Professional Documents
Culture Documents
District: Month
Block: Year
City/ Town/
Village:
Facility name
4.1 TT1
M2 Deliveries
8.3 Number of mothers paid Janani Suraksha Yogna incentive for Home deliveries
(a) Mothers
(b) ASHAs
(a) Male
(b) Female
Total ({a} + {b})
M5 Family Planning
15.1 At facility
16 IUD removals
(a) Male
(b) Female
Total {(a) to (b)}
M6 CHILD IMMUNISATION
(b) Female
24 Immunisation Status
Total number of children aged between 12 and 23 months who have been fully immunised
24.1
(BCG+DPT123+OPV123+Measles) during the month
(a) Male
(b) Female
(a) Abscess
(b) Death
(c) Others
M8 Number of cases of Childhood Diseases reported during the month (0-5 years)
28 Measles
30 Malaria
M9 Patient Services
33 Lab Tests
M11 Number of Deaths reported at Sub Centre or at home during the month:
35.1 Sepsis
35.2 Asphyxia
35.3 LBW
35.4 Others
Between 1
Between 1 year
36 Infant/Child Deaths up to 5 years by cause month and
& 5 years Total
11 months
36.1 Pneumonia
36.2 Diarrhoea
36.4 Measles
36.5 Others
37 Adolescent/Adult deaths by cause 6-14 yrs 15-55 yrs. Above 55 yrs. Total
37.02 Tuberculosis
37.04 Malaria
37.06 HIV/AIDS
37.09 Maternal
(a) Abortion
(c ) Severe hypertension/fits
(d) Bleeding
37.11 Suicide
Ref No.
M1
1.1
1.1.1
1.2
1.3
1.4
1.4.1
1.4.2
1.5
1.6
1.6.1
1.7
1.7.1
M2
2.1
2.1.1
2.1.1(a)
2.1.1(b)
2.1.2
2.1.3
Ref No.
2.2
2.2.1
2.2.2
2.2.2(a)
2.2.2(b)
2.2.2(c)
M4
4.1
4.1.1
4.1.1(a)
4.1.1(b)
4.1.2
4.1.3
4.2
4.2.1
4.2.2
4.3
M6
6.1
6.2
M9
9.05
9.5.1
9.06
9.07
9.08
9.09
9.10
9.11
9.11.1
9.11.1 (a)
9.11.1 (b)
Ref No.
9.11.2
9.11.2(a)
9.11.2(b)
9.11.3
9.11.3 (a)
9.11.3 (b)
M10
10.1
10.1.01
10.1.02
10.1.03
10.1.04
10.1.05
10.1.06
10.1.07
10.1.08
10.1.09
10.1.10
10.1.11
10.1.12
10.1.13
10.1.13 (a)
10.1.13 (b)
10.2
10.2.1
10.2.2
10.2.3
10.3
10.3.1
10.3.1(a)
10.3.1(b)
Ref No.
10.3.2
10.3.3
10.3.4
10.3.5
10.3.5 (a)
10.3.5 (b)
10.3.5 (c)
10.4
10.4.1
10.4.2
10.4.3
10.5
10.5.1
10.5.2
10.5.3
M11
11.1
11.1.1
11.1.2
11.1.3
M12
12.6
12.7
12.8
M14
14.03
14.12
14.12.1
M15
15.1
15.1.1 (a)
15.1.1 (b)
Ref No.
M17
17.1
17.2
17.2.1
17.2.2
17.2.3
17.2.4
17.3
17.3.1
17.3.2
17.3.3
17.3.4
17.3.5
17.4
17.4.01
17.4.02
17.4.03
17.4.04
17.4.05
17.4.06
17.4.07
17.4.08
17.4.09
17.4.09(a)
17.4.09(b)
17.4.09(c )
17.4.09(d )
17.4.09(e )
17.4.09(f )
17.4.10
17.4.11
17.4.12
17.4.13
17.4.13(a)
17.4.13(b)
17.4.13(c )
Ref No.
