Date last revised:15-Jun-12Date last revised:
Last revised by:MohiniLast revised by:
keyword - This is a unique one or two key word description of the prompt. Keywords cannot be repeated.logic - Logical description on when to show/hide this prompt with respect to data entered up to this pointvisible text - This text will be displayed on screen. If you are using images, please limit the visible text to one or two key words so that the image will fit on the screen at the same description - This text will not be displayed on screen. This is a description of the message that will be played upon pressing the # key. These messages should be reviewed and finalized before any audio recordings are made. Note that you may not be able to see longer messages displayed entirely inside the cells below, click on the cell to see the entire message.image description - You may insert a pre-existing image or type a description for a new illustrationtype - Prompt type (input, select1, select, label)validation - Logical description of the range of accepted values for this prompt (usually for numeric input fields)image file - The filename of the imageaudio file - The filename of the audio clip to be played upon pressing the # key
keywordshow ifvisible text - englishvisible text - hindiaudio description - englishaudio description - hindiimage descriptiontyperequiredcase uploadvalidationvalidation error message - hindivalidation error message - englishcalculationimage fileaudio file - englishaudio file - hindi
1show_ASHA_namen/a<output ref="/data/ASHA_name"/>n/an/an/alabelyesx
2show_issueIssue: <output ref="/data/technical_issue"/>x
3issue_statusShow alwaysIs the issue resolved?n/an/an/aSingle Select
resolved_yes(this closes the issue in the follow-up tech issues list)1. yesn/an/an/aSelect Valuex
resolved_no2. non/an/an/aSelect Value
4resolved_in_fieldif resolved_yes = yesWas the issue resolved in the field by you?
resolved_in_field_yes1. yesn/an/an/aSelect Valuex
resolved_in_field_no2. non/an/an/aSelect Value
5location_resolved_fieldif resolved_in_field = yesWhere at the field level was the issue resolved?
resolved_field1. In field only (village, CHW home, PHC)
resolved_office2. In office (drop-in by ASHA or collected phones)
resolved_remotely3. Remotely over the phone
6resolved_in_field_labelif issue_status = yesIt's great that you were able to resolve the issue. Please report further details about the issue.
7date_resolvedShow if issue_status = yesWhen was the issue resolved?input (date)yesxCan be equal to today, or in the past. Must be after the date_identified
8escalate_issueissue_status = no'Would you like to refer the issue to a higher level of support?
escalate_issue_yes1. yes
escalate_issue_no2. no
9reason_not_referringshow if escalate_issue = noPlease elaborate why issue is not referred to higher level for support.input (text)
10external_supportShow if issue_status = yesDid you seek support from a higher level to resolve the issue? n/an/an/aSingle Selectx
external_support_yes1. yesn/an/an/aSelect Value
external_support_no2. non/an/an/aSelect Value
11external_suppport_typeif external_support = yesPlease select the highest level of support required to resolve this issue:n/an/an/aSingle Select
external_support_type_district1. District team
external_support_type_lucknow2. CRS Lucknow
external_support_type_delhi3. CRS Delhi
external_support_type_dimagi4. Dimagi
12escalate_issue_toshow if escalate_issue = yesPlease refer this issue to the Vatsalya Project Officer within the next 24 hours.Label
13not_resolved_field_labelshow is escalate_issue = noPlease monitor the issue at the field level in the Follow up Tech Issue form.
14not_resolved_field_supportescalate_issue = yesPlease update the issue when resolved with higher tech support.
15followup__dateif issue_status = noPlease set a date to follow-up on this issueInput(date)yes
16Tech_Report_CompleteThank you for following up on this technical issue. n/an/a label