1. Are you here for follow-up?
0 = no
1 = yes

2.Is one of the reasons that you are here that you are having difficulty with breathing?
0 = no
3 = yes

3. Is one of the reasons that you are here that you are having cough for more than two weeks?
0 = no
6 = yes

7. Indicate sum of score
1 = 0
2 = 1
3 = 2-5
4 = 6-10

Patient's sex
f = female
m = male

7. Designation
ahw = AHW
anm = ANM
ha = health assistant
mo = medical officer
msw = MSW
oth = OTHERS
vhw = VHW

9. training of health worker in PAL
0 = No
1 = Yes

11.Age
1 = YES
2 = NO
3 = NA