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fodkl[k.M o"kZ
'kgj@dLck@xka
o
laLFkk dk uke
ekg dh
miyC/kh
4.1 TT1
M2 izlo
8.2 uotkr f'k'kqvksa dh la[;k ftUgsa 24 ?kaVs ds vUnj x`g HksaV dh xbZ
8.3 izlwrk efgykvksa dh la[;k ftUgsa ?kj ij izlo ds ckn tuuh lqj{kk ;kstuk dh jkf'k nh xbZ
ekg dh
miyC/kh
9 laLFkkxr izlo
(a) ckyd
(b) ckfydk
dqy ({a} + {b})
10.3 xHkZikr
14 izlwrk efgyk ftUgsa 48 ?k.Vs o 14 fnu ds vanj izlo Ik'pkr lqfo/kk feyh
M5 ifjokj fu;kstu
ekg dh
miyC/kh
(a) iq:"k
(b) efgyk
dqy {(a) to (b)}
M6 Vhdkdj.k
(b) ckfydk
24 Vhdkdj.k Lrj
12&23 ekg ds cPpksa dh la[;k ftudk bl ekg esa iw.kZ Vhdkdj.k gqvk ¼chlhth $ MhihVh 1 2 3 $
24.1
iksfy;ks 1 2 3 $ ehtYl½
(a) ckyd
(b) ckfydk
ekg dh
miyC/kh
(a) QksM+k
(b) e`R;q
(c) vU;
25.1 fu;ksftr l=
25.2 vk;ksftr l=
28 ehtYl
30 eysfj;k
33 tkapsa
ekg dh
miyC/kh
M11 ekg esa ?kj ij vFkok miLokLF; dsUnz esa gqbZ e`R;q
35.3 de out
35.4 vU;
1 ekg ls 11
36 5 lky rd ds cPpksa dh e`R;q ds dkj.k ekg dh mez
1&5 o"kZ dh mez dqy
36.1 fueksfu;k
36.2 nLr
36.3 cq[kkj
36.4 ehtYl
36.5 vU;
37 fd'kksj@o;Ld e`R;q ds dkj.k 6&14 o"kZ 15&55 o"kZ > 55 o"kZ dqy
37.01 nLr
37.02 {k;jksx
37.04 eysfj;k
37.06 ,p-vk;-oh@,M~l
37.08 rkaf=dh@nkSjk
(a) xHkZikr
(c ) mPp jDrpki@>Vds
(d) jDrL=ko
37.11 vkRegR;k
jsQjsUl Øekad
M1
1.1
1.1.1
1.2
1.3
1.4
1.4.1
1.4.2
1.5
1.6
1.6.1
1.7
1.7.1
M2
2.1
2.1.1
2.1.1(a)
2.1.1(b)
2.1.2
2.1.3
jsQjsUl Øekad
2.2
2.2.1
2.2.2
2.2.2(a)
2.2.2(b)
2.2.2(c)
M4
4.1
4.1.1
4.1.1(a)
4.1.1(b)
4.1.2
4.1.3
4.2
4.2.1
4.2.2
4.3
M6
6.1
6.2
M9
9.05
9.5.1
9.06
9.07
9.08
9.09
9.10
9.11
9.11.1
9.11.1 (a)
9.11.1 (b)
jsQjsUl Øekad
9.11.2
9.11.2(a)
9.11.2(b)
9.11.3
9.11.3 (a)
9.11.3 (b)
M10
10.1
10.1.01
10.1.02
10.1.03
10.1.04
10.1.05
10.1.06
10.1.07
10.1.08
10.1.09
10.1.10
10.1.11
10.1.12
10.1.13
10.1.13 (a)
10.1.13 (b)
10.2
10.2.1
10.2.2
10.2.3
10.3
10.3.1
10.3.1(a)
10.3.1(b)
jsQjsUl Øekad
10.3.2
10.3.3
10.3.4
10.3.5
10.3.5 (a)
10.3.5 (b)
10.3.5 (c)
10.4
10.4.1
10.4.2
10.4.3
10.5
10.5.1
10.5.2
10.5.3
M11
11.1
11.1.1
11.1.2
11.1.3
M12
12.6
12.7
12.8
M14
14.03
14.12
14.12.1
M15
15.1
15.1.1 (a)
15.1.1 (b)
jsQjsUl Øekad
M17
17.1
17.2
17.2.1
17.2.2
17.2.3
17.2.4
17.3
17.3.1
17.3.2
17.3.3
17.3.4
17.3.5
17.4
17.4.01
17.4.02
17.4.03
17.4.04
17.4.05
17.4.06
17.4.07
17.4.08
17.4.09
17.4.09(a)
17.4.09(b)
17.4.09(c )
17.4.09(d )
17.4.09(e )
17.4.09(f )
17.4.10
17.4.11
17.4.12
17.4.13
17.4.13(a)
17.4.13(b)
17.4.13(c )