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pnc_edit.html
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pnc_edit.html
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<?xml version="1.0"?>
<root><model>
<instance>
<PNC_edit encounter_type="PNC Edit" id="pnc_edit" version="201512020804">
<formhub>
<uuid/>
</formhub>
<start/>
<today/>
<deviceid/>
<simserial/>
<phonenumber/>
<generated_note_name_7/>
<hpht/>
<usiakehamilan/>
<usia_kehamilan_hpht/>
<keadaan_ibu/>
<keadaan_bayi/>
<persalinan/>
<tanggal__kala_i_aktif/>
<jam__kala_i_aktif/>
<tanggal__kala_ii/>
<jam__kala_ii/>
<tanggal__plasenta_lahir/>
<jam__plasenta_lahir/>
<perdarahan_kala_iv_2_jam_postpartum/>
<persentasi/>
<tempat/>
<penolong/>
<penolong_lain_lain/>
<cara_persalinan_ibu/>
<manajemen_aktif_kala_iii/>
<pelayanan/>
<integrasi_program/>
<komplikasi/>
<komplikasilain-lain/>
<dirujuk_ke/>
<dirujuk_ke_lain_lain/>
<alamat_bersalin/>
<generated_note_name_35/>
<high_risk_post-partum_distosia/>
<high_risk_post-partum_PIH/>
<high_risk_post-partum_Hemorrhage/>
<high_risk_post-partum_infection/>
<high_risk_post-partum_maternal_sepsis/>
<high_risk_post-partum_Pre-eclampsia_eclampsia/>
<high_risk_post-partum_vacum/>
<high_risk_post-partum_forceps/>
<high_risk_post-partum_Sectio_Caesaria/>
<end/>
<meta>
<instanceID/>
</meta>
</PNC_edit>
</instance>
</model><form autocomplete="off" novalidate="novalidate" class="or clearfix" id="pnc_edit">
<!--This form was created by transforming a OpenRosa-flavored (X)Form using an XSLT sheet created by Enketo LLC.--><section class="form-logo"> </section><h3 id="form-title">PNC Edit</h3><select id="form-languages" data-default-lang="Bahasa"><option value="Bahasa">Bahasa</option> <option value="en">English</option> </select>
<label class="note non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/generated_note_name_7:label">DOKUMENTASI PERSALINAN</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/generated_note_name_7:label">DOCUMENTATION OF DELIVERY</span><input type="text" name="/PNC_edit/generated_note_name_7" data-type-xml="string" readonly="readonly"/></label>
<label class="note non-select "><span lang="Bahasa" class="or-constraint-msg active" data-itext-id="/PNC_edit/usia_kehamilan_hpht:jr:constraintMsg">Nilai yang dimasukkan tidak memenuhi syarat, mohon periksa kembali</span><span lang="en" class="or-constraint-msg " data-itext-id="/PNC_edit/usia_kehamilan_hpht:jr:constraintMsg">The entered value doesn't meet the criteria, please check it again</span><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/usia_kehamilan_hpht:label">Usia kehamilan berdasarkan HPHT: <span class="or-output" data-value=" /PNC_edit/usiakehamilan ">
</span> minggu</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/usia_kehamilan_hpht:label">Age of pregnancy based on HPHT</span><input type="text" name="/PNC_edit/usia_kehamilan_hpht" data-constraint=".>0" data-type-xml="string" readonly="readonly"/></label>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/keadaan_ibu:label">Keadaan Ibu</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/keadaan_ibu:label">Condition of mother</span><span class="required">*</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/keadaan_ibu:hint">Kondisi Ibu setelah proses persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/keadaan_ibu:hint">Mother's condition post-delivery</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/PNC_edit/keadaan_ibu" data-name="/PNC_edit/keadaan_ibu" value="hidup" required="required" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/keadaan_ibu/hidup:label">Hidup (H)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/keadaan_ibu/hidup:label">Alive (A)</span></label><label class=""><input type="radio" name="/PNC_edit/keadaan_ibu" data-name="/PNC_edit/keadaan_ibu" value="mati" required="required" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/keadaan_ibu/mati:label">Mati (M)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/keadaan_ibu/mati:label">Dead (D)</span></label></div></fieldset></fieldset>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/keadaan_bayi:label">Keadaan bayi</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/keadaan_bayi:label">Condition of baby</span><span class="required">*</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/keadaan_bayi:hint">Kondisi bayi setelah proses persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/keadaan_bayi:hint">Baby's condition post-delivery</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/PNC_edit/keadaan_bayi" data-name="/PNC_edit/keadaan_bayi" value="hidup" required="required" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/keadaan_bayi/hidup:label">Hidup (H)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/keadaan_bayi/hidup:label">Alive (A)</span></label><label class=""><input type="radio" name="/PNC_edit/keadaan_bayi" data-name="/PNC_edit/keadaan_bayi" value="mati" required="required" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/keadaan_bayi/mati:label">Mati (M)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/keadaan_bayi/mati:label">Dead (D)</span></label></div></fieldset></fieldset>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/persalinan:label">PERSALINAN</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/persalinan:label">DELIVERY</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/persalinan:hint">Isi Kala Persalinan dimulai dari kedatangan Ibu hamil</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/persalinan:hint">Fill in information of Labor Stage started from mother's arrival in health facility</span>
</legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/PNC_edit/persalinan" value="kalasatu" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/persalinan/kalasatu:label">Kala I Aktif</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/persalinan/kalasatu:label">Active Stage I</span></label><label class=""><input type="checkbox" name="/PNC_edit/persalinan" value="kaladua" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/persalinan/kaladua:label">Kala II</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/persalinan/kaladua:label">Stage II</span></label><label class=""><input type="checkbox" name="/PNC_edit/persalinan" value="kalatiga" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/persalinan/kalatiga:label">Kala III (Bayi Lahir/Plasenta Lahir)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/persalinan/kalatiga:label">Stage III placenta expulsion</span></label><label class=""><input type="checkbox" name="/PNC_edit/persalinan" value="kalaempat" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/persalinan/kalaempat:label">Kala IV (2 Jam Postpartum)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/persalinan/kalaempat:label">Stage IV (2 hours Postpartum)</span></label></div></fieldset></fieldset>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/tanggal__kala_i_aktif:label">Tanggal / Kala I Aktif</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/tanggal__kala_i_aktif:label">Date/ Active Stage I</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/tanggal__kala_i_aktif:hint">Menunjukan Tanggal Kala I Aktif</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/tanggal__kala_i_aktif:hint">Indicating date of active stage 1</span><input type="date" name="/PNC_edit/tanggal__kala_i_aktif" data-relevant="selected( /PNC_edit/persalinan ,'kalasatu')" data-type-xml="date"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/jam__kala_i_aktif:label">Jam / Kala I Aktif</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/jam__kala_i_aktif:label">Time/ Active Stage I</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/jam__kala_i_aktif:hint">Menunjukkan Jam Kala I Aktfi</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/jam__kala_i_aktif:hint">Indicating time of active stage 1</span><input type="time" name="/PNC_edit/jam__kala_i_aktif" data-relevant="selected( /PNC_edit/persalinan ,'kalasatu')" data-type-xml="time"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/tanggal__kala_ii:label">Tanggal / Kala II</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/tanggal__kala_ii:label">Date/ Stage II</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/tanggal__kala_ii:hint">Menunjukkan Tanggal Terjadinya Kala II Pada Ibu</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/tanggal__kala_ii:hint">Indicating date of stage 2</span><input type="date" name="/PNC_edit/tanggal__kala_ii" data-relevant="selected( /PNC_edit/persalinan ,'kaladua')" data-type-xml="date"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/jam__kala_ii:label">Jam / Kala II</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/jam__kala_ii:label">Time/ Stage II</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/jam__kala_ii:hint">Menunjukkan Jam Terjadinya Kala II Pada Ibu</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/jam__kala_ii:hint">Indicating time of stage 2</span><input type="time" name="/PNC_edit/jam__kala_ii" data-relevant="selected( /PNC_edit/persalinan ,'kaladua')" data-type-xml="time"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/tanggal__plasenta_lahir:label">Tanggal / Plasenta Lahir</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/tanggal__plasenta_lahir:label">Date/ Placenta Expulsion</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/tanggal__plasenta_lahir:hint">Menunjukkan Tanggal Plasenta Lahir</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/tanggal__plasenta_lahir:hint">Indicating date when placenta is born</span><input type="date" name="/PNC_edit/tanggal__plasenta_lahir" data-relevant="selected( /PNC_edit/persalinan ,'kalatiga')" data-type-xml="date"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/jam__plasenta_lahir:label">Jam / Plasenta Lahir</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/jam__plasenta_lahir:label">Time/ Placenta Expulsion</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/jam__plasenta_lahir:hint">Menunjukkan Jam Plasenta Lahir</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/jam__plasenta_lahir:hint">Indicating time when placenta is born</span><input type="time" name="/PNC_edit/jam__plasenta_lahir" data-relevant="selected( /PNC_edit/persalinan ,'kalatiga')" data-type-xml="time"/></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="or-constraint-msg active" data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:jr:constraintMsg">Nilai yang dimasukkan tidak memenuhi syarat, mohon periksa kembali</span><span lang="en" class="or-constraint-msg " data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:jr:constraintMsg">The entered value doesn't meet the criteria, please check it again</span><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:label">Perdarahan Kala IV 2 jam Postpartum</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:label">Stage IV hemorrhage 2 hours Postpartum</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:hint">Menunjukkan Volume / Jumlah Darah Setelah 2 Jam Persalinan (cc)</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum:hint">Indicating volume/amount of bleeding 2 hours post-partum (cc)</span><input type="number" name="/PNC_edit/perdarahan_kala_iv_2_jam_postpartum" data-constraint=".>0" data-relevant="selected( /PNC_edit/persalinan ,'kalaempat')" data-type-xml="decimal" step="any"/></label>
<label class="question or-appearance-minimal or-branch pre-init "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/persentasi:label">Persentasi</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/persentasi:label">Presentation</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/persentasi:hint">Menunjukkan Bagian Terendah Janin, yang Sudah Masuk Ke dalam PAP</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/persentasi:hint">Indicating the lowest part of fetus that has gotten into mother's pelvic inlet</span><select name="/PNC_edit/persentasi" data-name="/PNC_edit/persentasi" data-relevant="selected( /PNC_edit/persalinan ,'kalaempat')" data-type-xml="select1"><option value="">...</option><option value="puncak_kepala">Puncak Kepala (PK)</option><option value="belakang_kepala">Belakang Kepala (BK)</option><option value="lintang_oblique">Lintang/Oblique (LG/OB)</option><option value="menumbung">Menumbung (MG)</option><option value="bokong">Bokong (BK)</option><option value="dahi">Dahi (Dahi)</option><option value="muka">Muka (MK)</option><option value="kaki">Kaki (KK)</option><option value="rangkap">Rangkap (RK)</option><option value="Belum teraba">Belum teraba</option></select><span class="or-option-translations" style="display:none;"><span data-option-value="puncak_kepala" lang="Bahasa">Puncak Kepala (PK)</span><span data-option-value="puncak_kepala" lang="en">Head crown</span><span data-option-value="belakang_kepala" lang="Bahasa">Belakang Kepala (BK)</span><span data-option-value="belakang_kepala" lang="en">Oociput</span><span data-option-value="lintang_oblique" lang="Bahasa">Lintang/Oblique (LG/OB)</span><span data-option-value="lintang_oblique" lang="en">Oblique</span><span