Pre-Pregnancy Care Screening Register
Annexure IIStandard Screening & Counselling Checklist for Women of Reproductive Age (VHSND / Ayushman Arogya Mandir)
Unit: • Month:
Monthly Screening Metrics
Screening Activity for0
Screened this month
Registered clients →0
High risk identified
Requires follow-up →0
Follow-up pending
Action pending →Report status
To District Office →| # | Date | Woman Name | Age | Husband/Guardian | Village / Contact | Risk Level | Referral Facility | Follow-up Date | Actions |
|---|
ANM / CHO-Level Monthly Reporting Format
Annexure IIIOfficial Sub-Centre Monthly Pre-Pregnancy Care Consolidated Report
A. High-Risk Identification
| # | Category | Number |
|---|---|---|
| 1 | Total number of women screened under Pre-Pregnancy Care | 0 |
| 2 | Total no. of Women identified with under weight (BMI < 18.5) | 0 |
| 3 | Total no. of Women identified with over weight (BMI ≥ 23) | 0 |
| 4 | Total no. of women identified with Anemia | 0 |
| 5 | Total no. of women identified with Hypertension | 0 |
| 6 | Total no. of women identified with Diabetes | 0 |
| 7 | Total no. of women identified with Infections (HIV/Syphilis & Hepatitis) | 0 |
| 8 | Total no. of women identified as Sickle cell/Thalassemia | 0 |
| 9 | Total no. of women identified with Tuberculosis | 0 |
| 10 | Total no. of women identified with Mental health | 0 |
| 11 | Total no. of women identified with Tobacco & Alcohol use | 0 |
B. Referral and Follow-up
| # | Indicator | Number |
|---|---|---|
| 12 | Total no. of women Referred to AAM/ PHC/ CHC | 0 |
| 13 | Total no. of High-Risk women whose follow-ups are conducted | 0 |
C. Key Services Delivered
| # | Service | Number |
|---|---|---|
| 14 | Total no. of women received Folic acid 400mcg | 0 |
| 15 | Total no. of women received vaccination (Td / others) | 0 |
Certified Official Report • Pre-Pregnancy Care
ANM / CHO Signature & Date
PHC / CHC / Block-Level Monthly Reporting Format
ConsolidatedSum of all Sub-Centres under this Main Centre
District Submissions Tracker
Real-time monitoring across all 40 Sub-Centres & 6 Main Centres
TOTAL SUB-CENTRES
40
Across 6 Main Centre posting areas
Chief Medical Officer, Aizawl EastREPORT SUBMISSION STATUS
Health Infrastructure (Main Centres)
40 Sub-Centres total11
Aizawl East
Subcentres →10
Aizawl North
Subcentres →5
Darlawn
Subcentres →2
Khawruhlian
Subcentres →8
Sakawrdai
Subcentres →4
Thingsulthliah
Subcentres →Sub-Centre Submissions Inventory (40 Units)
Month:| # | Main Centre | Sub-Centre Name | Status | Report Type | Screened | Submitted At | Actions |
|---|
District-Level Monthly Consolidated Reporting Format
All 40 Sub-CentresConsolidated for Office of the Chief Medical Officer, Aizawl East
Drill-Down Inspector
Inspect individual register records or specific monthly reports for any Main Centre or Sub-Centre
Portal Accounts & Password Management
Manage passwords for District Admin and the 6 Main Centre accounts
| # | Account Name | Username | Role | Action |
|---|