Questionnaire-ANCB10

Sourcewho.fhir.anc-cds#current:WHO Antenatal Care Guideline Implementation Guide (v4.0.1)
resourceTypeQuestionnaire
idANCB10
canonicalhttp://fhir.org/guides/who/anc-cds/Questionnaire/ANCB10
version0.3.0
statusactive
publisherWorld Health Organization (WHO)
nameANCB10
titleANC.B10 Counselling & treatment
date2023-07-17T07:31:01+00:00
experimentalfalse
descriptionBased on the previous steps, health worker provides counselling for potential risk, behaviours and diagnoses, as well as preventive services and any treatment that can be provided at the facility, including through admission to a different part of the facility.
jurisdictionsuv
Usages(none)

Counselling conducted on caffeine reduction

Reason counselling on caffeine reduction was not done

Counselling conducted on tobacco cessation

Reason counselling on tobacco cessation was not conducted

Counselling conducted on second-hand smoke

Reason counselling on second-hand smoke was not conducted

Counselling conducted on condom use

Reason counselling on condom use was not conducted

Counselling conducted on alcohol / substance use

Reason counselling on alcohol / substance use was not conducted

Counselling conducted on non-pharma measures to relieve nausea and vomiting

Reason counselling on non-pharma measures to relieve nausea and vomiting was not conducted

Counselling conducted on pharmacological treatments for nausea and vomiting

Reason counselling on pharmacological treatments for nausea and vomiting was not conducted

Counselling conducted on diet and lifestyle changes to prevent and relieve heartburn

Reason counselling on diet and lifestyle changes to prevent and relieve heartburn was not conducted

Counselling conducted on antacid preparations to relieve heartburn

Reason counselling on antacid preparations to relieve heartburn was not conducted

Counselling on non-pharmacological treatment for the relief of leg cramps

Reason counselling on non-pharmacological treatment for the relief of leg cramps was not conducted

Counselling conducted on use of magnesium and calcium to relieve leg cramps

Reason counselling on use of magnesium and calcium to relieve leg cramps was not conducted

Counselling conducted on dietary modifications to relieve constipation

Reason counselling on dietary modifications to relieve constipation was not conducted

Counselling conducted on use of wheat bran or other fibre supplements to relieve constipation

Reason counselling on use of wheat bran or other fibre supplements to relieve constipation was not conducted

Counselling conducted on regular exercise, physiotherapy, support belts and acupuncture to relieve low back and pelvic pain

Reason counselling on regular exercise, physiotherapy, support belts and acupuncture to relieve low back and pelvic pain was not conducted

Counselling conducted on non-pharmacological options for varicose veins and oedema

Reason counselling on non-pharmacological options for varicose veins and oedema was not conducted

Counselling conducted on healthy eating and keeping physically active

Reason counselling on healthy eating and keeping physically active was not conducted

Counselling conducted on increasing daily energy and protein intake

Reason counselling on increasing daily energy and protein intake was not conducted

Counselling conducted on balanced energy and protein dietary supplementation

Reason counselling on balanced energy and protein dietary supplementation was not conducted

Hypertension

Severe hypertension

Pre-eclampsia

Severe pre-eclampsia

Counselling conducted on hypertension

Counselling conducted on HIV positive

Counselling conducted on hepatitis B positive

Counselling conducted on hepatitis C positive

Syphilis counselling and treatment

Syphilis counselling, treatment and further testing

Seven-day antibiotic regimen for asymptomatic bacteriuria (ASB) provided

Reason seven-day antibiotic regimen for asymptomatic bacteriuria (ASB) not provided

Counselling conducted on TB screening positive

Counselling conducted on gestational diabetes mellitus (GDM)

Counselling conducted on diabetes mellitus (DM)

Counselling conducted on anaemia

Amount of iron prescribed

Type of iron supplement dosage provided

Amount of daily dose of folic acid prescribed

Reason iron and folic acid not prescribed

Amount of vitamin A supplementation provided

Type of vitamin A supplement dosage provided

Vitamin A supplementation not provided

Amount of daily calcium supplements provided

Reason calcium not prescribed

Risk of pre-eclampsia

Pre-eclampsia risk counselling provided

Amount of daily aspirin prescribed until delivery

Reason aspirin not prescribed

Risk of gestational diabetes mellitus (GDM)

Gestational diabetes mellitus (GDM) risk counselling conducted

Counselling conducted on HIV risk

PrEP for HIV prevention provided

Reason PrEP for HIV prevention was not provided

Amount of oral PrEP provided

Counselling conducted on seeking care when danger signs occur

Counsel to immediately go to the hospital if severe danger signs are present

Counselling on ANC contact schedule conducted

Counselling conducted on birth preparedness and complications readiness

Planned birth place

Counselling conducted on Rh factor negative

Counselling conducted on intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection

Counselling on postpartum family planning conducted

Family planning method selected

Counselling conducted on breastfeeding

Tetanus toxoid (TT) 1 immunization provided

Date tetanus toxoid 1 immunization was received

Tetanus toxoid (TT) 2 immunization provided

Date tetanus toxoid 2 immunization was received

Tetanus toxoid (TT) 3 immunization provided

Date tetanus toxoid 3 immunization was received

Tetanus toxoid (TT) 4 immunization provided

Date tetanus toxoid 4 immunization was received

Tetanus toxoid (TT) 5 immunization provided

Date tetanus toxoid 5 immunization was received

Reason tetanus toxoid (TT) vaccination not provided

Counselling conducted on Hep B negative

Hepatitis B-1 immunization provided

Date hepatitis B-1 immunization was received

Hepatitis B-2 immunization provided

Date hepatitis B-2 immunization was received

Hepatitis B-3 immunization provided

Date hepatitis B-3 immunization was received

No doses of hepatitis B

Reason Hep B vaccination not provided

Flu immunization provided

Date flu immunization was received

Reason flu vaccine not provided

IPV first-line support provided

Reason IPV first line support not done

What additional type of care provided

Safety assessement

Has the physical violence happened more often or gotten worse over the past 6 months

Has he ever used a weapon or threatened you with a weapon

Has he ever tried to strangle you

Has he ever beaten you when you were pregnant

Is he violently and constantly jealous of you

Do you believe he could kill you

Referrals made as part of first-line support and care

Was client referred

Reason no preventative treatment provided

Counselling conducted on malaria prevention

IPTp-SP dose 1 provided

IPTp-SP dose 1 date

IPTp-SP dose 2 provided

IPTp-SP dose 2 date

IPTp-SP dose 3 provided

IPTp-SP dose 3 date

Reason malaria prophylaxis not provided


Produced 08 Sep 2023