Highest level of education achieved Does not know level of education No education Primary school Secondary school Higher education

• linkId: 1
• Definition: Patient.educationLevel
• Answers: Highest level of education achieved Choices

Occupation Student Unemployed Formal employment Other (specify) Employment that puts woman at increased risk for HIV (e.g. sex worker) Informal employment (other)

• linkId: 2
• Definition: Patient.occupation
• Answers: Occupation Choices Grouper

Last menstrual period (LMP) date

• linkId: 3
• Definition: Observation.value[x]

Ultrasound done

• linkId: 4
• Definition: Observation.value[x]

Ultrasound date

• linkId: 5
• Definition: Procedure.performed[x]

Gestational age

• linkId: 6
• Definition: Observation.value[x]

Source of gestational age Last menstrual period (LMP) Ultrasound Symphysis fundal height (SFH) or abdominal palpation

• linkId: 7
• Definition: Observation.value[x]
• Answers: Source of gestational age Choices

Expected date of delivery (EDD)

• linkId: 8
• Definition: Observation.value[x]

Number of pregnancies (gravida)

• linkId: 9
• Definition: Observation.value[x]

Number of miscarriages and/or abortions

• linkId: 10
• Definition: Observation.value[x]

Number of live births

• linkId: 11
• Definition: Observation.value[x]

Whether last live birth was preterm Last live birth was preterm Last live birth was not preterm Don't know if last live birth was preterm

• linkId: 12
• Definition: Observation.value[x]
• Answers: Whether last live birth was preterm Choices

Number of stillbirths

• linkId: 13
• Definition: Observation.value[x]

Parity

• linkId: 14
• Definition: Observation.value[x]

Number of caesarian sections

• linkId: 15
• Definition: Observation.value[x]

Past pregnancy complications No past pregnancy complications Does not know of any past pregnancy complications Alcohol use Baby died within 24 hours of birth Substance use Tobacco use Vacuum delivery Other past pregnancy problems (specify) Pre-eclampsia Eclampsia Convulsions Forceps Gestational diabetes mellitus Heavy bleeding (during or after delivery) Macrosomia Perineal tear (3rd or 4th degree)

• linkId: 16
• Definition: Observation.value[x]
• Answers: Past pregnancy complications Choices Grouper

Substance use during past pregnancy specification Cocaine Injectable drugs Marijuana Other illicit substance use (specify)

• linkId: 17
• Definition: Observation.value[x]
• Answers: Substance use during past pregnancy specification Choices

Allergies No known allergies Albendazole Aluminium hydroxide Calcium Chamomile Folic acid Ginger Iron Magnesium carbonate Malaria medication (sulfadoxine-pyrimethamine) Mebendazole Penicillin PrEP tenofovir disoproxil fumarate (TDF) Other allergies (specify)

• linkId: 18
• Definition: Observation.value[x]
• Answers: Allergies Choices

Past surgeries No known past surgeries Does not know of any past surgeries Dilation and curettage Myomectomy Removal of ovarian cysts Oophorectomy Salpingectomy Cervical cone Other gynecological procedures (specify) Other surgeries (specify)

• linkId: 19
• Definition: Observation.value[x]
• Answers: Past surgeries Choices

Existing chronic health conditions No chronic or past health conditions Don't know if there are any chronic or past health conditions Blood disorder (e.g. sickle cell, anaemia, thalassemia) Cancer - gynaecological Cancer - other site (specify) Epilepsy HIV positive Other (specify) Autoimmune disease Diabetes arising in pregnancy (gestational diabetes) Diabetes, other or unspecified Diabetes, pre-existing type 1 Diabetes, pre-existing type 2 Hypertension Kidney disease

• linkId: 20
• Definition: Observation.value[x]
• Answers: Existing chronic health conditions Choices Grouper

HIV diagnosis date ??

• linkId: 21
• Definition: Observation.value[x]

Tetanus toxoid-containing vaccine (TTCV) immunization history Fully immunized Under-immunized No doses Unknown

• linkId: 22
• Definition: Observation.value[x]
• Answers: Tetanus toxoid-containing vaccine (TTCV) immunization history Choices Grouper

Flu immunization history Fully immunized No doses Unknown

• linkId: 23
• Definition: Observation.value[x]
• Answers: Flu immunization history Choices Grouper

Current medications No medications Does not know of any current medications Analgesic Antacids Anti-convulsive Anti-diabetic Antihelmintic Anti-hypertensive Anti-malarials Antiretrovirals (ARVs) Antitussive Antivirals Aspirin Asthma Calcium Doxylamine Folic acid Hematinic Hemorrhoidal medication Iron Magnesium Metoclopramide Multivitamin Oral pre-exposure prophylaxis (PrEP) for HIV Other antibiotics Thyroid medication Vitamin A Other medications (specify) Co-trimoxazole

• linkId: 24
• Definition: Observation.value[x]
• Answers: Current medications Choices Grouper

Daily caffeine intake More than 2 cups of coffee (brewed, filtered, instant or espresso) More than 4 cups of tea More than 12 bars (50 g) of chocolate More than one can of soda or energy drink None of the above daily caffeine intake

• linkId: 25
• Definition: Observation.value[x]
• Answers: Daily caffeine intake Choices Grouper

Clinical enquiry for alcohol and other substance use done ??

• linkId: 26
• Definition: Observation.value[x]

Current alcohol and/or other substance use No alcohol and/or substances Alcohol Cocaine Injectable drugs Marijuana Other substance use (specify)

• linkId: 27
• Definition: Observation.value[x]
• Answers: Current alcohol and/or other substance use Choices Grouper

Tobacco use

• linkId: 28
• Definition: Observation.value[x]

Recently quit tobacco products

• linkId: 29
• Definition: Observation.value[x]

Exposure to second-hand smoke

• linkId: 30
• Definition: Observation.value[x]

Partner HIV status (reported) HIV positive HIV negative Inconclusive

• linkId: 31
• Definition: Observation.value[x]
• Answers: Partner HIV status (reported) Choices Grouper

Contraceptive use of male condoms

• linkId: 32
• Definition: Observation.value[x]

Contraceptive use of female condoms

• linkId: 33
• Definition: Observation.value[x]