after PPIUCD
D5.6 Number of beneficiaries received counselling for FP
D5.7 Number of complications from PPIUCD reported
D6 JSSK
D6.1 Number of Beneficiaries under JSSK received drugs and Consumables
Section E Process Indicator
E.1 Date of AAA meetings held
E.2 No of ASHA participated in the AAA meeting
E.3 No of AWW in SC area and participated in the AAA meeting
Section F Village Health & Nutrition Day (VHND)
F.1 No of condom distributed through ASHA to beneficiary by social Marketing
F.2 No of OCP distributed through ASHA to beneficiary by social Marketing
F.3 No of ECP distributed through ASHA to beneficiary by social Marketing
F.4 No of sanitary napkins distributed through ASHA to beneficiary by social Marketing
F.5 No of PTK distributed through ASHA to beneficiary by social Marketing
F.6 No adolescent girls visited for health check-up during VNHD
F.6 No adolescent girls tested for anaemia during VNHD
F.7 No of severely anaemia adolescent girls (<7 hb/dl)
F.8 No of moderate anaemic adolescent girls (>=7 and <11 hb/dl)
F.9 No of adolescent girls received IFA tablets during VHND
F.10 No of PW received full ANC check-ups (4 ANC, 100 IFA tablets, 2 TT,HB, BP, Weight and urine albumin test)
F.11 No of PW planned their Birth as advised by FLW
F.12 No of PW in the last trimester contacted by ASHA
F.13 No of PW Blood pressure & U/Alb tested during ANC check-up
F.14 No of SAM / severely underweight children checked during VHND by ANMs
Page 22
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midsanz
jkT; ekg&
ftyk
CykWd
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midsanz dk uke ljdkjh Hkou@bekjr@
iapk;r@fdjk, dh bekjr
izlo dsUnz
¼gk¡@ugha½
izlo dsUnz
¼;fn gk¡½&L1/L2/L3)
Section A ekuo lalk/ku ekg
A1 ekuo lalk/ku ¼fu;fer½
A 1.1.1 LokLF; dsanz ls tqM+h ysMh gsYFk foftVj ¼,y-,p-oh-½dh la[;k
A1.1.2 LokLF; dsanz esa dk;Zjr fu;fer ,,u,e dh la[;k
A2 ekuo lalk/ku ¼lafonk½
A2.1 LokLF; dsanz esa dk;Zjr ,-,u-,e- dh la[;k
A2.2 Lohd`r vk'kk inksa dh la[;k
A2.3 LokLF; dsanz ls tqM+h vk'kk dh la[;k
Section B izf'k{k.k
B1.1 ,l-ch-,- esa dk;Zjr izf'kf{kr ,-,u-,e-@ysMh gsYFk foftVj ¼,y-,p-oh-½ dh la[;k
B1.1b ih-ih-vkbZ-;w-lh-Mh- esa izf'kf{kr ,-,u-,e-@ysMh gsYFk foftVj ¼,y-,p-oh-½ dh la[;k
B1.1c vkb-Z;w-lh-Mh- esa izf'kf{kr ,-,u-,e-@ysMh gsYFk foftVj ¼,y-,p-oh-½ dh la[;k