data-option-value="menumbung" lang="Bahasa">Menumbung (MG)</span><span data-option-value="menumbung" lang="en">Funiculi Prolapsus</span><span data-option-value="bokong" lang="Bahasa">Bokong (BK)</span><span data-option-value="bokong" lang="en">Buttock</span><span data-option-value="dahi" lang="Bahasa">Dahi (Dahi)</span><span data-option-value="dahi" lang="en">Forehead</span><span data-option-value="muka" lang="Bahasa">Muka (MK)</span><span data-option-value="muka" lang="en">Face</span><span data-option-value="kaki" lang="Bahasa">Kaki (KK)</span><span data-option-value="kaki" lang="en">Feet</span><span data-option-value="rangkap" lang="Bahasa">Rangkap (RK)</span><span data-option-value="rangkap" lang="en">Complete breech</span><span data-option-value="Belum teraba" lang="Bahasa">Belum teraba</span><span data-option-value="Belum teraba" lang="en">Not palpable</span>
</span></label>
<label class="question or-appearance-minimal "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/tempat:label">Tempat bersalin</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/tempat:label">Place of delivery</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/tempat:hint">Menunjukkan tempat persalinan Ibu</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/tempat:hint">Indicating mother's place of delivery</span><select name="/PNC_edit/tempat" data-name="/PNC_edit/tempat" data-type-xml="select1"><option value="">...</option><option value="rumah">Rumah (RMH)</option><option value="podok_bersalin_desa">Podok Bersalin desa ( Polindes)</option><option value="pusat_kesehatan_masyarakat_pembantu">Pusat Kesehatan Masyarakat Pembantu (Pustu)</option><option value="pusat_kesehatan_masyarakat">Pusat Kesehatan Masyarakat (Puseksmas )</option><option value="rumah_bersalin">Rumah Bersalin (RB)</option><option value="rumah_sakit_ibu_dan_anak">Rumah Sakit Ibu dan Anak (RSIA)</option><option value="rumah_sakit">Rumah Sakit (RS)</option><option value="rumah_sakit_orang_dengan_hiv_aids">Rumah Sakit Orang dengan HIV / AIDS (RS Odha)</option></select><span class="or-option-translations" style="display:none;"><span data-option-value="rumah" lang="Bahasa">Rumah (RMH)</span><span data-option-value="rumah" lang="en">House</span><span data-option-value="podok_bersalin_desa" lang="Bahasa">Podok Bersalin desa ( Polindes)</span><span data-option-value="podok_bersalin_desa" lang="en">Community-based Health Post</span><span data-option-value="pusat_kesehatan_masyarakat_pembantu" lang="Bahasa">Pusat Kesehatan Masyarakat Pembantu (Pustu)</span><span data-option-value="pusat_kesehatan_masyarakat_pembantu" lang="en">Sub-Center</span><span data-option-value="pusat_kesehatan_masyarakat" lang="Bahasa">Pusat Kesehatan Masyarakat (Puseksmas )</span><span data-option-value="pusat_kesehatan_masyarakat" lang="en">Primary Health Center</span><span data-option-value="rumah_bersalin" lang="Bahasa">Rumah Bersalin (RB)</span><span data-option-value="rumah_bersalin" lang="en">Maternity Hospital</span><span data-option-value="rumah_sakit_ibu_dan_anak" lang="Bahasa">Rumah Sakit Ibu dan Anak (RSIA)</span><span data-option-value="rumah_sakit_ibu_dan_anak" lang="en">Maternal and Child Hospital</span><span data-option-value="rumah_sakit" lang="Bahasa">Rumah Sakit (RS)</span><span data-option-value="rumah_sakit" lang="en">Hospital</span><span data-option-value="rumah_sakit_orang_dengan_hiv_aids" lang="Bahasa">Rumah Sakit Orang dengan HIV / AIDS (RS Odha)</span><span data-option-value="rumah_sakit_orang_dengan_hiv_aids" lang="en">Hospital which also occupied by HIV/AIDS patiets</span>
</span></label>
<label class="question or-appearance-minimal "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/penolong:label">Penolong</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/penolong:label">Birth Attendant</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/penolong:hint">Menunjukkan penolong persalinan Ibu</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/penolong:hint">Indicating mother's birth attendant</span><select name="/PNC_edit/penolong" data-name="/PNC_edit/penolong" data-type-xml="select1"><option value="">...