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Data Collection Format For ANM

The document outlines a comprehensive data collection format for Auxiliary Nurse Midwives (ANM) that includes sections for personal information, health history, current health status, antenatal and postnatal care, immunization records, family planning services, and services provided. Each section specifies the relevant details to be recorded, such as patient demographics, medical history, and health assessments. Additionally, there is a section for remarks or notes to capture any additional observations or recommendations.

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699 views2 pages

Data Collection Format For ANM

The document outlines a comprehensive data collection format for Auxiliary Nurse Midwives (ANM) that includes sections for personal information, health history, current health status, antenatal and postnatal care, immunization records, family planning services, and services provided. Each section specifies the relevant details to be recorded, such as patient demographics, medical history, and health assessments. Additionally, there is a section for remarks or notes to capture any additional observations or recommendations.

Uploaded by

dasrima713
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Data Collection Format for ANM

1. Personal Information of Patient

 Name of Patient:
 Age:
 Gender:
 Date of Birth:
 Address:
 Contact Number:
 Husband's Name (if applicable):
 Date of Visit:

2. Health History

 Marital Status:
 Gravida (Number of Pregnancies):
 Para (Number of Live Births):
 Any Previous Complications (e.g., high blood pressure, diabetes, etc.):
 Menstrual History (for females):
o Last Menstrual Period (LMP):
o Duration:
o Regularity:
 Any Previous Surgeries:
 Chronic Illnesses:
 Allergies:

3. Current Health Status

 Height:
 Weight:
 Blood Pressure:
 Temperature:
 Pulse Rate:
 Respiratory Rate:
 Any Signs or Symptoms (fever, cough, pain, swelling, etc.):

4. Antenatal Care (If Pregnant)

 Expected Date of Delivery (EDD):


 Previous Deliveries (Normal/Cesarean):
 Immunizations Given (TT vaccine, etc.):
 Iron/Folic Acid Supplementation:
 Previous Pregnancy Complications:
 Routine Tests (Urine, Blood, etc.):
 Any Health Concerns (e.g., swelling, headache, blurred vision):

5. Postnatal Care (For mothers and newborns)

 Date of Delivery:
 Mode of Delivery:
 Breastfeeding:
 Postnatal Check-up (days after delivery):
 Family Planning Counseling:
 Vaccination Given to Newborn:

6. Immunization Records (For Children)

 Immunization Schedule (BCG, DPT, OPV, Hepatitis, etc.):


 Date of Last Vaccination:
 Next Vaccination Due:

7. Family Planning Services

 Contraceptive Method Used:


 Date of Last Family Planning Visit:
 Any Issues with Family Planning (Side effects, discontinuation, etc.):

8. Services Provided

 Health Education (Topics Covered):


 Nutritional Counseling:
 Referral to Doctor or Hospital (If Needed):
 Other Services (E.g., Blood Pressure Monitoring, Family Planning):

9. Remarks/Notes

 Additional Observations/Recommendations:

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