B1.2a ,u,l,lds esa izf'kf{kr ,-,u-,e-@ysMh gsYFk foftVj ¼,y-,p-oh-½ dh la[;k
B1.2b izf'kf{kr vk'kk dh la[;k ¼5 ekM~;wy rd½
B1.2c 6osa vkSj 7osa ekM~;wy rd iwjk djus okyh vk'kk dh la[;k
Section C 5×5 eSfVªDl ds vuqlkj iztuu] ekr`] uotkr f'k'kq] cky ,oa fd'kksj LokLF; dh nokvksa]
vkiwfrZ;ksa vkSj midj.k dh miyC/krk
fiNys eghus
dk vafre 'ks"k
C1.1 iztuu LokLF;
C1.1.1 vkbZ-;w-lh-Mh- 375]380 A
C1.1.2 vk-slh-ih-
C1.1.3 bZ-lh-ih-
C1.1.4 daMkse
C1.1.5 ekbQfizLVksu $ felksizksLVkWy ¼MMA½
C2.1 ekr` LokLF;
C2.1.1 vkDlhVksflu batsD'ku
C2.1.2 felksizksLVkWy VScsysV
C2.1.3 vYQk esfFkyMksik VScysV
C2.1.4 yscysVkWy VScysV
C2.1.5 ukbQfMfiu VScysV
C2.1.6 eSXuhf'k;e lYQsV batsD'ku
C2.1.7 fVVusl VkDlkbM batsD'ku (TT)
C2.1.8 LVjkby iSM
C2.1.9 vk;ju Qksfyd ,flM VScysV (IFA)
C2.1.10 izsXusalh VsLV fdV
C2.1.11 gheksXyksfcuksehVj
C2.1.12 ;wjhu ,Ycwfeu fdV
C2.1.13 ikVksZxzkQ ¼Mhih gsrq½ ¼gk¡@ ugha½
C2.1.14 ,y-vkj- ij iznf'kZr izksVksdkWy ¼gk¡@ ugha½
C2.1.15 vkbZ-oh-¶ywM-
anand.tripathi
Typewritten text
Hindi version
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C2.1.16 MsDlkesFkklksu batsD'ku
C2.1.17 iSjkflVkekWy VScysV
C2.1.18 dSfYl;e VScysV
C3.1 uotkr f'k'kq LokLF;
C3.1.1 bUtsD”ku foVkfeu K ¼1 fexzk@feyh½
C3.1.2 E;wdl,DLVªSDVj
C3.1.3 cSx ,oa ekLd ¼240 feyh½ nksuks izh&VeZ ekLd lfgr
C3.1.4 uotkr f'k'kq dks ysus ds fy, lkQ diM+k@ rkSfy;k
C3.1.5 LVjkby xHkZuky dkVus dk midj.k
C3.1.6 fu/kkZfjr U;wckuZ ds;j dkuZj ¼gk¡@ ugha½
C3.1.7 QaD”kuy jSfM,aV okeZj ¼gk¡@ ugha½
C4.1 cky LokLF;
C4.1.1 vk-svkj-,l- (vks-vkj-,l-)
C4.1.2 ftad fMLiflZcy VScysV ¼20 fexzk½
C4.1.3 flji lkYcqVkekWy
C4.1.4 lkYcqVkekWy uscqykbftax lksyq'ku
C4.1.5 flji vYcaMktksy
C4.1.6 flji foVkfeu A
C4.1.7 batsD'ku tsaVkekbflu
C4.1.8 ,eksDlhflfyu fMLiflZcy VScysV ¼125 fexzk½
C4.1.9 ,eksDlhflfyu fMLiflZcy VScysV ¼250 fexzk½
C4.1.10 ,eksDlhflfyu flji
C5.1 fd'kksj LokLF;
C5.1.1 vYcaMktksy VScysV
C6.1 vko';d lkexzh
C6.1.1 Cyhfpax ikmMj ¼gk¡@ ugha½
C6.1.2 ihihvkbZ;wlhMh QksjlsIl
C6.1.3 QhVksLdksi@ MkIyj
C6.1.4 lkcqu
C6.1.5 dyj dksMsM fcu ,oa cSx& osLV fMLiksty gsrq
C6.1.6 ,e-lh-ih- dkMZ ¼DP gsrq½
C7.1 LokLF; dsanz esa vU; pkyw midj.k ¼gk¡@ ugha½
C7.1.1,a otu ukius dh e'khu& ¼ uotkr f'k'kq½
C7.1.1,b otu ukius dh e'khu& o;Ld
C7.1.2 gc dVj rFkk uhfMy MsLVªk;j
C7.1.3 pkyw vkWDlhtu flfyaMj
C7.1.4 LVsFkksLdksi ,oa ch-ih- midj.k
C7.1.5 FkekZehVj
