FORM - I Performance Based Incentive - Monthly Scorecard Assessment and Consoildition format for DDHS Level (One Sheet for One HWC-HSC ) ‘Block Name :- Name of the PHC : HWC HSC :- Month: MM/YYYY Total Percentage Obtained each week| Total Percentage Week I|Week Il] Week I |WeekIv| achieved PHC Services S.No (As per Form 1) Avg Percentage for jall 22 CPHC 1 [Services in this | Week (for applicable Specific indicators) ‘Average Percentage (%) for this month = Total /#= Assessment & Consolidation and verified by = DMCHO / DTTMO/ NCD DPo/ APM/ Approved By DDES.... (& scanned with OKEN ScannerPesormance Based Incentive» WEEKLY Performance ApraaaSIEET In Focentge For Team Membere Tove tent to DONS occ (eekly Has fom lok PE ‘HUD Mame “ra 50 serveee | 2 Specie Inteator sees | “eee [reste careie Pregnant Women epatered nthe fat] | 1 pregnancy and | 1 ltrmester of the total registered ANC | | ld ich luis Visio: (carly _reistcaion | i | Fe Childen i the age group of O-12 month 1 2 [whe have received all due vaccines (BCS to Measies Ist dose) before se st year of Neonatal and i iti | 2 |intant Heat tae Heatn [Ye harm ne ge go a8 monte | 4 [2S monte who have receved all due | Ivaccines (up to Measles 2nd doze and DPT | st boosts) within 2 years of ie Citznood ane | [Proportion af adolescent git (10-19 years) | 15 fadotescens «4 |imrural areas both school going and non Heath care school ging gre received Sanitary services napkins forlast 3 months Family 14 [Panolng.conntsa) 5 [Proportion of eile couples sing modern | Jeptve ena al lontraceptive methods | faci acues IManagement oF / Komen ie | __ [Propation ot people with ever/cough and s 6 [weight ore fe more than 2 wecks refered aiseasessNational] © |i.Sputum examination and follow up | Heath IH | joeneral Gut patent care for 6 reatesimpie | 7 [Number of O / Day (Minimum 15/day) | nesses and 7 nor ailment | a Jpoporion of erget population of 30 years lSereening and |g land above covered in population Management of | © |enumeration using CBAC ~ form | 7 |won- [Communicable | |Nurnber of Out Patents ever 30 yeare | Diseases 9. [hose blood pressure and blogd sugar | sured in this week 10 [1.RoT- test lt HBSAG, Mara, | 4. [Diagnostic = 7 a [serdces 11 [a. Haemoglobin Test ISerening ane facie Inumber of General OP patents screened fr 9 lrmanagement of | 12 {mental ines sing sreening Mental Health [guceionarie 00s i ewer | are fr Common) | |rumber of General OP patients 10 Jopthatnic ENT | 19 | 7 eye and ear problems problems = asic Dental | ,4 [Number of General OP patente screened fr 11 neath care Joral Problems and Oral Cancer [Geriatric and Number of patints vated who were 12 [pattatve Heatth | 15 fearalted for palate care at HIWC for Us |care Services week Bee eee (& scanned with OKEN Scannerpele Indlestor ta een tn sie | ern Percentage rl frawima Care hat can be managed atthe 33 eeetand lEmergency Medical Services 16 frvumber of trauma eases seen and refered Hvitiage Health Water Sanitauon and a [Community — | yy [Nutrition comiteetVRWSNCIMectin JParucipation jwith IEC ef UHC activities (No.of meetings [per month) } [Patent sapport [as [eran teeing [ag [umber orr5e mecun conducted ave Crour reek | 16 [SCeramanig | ag Plumber of Patent receives Tablet through | eco WH under ae | 17 TE Sanjeeveni 120 |Tele Consultation conducted in HWC } fbocumentation a ; i ag [orn eewices |?" |peportingin_ AB Portal ig [Wellness Acitvity| 22 |Number of Wellness session conducted J Sanitation 20 |Actiy 23 |chiorination Checked 21-[VBDC sekiviy —| 22 [Blood Soeur Taken [Al the beneficiaries of the 1 services ‘ag |Undating Family | 25 fassigned UHID under Population Health Folder [Registry (PHR) and CMCHIS Family Jnumber (every week before Saturday) “Total Percentage achieved ‘Avg Percentage this Week (for applicable Specitie indicators) (& scanned with OKEN Scanner