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Submission Time

today

start_time

end_time

Woman's ID number:

Which ANC visit is this?

ANC visit date?

Place of ANC visit?

Who did ANC visit?

BP (systolic)

BP (diastolic)

Pulse rate

Temperature (°C)

Weight (in kgs)

Did you conduct an abdominal exam?

Is this a multiple pregnancy (twins, triplets)?

Is there malpresentation of the fetus?