C7.1.6 vkVksDyso@ckW;yj
C7.1.7 dksYM ckWDl
C.7.1.8 vkbZ-;w-lh-Mh- fdV
C.7.1.9 ,e-;w-,lh- Vsi
C.7.1.10 yackbZ ukius dk Ldsy
Section D ijQkWjesUl baMhdsVj
D ekr` LokLF;
D2.1 gheksXyksfcu dk ijh{k.k djkbZ gqbZ xHkZorh efgykvksa dh la[;k
D2.1. A muesa ls xaHkhj :i ls ,uhfe;k ls xzflr xHkZorh efgykvksa dh la[;k
D2.3 37 g¶rs dh xHkkZoLFkk ls igys izlo djkus okyh xHkZorh efgykvksa dh la[;k
D2.4 izlo ls igys dkfVZdksLVjkW;M izkIr djus okyh xHkZorh efgykvksa dh la[;k
D2.5 ,-ih-,p-@ih-ih-,p- (APH/PPH) ls xzLr xHkZorh efgykvksa dh la[;k
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D2.6 lsfIll ls xzLr xHkZorh efgykvkas dh la[;k
D2.7 vU; tfVyrkvksa ls xzLr xHkZorh efgykvksa dh la[;k
D2.8 mPp@vU; LokLF; dsanz ds fy, jsQj dh xbZ xHkZorh efgykvkas dh la[;k
D3 uotkr f'k'kq LokLF;
D3.1 le; ls igys izlo djkus ds dkj.k lEkL;k xzLr uotkr f'k'kqvksa dh la[;k
D3.2 vojksf/kr uotkr f'k'kqvksa dh la[;k
D3.3 folaxfr okys tUesa uotkr f'k'kqvksa dh la[;k
D3.4 lsfIll ds dkj.k leL;kxzLr uotkr f'k'kqvksa dh la[;k
D3.5 tUe ds le; 'oklkojks/k okys uotkr f'k'kqvksa dh la[;k
D3.6 vU; tfVyrkvksa ls xzLr uotkr f'k'kqvksa dh la[;k
D3.7 mPp@vU; LokLF; dsanz esa jsQj fd;s x, uotkr f'k'kqvkas dh la[;k
D4 cky LokLF;
D4.1 ,-,u-,e- }kjk lsfIll ds funku okys f'k'kqvksa dh la[;k
D4.2 izh&jsQjy [kqjkd fn;s tkus okys f'k'kqvksa dh la[;k
D4.3 mu f'k'kqvksa dh la[;k ftUgkasus 7 fnu ds ,aVhck;ksfVd mipkj dks iwjk fd;k gS
D4.4 mu f'k'kqvksa dh la[;k ftudk ,,u,e }kjk mipkj fd;k x;k gS rFkk os thfor gSa
D4.5 vk'kk }kjk fpfUgr fd;s x;s Mk;fj;k ls xzflr cPpksa ¼2 eghus ls 5 o"kZ rd½ dh la[;k
D4.6 ,-,u-,e- }kjk fpfUgr fd;s x;s Mk;fj;k ls xzflr cPpksa ¼2 eghus ls 5 o"kZ rd½ dh
la[;k
D4.7 Mk;fj;k ls xzflr mu cPpksa ¼2 eghus ls 5 o"kZ½ dh la[;k ftUgksaus vks-vkj-,l- vkSj ftad
nksuksa dh [kqjkdsa ys yh gSaA
D4.8 Mk;fj;k ls xzflr mu cPpksa ¼2 eghus& 5 o"kZ½ dh la[;k ftUgsa jsQj fd;k x;k
D4.9 vksvkj,l ,oa ftad ds LVkWd okyh vk'kk dh la[;k
D4.10 vk'kk }kjk fpfUgr fd;s x;s fueksfu;k ls xzflr cPpksa ¼2 eghus ls 5 o"kZ rd½ dh la[;k
D4.11 ,-,u-,e- }kjk fpfUgr fd;s x;s fueksfu;k ls xzflr cPpksa ¼2 eghus ls 5 o"kZ rd½ dh
la[;k
D4.12 U;weksfu;k ls xzflr mu cPpksa ¼2 eghus& 5 o"kZ½ dh la[;k ftUgsa ,ekWDlhflfyu nh xbZ gS
D4.13 U;weksfu;k ls xzflr mu cPpksa ¼2 eghus& 5 o"kZ½ dh la[;k ftUgsa jsQj fd;k x;k
D4.14 ,ekWDlhflfyu vkiwfrZ okyh vk'kk dh la[;k
