Get Annexure 1: Facility Based Maternal Death Review Form
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How to fill out the Annexure 1: Facility Based Maternal Death Review Form online
Filling out the Annexure 1: Facility Based Maternal Death Review Form online is an important process that requires careful attention to detail. This guide is designed to help you navigate each section of the form effectively, ensuring completeness and accuracy in reporting maternal deaths.
Follow the steps to complete the form accurately and efficiently.
- Press the ‘Get Form’ button to access the form and load it into your editing tool.
- Begin with the section labeled 'For Official Use Only.' Fill in the FBMDR number and year at the top of the form.
- In the 'General Information' section, provide the name, designation, and address of the District Nodal Officer, as well as details about the deceased woman including her name, age, address, and the facility where the death occurred.
- Proceed to the 'Details of Deceased' section. Enter the inpatient number, gravidity, parity, number of living children, and the critical dates and times related to admission, delivery, and death.
- In the 'Details of Admission' section, select the type of facility and provide the reasons for admission as well as key medical information leading up to and during the period of admission.
- If applicable, complete the 'Abortions' section by indicating whether the abortion was spontaneous or induced, detailing the method of termination, and any complications.
- Fill out the 'Antenatal Care' section, noting if the woman received antenatal care, the number of visits, and any complications or identified risk factors during this period.
- Complete the 'Delivery, Puerperium and Neonatal Information' section, providing information about labour, delivery, and the status of the newborn.
- In the 'Cause of Maternal Death' section, offer an analysis of the probable causes, including any direct or indirect factors that contributed to the death.
- Finally, review the sections on avoidable factors and substandard care, and complete the autopsy information if applicable. Provide a concise case summary at the end.
- Once the form is complete, ensure all information is accurate before saving your changes. Then, you can download, print, or share the form.
Complete your forms online today to ensure timely and accurate reporting.
Investigation of the maternal deaths will be done using Verbal Autopsy Format (annex 2). In section 11 of the format, narration on the various events which led to the death of the mother, should be explained in detail. The Block Medical Nodal Officer (BMNO) is the MO in charge of the Block PHC.
Fill Annexure 1: Facility Based Maternal Death Review Form
Attach a copy of the case records to this form. 3. Complete the form in triplicate within 24 hours of a maternal death. ➢ Select Data entry for FB (Facility based) or CB (Community based) case and enter. Mother ID and click Get Result. For deaths in the health system. Time lines and incentives given. List of registers to be maintained at various levels. Maternal and Perinatal Death Surveillance and Response Guidelines 2017. Annex 13: Action plan template following Facility review committee meetings.
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