</option><option value="keluarga">Keluarga (K)</option><option value="dukun">Dukun (D)</option><option value="bidan">Bidan (B)</option><option value="dr.umum">Dr.Umum (DU)</option><option value="dr.spesialis">Dr.Spesialis (DS)</option><option value="lain-lain">Lain-Lain (LN)</option><option value="tidak_ada">Tidak Ada (TA)</option></select><span class="or-option-translations" style="display:none;"><span data-option-value="keluarga" lang="Bahasa">Keluarga (K)</span><span data-option-value="keluarga" lang="en">Family</span><span data-option-value="dukun" lang="Bahasa">Dukun (D)</span><span data-option-value="dukun" lang="en">Traditional Birth Attendant</span><span data-option-value="bidan" lang="Bahasa">Bidan (B)</span><span data-option-value="bidan" lang="en">Midwife</span><span data-option-value="dr.umum" lang="Bahasa">Dr.Umum (DU)</span><span data-option-value="dr.umum" lang="en">Doctor</span><span data-option-value="dr.spesialis" lang="Bahasa">Dr.Spesialis (DS)</span><span data-option-value="dr.spesialis" lang="en">Medical Specialist</span><span data-option-value="lain-lain" lang="Bahasa">Lain-Lain (LN)</span><span data-option-value="lain-lain" lang="en">Others</span><span data-option-value="tidak_ada" lang="Bahasa">Tidak Ada (TA)</span><span data-option-value="tidak_ada" lang="en">None</span>
</span></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/penolong_lain_lain:label">Lain-lain</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/penolong_lain_lain:label">Other</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/penolong_lain_lain:hint">Menunjukkan penolong persalinan Ibu selain yang disebutkan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/penolong_lain_lain:hint">Indicating other birth attendant</span><input type="text" name="/PNC_edit/penolong_lain_lain" data-relevant=" /PNC_edit/penolong = 'lain-lain'" data-type-xml="string"/></label>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/cara_persalinan_ibu:label">Cara persalinan Ibu</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/cara_persalinan_ibu:label">Ways of mother delivery</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/cara_persalinan_ibu:hint">Menunjukkan cara persalinan Ibu (prosesnya normal atau tidak)</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/cara_persalinan_ibu:hint">Indicating mother's mode of delivery (whether normal or abnormal)</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/PNC_edit/cara_persalinan_ibu" data-name="/PNC_edit/cara_persalinan_ibu" value="normal" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/cara_persalinan_ibu/normal:label">Normal (N)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/cara_persalinan_ibu/normal:label">Normal (N);</span></label><label class=""><input type="radio" name="/PNC_edit/cara_persalinan_ibu" data-name="/PNC_edit/cara_persalinan_ibu" value="vacum" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/cara_persalinan_ibu/vacum:label">Vacum (VC)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/cara_persalinan_ibu/vacum:label">Vacuum (VC)</span></label><label class=""><input type="radio" name="/PNC_edit/cara_persalinan_ibu" data-name="/PNC_edit/cara_persalinan_ibu" value="forceps" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/cara_persalinan_ibu/forceps:label">Forceps (FS)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/cara_persalinan_ibu/forceps:label">Forceps (FS)</span></label><label class=""><input type="radio" name="/PNC_edit/cara_persalinan_ibu" data-name="/PNC_edit/cara_persalinan_ibu" value="sectio_caesaria" data-type-xml="select1"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/cara_persalinan_ibu/sectio_caesaria:label">Sectio Caesaria (SC)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/cara_persalinan_ibu/sectio_caesaria:label">Sectio Caesaria (SC)</span></label></div></fieldset></fieldset>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/manajemen_aktif_kala_iii:label">Manajemen Aktif Kala III</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/manajemen_aktif_kala_iii:label">Active Management of Stage III</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/manajemen_aktif_kala_iii:hint">Menunjukkan tindakan yang dilakukan pada saat Kala III untuk mengeluarkan plasenta</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/manajemen_aktif_kala_iii:hint">Indicating actions taken during management of stage 3 to remove placenta</span>
</legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/PNC_edit/manajemen_aktif_kala_iii" value="injeksi_oksittosin" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/injeksi_oksittosin:label">Injeksi Oksittosin (IO)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/injeksi_oksittosin:label">Oxytocin injection</span></label><label class=""><input type="checkbox" name="/PNC_edit/manajemen_aktif_kala_iii" value="peregangan_tali_pusat" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/peregangan_tali_pusat:label">Peregangan Tali Pusat (PP)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/peregangan_tali_pusat:label">Umbilicus dilatation</span></label><label class=""><input type="checkbox" name="/PNC_edit/manajemen_aktif_kala_iii" value="masase_fundus_uteri" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/masase_fundus_uteri:label">Masase Fundus Uteri (MU)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/manajemen_aktif_kala_iii/masase_fundus_uteri:label">Uterine fundus effleurage</span></label></div></fieldset></fieldset>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/pelayanan:label">Pelayanan</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/pelayanan:label">Service</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/pelayanan:hint">Jenis pelayanan yang diberikan ke Ibu dari proses persalinan sampai 2 jam setelah persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/pelayanan:hint">Type of services provided to mother since labor untuil 2 hours-post partum</span>
</legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/PNC_edit/pelayanan" value="imd_k_1_jam_l_1_jam" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/pelayanan/imd_k_1_jam_l_1_jam:label">IMD < 1 Jam / > 1 Jam (IMD)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/pelayanan/imd_k_1_jam_l_1_jam:label">Early initiation of breastfeeding</span></label><label class=""><input type="checkbox" name="/PNC_edit/pelayanan" value="menggunakan_partograf" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/pelayanan/menggunakan_partograf:label">Menggunakan Partograf (MP)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/pelayanan/menggunakan_partograf:label">Using partograph</span></label><label class=""><input type="checkbox" name="/PNC_edit/pelayanan" value="catat_di_buku_kia" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/pelayanan/catat_di_buku_kia:label">Catat di Buku KIA (CK)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/pelayanan/catat_di_buku_kia:label">Updated in Maternal and Child Health Booklet (pink book)</span></label></div></fieldset></fieldset>
<label class="question non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/integrasi_program:label">Integrasi Program</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/integrasi_program:label">Program Integration</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/integrasi_program:hint">Diisi dengan nama obat ( ARV Profilaksis / Anti Malaria / Anti TB) yang diberikan bidan ke Ibu</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/integrasi_program:hint">Fill in type of medicines (ARV prophylaxis / Anti Malaria / Anti-TB) that midwife gives to mother</span><input type="text" name="/PNC_edit/integrasi_program" data-type-xml="string"/></label>
<fieldset class="question "><fieldset><legend><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/komplikasi:label">Komplikasi</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/komplikasi:label">Complications</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/komplikasi:hint">Jenis komplikasi yang terjadi pada Ibu setelah persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/komplikasi:hint">Type of labor complication that occured</span>
</legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="tidak_ada_komplikasi" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/tidak_ada_komplikasi:label">Tidak ada komplikasi persalinan</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/tidak_ada_komplikasi:label">No labor complication</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="distosia" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/distosia:label">Distosia (DS)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/distosia:label">Dystocia</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="hipertensi_dalam_kehamilan" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/hipertensi_dalam_kehamilan:label">Hipertensi dalam Kehamilan (HDK)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/hipertensi_dalam_kehamilan:label">Hypertension in Pregnancy</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="perdarahan_post-partum" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/perdarahan_post-partum:label">Perdarahan Post-Partum (PPP)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/perdarahan_post-partum:label">Postpartum Haemorrhage</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="Infeksi" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/Infeksi:label">Infeksi</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/Infeksi:label">Infection</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="sepsis_maternal" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/sepsis_maternal:label">Sepsis maternal</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/sepsis_maternal:label">Maternal Sepsis</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="preeklampsi_eklampsi" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/preeklampsi_eklampsi:label">Pre-eklampsi/eklampsi</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/preeklampsi_eklampsi:label">Pre-eclampsia/eclampsia</span></label><label class=""><input type="checkbox" name="/PNC_edit/komplikasi" value="lain_lain" data-type-xml="select"/><span lang="Bahasa" class="option-label active" data-itext-id="/PNC_edit/komplikasi/lain_lain:label">Lain - Lain (LN)</span><span lang="en" class="option-label " data-itext-id="/PNC_edit/komplikasi/lain_lain:label">Others</span></label></div></fieldset></fieldset>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/komplikasilain-lain:label">Lain-lain</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/komplikasilain-lain:label">Other</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/komplikasilain-lain:hint">Jenis komplikasi yang terjadi pada Ibu setelah persalinan selain yang disebutkan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/komplikasilain-lain:hint">Other type of labor complication that occured</span><input type="text" name="/PNC_edit/komplikasilain-lain" data-relevant="selected( /PNC_edit/komplikasi , 'lain_lain')" data-type-xml="string"/></label>
<label class="question or-appearance-minimal "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/dirujuk_ke:label">Dirujuk Ke</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/dirujuk_ke:label">Referred to</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/dirujuk_ke:hint">Tempat Ibu dirujuk, jika Ibu mengalami komplikasi persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/dirujuk_ke:hint">Facility where mother is referred to, if mother has labor complication</span><select name="/PNC_edit/dirujuk_ke" data-name="/PNC_edit/dirujuk_ke" data-type-xml="select1"><option value="">...</option><option value="pusat_kesehatan_masyarakat">Pusat Kesehatan Masyarakat (Puskesmas )</option><option value="rumah_bersalin">Rumah Bersalin (RB)</option><option value="rumah_sakit_ibu_dan_anak">Rumah Sakit Ibu dan Anak (RSIA)</option><option value="rumah_sakit">Rumah Sakit (RS)</option><option value="lain-lain">Lain-lain (LN)</option><option value="tidak_diujuk">Tidak Diujuk (TD)</option></select><span class="or-option-translations" style="display:none;"><span data-option-value="pusat_kesehatan_masyarakat" lang="Bahasa">Pusat Kesehatan Masyarakat (Puskesmas )</span><span data-option-value="pusat_kesehatan_masyarakat" lang="en">Primary Health Center</span><span data-option-value="rumah_bersalin" lang="Bahasa">Rumah Bersalin (RB)</span><span data-option-value="rumah_bersalin" lang="en">Maternity Hospital</span><span data-option-value="rumah_sakit_ibu_dan_anak" lang="Bahasa">Rumah Sakit Ibu dan Anak (RSIA)</span><span data-option-value="rumah_sakit_ibu_dan_anak" lang="en">Maternal and Child Hospital;</span><span data-option-value="rumah_sakit" lang="Bahasa">Rumah Sakit (RS)</span><span data-option-value="rumah_sakit" lang="en">Hospital</span><span data-option-value="lain-lain" lang="Bahasa">Lain-lain (LN)</span><span data-option-value="lain-lain" lang="en">Others</span><span data-option-value="tidak_diujuk" lang="Bahasa">Tidak Diujuk (TD)</span><span data-option-value="tidak_diujuk" lang="en">None</span>
</span></label>
