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ANC Register
Antenatal Care
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DHIS2 Report
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Client Name
Profile
Lab
Visits
Identification
Physical / Obstetric
Edit Profile
Haemoglobin
Blood Group / Sickling
Screening / HIV / PMTCT
IPT / IFA / TD
Edit Lab Results
Record New Visit
Home
Clients
Report
Setup
New Client
Step 1: Registration
Registration Number
Date of Registration
Source
Facility
External
ANC-???
Client registered at this facility — ID will appear in red
Previous ANC visits at other facility
Details available in maternal record book?
—
Yes
No
Have prior visit details been captured before current visit entry?
—
Yes
No
Continue
Step 2: Demographics
Full Name
Address
Phone
Age (years)
Parity
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Continue
Step 3: Registration Clinical & Lab
Form 1 & 2: Patient Identification / Physical Exams / Clinical Laboratory & Screening
Physical Examination
Blood Pressure
HT (m/cm)
Height below 150 cm — high-risk pregnancy
Weight (kg)
Gestation (wks)
Expected Date of Delivery
Tetanus Toxoid / TD
TT doses received before this pregnancy
—
0
1
2
3
4
5+
Haemoglobin
Hb at Reg (g/dL)
Hb < 11 g/dL — anaemic
Hb < 7 g/dL — severe anaemia
Midwife alert: check Hb at 28 and 36 weeks when due.
Seen at 36 wks
—
Yes
No
Hb at 36 wks
Hb < 11 g/dL at 36 weeks
Next Visit Date (optional)
Blood Group & Sickling
Blood Group
—
A+
A-
B+
B-
AB+
AB-
O+
O-
Sickling Status
—
+ Positive
− Negative
Sickling Type
—
AA
AS
SS
SC
AC
CC
Other
Syphilis Screening
Syphilis Status
—
+ Positive
− Negative
Treated?
—
Yes
No
ITN
ITN Given?
—
Yes
No
HIV Status / PMTCT
HIV Status
—
Known Positive
+ Positive (New)
− Negative
On ARV before pregnancy?
—
Yes
No
Newly put on treatment?
—
Yes
No
Put on ARV?
—
Yes
No
Retested at 34 weeks?
—
Yes
No
Retest Result
—
+ Positive
− Negative
Put on ARV after retest?
—
Yes
No
TB Screening
TB Screened?
—
Yes
No
TB Diagnosed?
—
Yes
No
TB Treatment Started?
—
Yes
No
SP/IPT & TT/TD at Registration Visit
SP/IPT Given This Visit?
—
Yes
No
IPT Dose Number
Auto
IPT 1
IPT 2
IPT 3
IPT 4
IPT 5+
TT/TD Dose Given This Visit
—
TD1
TD2
TD3
TD4
TD5
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Save Client
Follow-up Visit (Form 3)
Subsequent routine monitoring: Date, BP, WT, F.Ht, FHR, Urine (P/S), Folic Acid & Iron
Visit Date
Blood Pressure
Weight (kg)
Fundal Height (cm)
Fetal Heart Rate
Urine Protein
—
Nil
Trace
+
++
+++
Urine Sugar
—
Nil
Trace
+
++
+++
Folic Acid Given?
—
Yes
No
Iron Given?
—
Yes
No
SP/IPT Given This Visit?
—
Yes
No
IPT Dose Number
Auto
IPT 1
IPT 2
IPT 3
IPT 4
IPT 5+
TT/TD Dose Given This Visit
—
TD1
TD2
TD3
TD4
TD5
Next Visit Date (optional scheduling)
Save Visit
Edit Profile
Full Name
Address
Phone
Age (years)
Parity
Blood Pressure
HT (m/cm)
Weight (kg)
Gestation (wks)
EDD
Next Visit Date (optional)
Save Changes
Edit Lab Results
Haemoglobin
Hb at Registration
Hb at 28 weeks
Seen at 36 wks
—
Yes
No
Hb at 36 weeks
Blood Group & Sickling
Blood Group
—
A+
A-
B+
B-
AB+
AB-
O+
O-
Sickling Status
—
+ Positive
− Negative
Sickling Type
—
AA
AS
SS
SC
AC
CC
Other
Syphilis
Syphilis Status
—
+ Positive
− Negative
Treated?
—
Yes
No
ITN
ITN Given?
—
Yes
No
HIV Status / PMTCT
HIV Status
—
Known Positive
+ Positive (New)
− Negative
On ARV before pregnancy?
—
Yes
No
Newly put on treatment?
—
Yes
No
Put on ARV?
—
Yes
No
Retested at 34 weeks?
—
Yes
No
Retest Result
—
+ Positive
− Negative
Put on ARV after retest?
—
Yes
No
TB Screening
TB Screened?
—
Yes
No
TB Diagnosed?
—
Yes
No
TB Treatment Started?
—
Yes
No
IPT
IPT doses
IPT 1
IPT 2
IPT 3
IPT 4
IPT 5
IFA Supplementation
IFA Doses Received
—
1 time
2 times
3 times
4 times
5 times
6 times
Any reaction?
—
Yes
No
Tetanus Diphtheria
TD Status
—
TD0
TD1
TD2
TD3
TD4
TD5
Save Lab Results