D5 ifjokj fu;kstu
D5.1 dh xbZ iq#"k ulcanh dh la[;k ftldk dksbZ Hkh QkWyksvi fd;k x;k gks
D5.2 dh xbZ efgyk ulcanh dh la[;k ftldk dksbZ Hkh QkWyksvi fd;k x;k gks
D5.3 vkbZ-;w-lh-Mh- ds dkj.k tfVyrk xzLr dslksa dh la[;k
D5.4 dh xbZ vkbZ-;w-lh-Mh- dh la[;k ftudk dksbZ Hkh QkWyksvi fd;k x;k gks
D5.5 ih-ih-vkbZ-;w-lh-Mh- dh la[;k ftudk dksbZ Hkh QkWyksvi fd;k x;k gks
D5.6 ifjokj fu;kstu ds fy, lykg izkIr fd;s gq, ykHkkfFkZ;ksa dh la[;k
D5.7 dh xbZZ ih-ih-vkbZ-;w-lh-Mh- ftudh tfVyrk ls mRiUu leL;kvksa dh la[;k
D6 tuuh LokLF; lqj{kk dk;ZØe
D6.1 tuuh LokLF; lqj{kk dk;ZØe ds varxZr nok,¡ vkSj miHkksT; oLrq,¡ izkIr djus okys
ykHkkfFkZ;ksa dh la[;k
Section E izfØ;k lwpd
E.1 AAA cSBd dh vk;kstu frfFk
E.2 AAA cSBd esa Hkkx ysus okyh vk'kkvksa dh la[;k
E.3 midsUnz {ks= esa vkaxuckM+h dk;ZdrkZvksa dh la[;k ftUgksus AAA cSBd esa Hkkx fy;k gks
Section F xzke LokLF; ,oa iks"k.k fnol ¼oh-,p-,u-Mh-½
F.1 lkekftd foi.ku }kjk ykHkkfFkZ;ksa dks vk'kk }kjk forfjr fd;s x;s daMkse dh la[;k
F.2 lkekftd foi.ku }kjk ykHkkfFkZ;ksa dks vk'kk }kjk forfjr dh xbZ xHkZfujks/kd xksfy;ksa dh
la[;k
F.3 lkekftd foi.ku }kjk ykHkkfFkZ;ksa dks vk'kk }kjk forfjr fd;s x;s E.C.P dh la[;k
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F.4 lkekftd foi.ku }kjk ykHkkfFkZ;ksa dks vk'kk }kjk forfjr fd;s x;s lSuhVjh uSidhu dh
la[;k
F.5 lkekftd foi.ku }kjk ykHkkfFkZ;ksa dks vk'kk }kjk forfjr fd;s x;s P.T.K dh la[;k
F.6 oh-,p-,u-Mh- ds nkSjku LokLF; tkap ds fy, vkbZ fd'kksfj;ksa dh la[;k
F.6 Oh-,p-,u-Mh- ds nkSjku ,uhfe;k ls xzLr fd'kksfj;ksa dh la[;k
F.7 xaHkhj :i ls ,uhfe;k ls xzLr fd'kksfj;ksa dh la[;k ¼<7 hb/dl½
F.8 e/;e ,uhfed fd'kksfj;ksa dh la[;k ¼>=7 vkSj <11 hb/dl½
F.9 oh-,p-,u-Mh- ds nkSjku vk;ju Qksfyd ,flM VScysV izkIr dh gqbZ fd'kksfj;ksa dh la[;k
F.10 iw.kZ ,-,u-lh- psdvi ¼4 ,,ulh] 100 vk;ju Qksfyd ,flM VScysV] 2 fVVusl]
gheksXyksfcu] CyM izs'kj] otu vkSj ;wjhu ,Ycqfeu tkap½ izkIr dh gqbZ xHkZorh efgykvksa dh
la[;k
F.11 ,Q-,y-MCY;w- }kjk lykg fn;s tkus ds ckn tUe dh ;kstuk cukus okyh xHkZorh efgykvksa
dh la[;k
F.12 vk'kk }kjk fiNyh frekgh esa laidZ dh xbZ xHkZorh efgykvksa dh la[;k
F.13 ,-,u-lh- psdvi ds nkSjku CyM izs'kj vkSj ;wjhu ,Ycqfeu dh tkap dh gqbZ xHkZorh
efgykvksa dh la[;k
F.14 ,-,u-,e- }kjk oh-,p-,u-Mh- ds nkSjku tkap fd;s gq, ,l-,-,e-@xaHkhj :i ls de otu
ds cPpksa dh la[;k