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Date | _ || _ | . | _ || _ | . | _ || _ || _ || _ |PMTCT N° …………………………….PMTCT interventionForm completed by: ………………………………………………Mother1- Nevirapine1.1. Date of distribution of nevirapine | _ || _ || . | _ || _ | . | _ || _ || _ || _ |1.2. Date of onset of labour | _ || _ || . | _ || _ | . | _ || _ || _ || _ |1.3. Hour of onset of labour | _ || _ || h1.4. Did the woman take nevirapine at the onset of labour? □ yes □ noIf yes go to 1.5., if no go to 1.101.5. Date of first nevirapine intake | _ || _ || . | _ || _ | . | _ || _ || _ || _ |1.6. Hour of first nevirapine intake | _ || _ || h1.7. Date of delivery | _ || _ || . | _ || _ | . | _ || _ || _ || _ |1.8. Hour of delivery | _ || _ || h | _ || _ | mn1.9. Second dose of nevirapine? □ yes □ noIf yes, specify the date and hour| _ || _ || . | _ || _ | . | _ || _ || _ || _ | and | _ || _ || hSpecify the reasons ………………………………………………………………………………………..1.10. Have there been any intake problems? □ yes □ noIf yes, which problems ? ………………………………….…………………………………………………..2- Delivery2.1. Site of ANC visits ……………………………………………………………………………………………2.2. Delivery location □ Murambinda hospital maternity □ home□ other maternity (specify)…………………………………………………………………………2.3. Mode of expulsion □ normal □ forceps, suction cups□ planned caesarean □ emergency caesarean389