<label class="question or-branch pre-init non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/dirujuk_ke_lain_lain:label">Lain-lain</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/dirujuk_ke_lain_lain:label">Other</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/dirujuk_ke_lain_lain:hint">Tempat Ibu dirujuk, jika Ibu mengalami komplikasi persalinan</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/dirujuk_ke_lain_lain:hint">Other facility where mother is referred to, if mother has labor complication</span><input type="text" name="/PNC_edit/dirujuk_ke_lain_lain" data-relevant=" /PNC_edit/dirujuk_ke = 'lain-lain'" data-type-xml="string"/></label>
<label class="question non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/alamat_bersalin:label">Alamat Bersalin</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/alamat_bersalin:label">Address of delivery place</span><span lang="Bahasa" class="or-hint active" data-itext-id="/PNC_edit/alamat_bersalin:hint">Alamat Ibu bersalin</span><span lang="en" class="or-hint " data-itext-id="/PNC_edit/alamat_bersalin:hint">Address of place of delivery</span><input type="text" name="/PNC_edit/alamat_bersalin" data-type-xml="string"/></label>
<label class="note non-select "><span lang="Bahasa" class="question-label active" data-itext-id="/PNC_edit/generated_note_name_35:label">Register Bayi</span><span lang="en" class="question-label " data-itext-id="/PNC_edit/generated_note_name_35:label">Baby's Registration</span><input type="text" name="/PNC_edit/generated_note_name_35" data-type-xml="string" readonly="readonly"/></label>
<fieldset id="or-preload-items" style="display:none;"><label class="calculation non-select "><input type="hidden" name="/PNC_edit/start" data-preload="timestamp" data-preload-params="start" data-type-xml="dateTime"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/today" data-preload="date" data-preload-params="today" data-type-xml="date"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/deviceid" data-preload="property" data-preload-params="deviceid" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/simserial" data-preload="property" data-preload-params="simserial" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/phonenumber" data-preload="property" data-preload-params="phonenumber" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/end" data-preload="timestamp" data-preload-params="end" data-type-xml="dateTime"/></label></fieldset><fieldset id="or-calculated-items" style="display:none;"><label class="calculation non-select "><input type="hidden" name="/PNC_edit/usiakehamilan" data-calculate="int((( /PNC_edit/today - /PNC_edit/hpht ) div 7)+1)" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_distosia" data-calculate="(if(selected( /PNC_edit/komplikasi ,'distosia'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_PIH" data-calculate="(if(selected( /PNC_edit/komplikasi ,'hipertensi_dalam_kehamilan'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_Hemorrhage" data-calculate="(if(selected( /PNC_edit/komplikasi ,'perdarahan_post-partum'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_infection" data-calculate="(if(selected( /PNC_edit/komplikasi ,'Infeksi'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_maternal_sepsis" data-calculate="(if(selected( /PNC_edit/komplikasi ,'sepsis_maternal'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_Pre-eclampsia_eclampsia" data-calculate="(if(selected( /PNC_edit/komplikasi ,'preeklampsi_eklampsi'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_vacum" data-calculate="(if(selected( /PNC_edit/cara_persalinan_ibu ,'vacum'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_forceps" data-calculate="(if(selected( /PNC_edit/cara_persalinan_ibu ,'forceps'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/high_risk_post-partum_Sectio_Caesaria" data-calculate="(if(selected( /PNC_edit/cara_persalinan_ibu ,'sectio_caesaria'), 'yes','no'))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/meta/instanceID" data-calculate="concat('uuid:', uuid())" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/PNC_edit/formhub/uuid" data-calculate="'445bd1fd0e654c0dbfaadf359b1a6b1f'" data-type-xml="string"/></label></fieldset></form><xsltmessages><message level="0">XML to HTML transformation for form took 0.11 seconds</message></xsltmessages><jrvalidationmessages><message level="1">This validation is yet not functional.</message></jrvalidationmessages><xmlerrors/><xslformerrors/><xsldataerrors/></root>