Data Entry Form Annexure I: Entering Hospital —Please choose an option—Saveetha Dental CollegeYenepoya Craniofacial unitAIIMS, Mangalagiri Copy of consent Child name Gender—Please choose an option—MaleFemaleOthers DOB Mothers name Fathers name Address State —Please choose an option—Andhra PradeshArunachal PradeshAssamBiharChhattisgarhGoaGujaratHaryanaHimachal PradeshJharkhandKarnatakaKeralaMaharashtraMadhya PradeshManipurMeghalayaMizoramNagalandOdishaPunjabRajasthanSikkimTamil NaduTripuraTelanganaUttar PradeshUttarakhandWest BengalAndaman & Nicobar (UT)Chandigarh (UT)Dadra & Nagar Haveli and Daman & Diu (UT)Delhi (NCT)Jammu & Kashmir (UT)Ladakh (UT)Lakshadweep (UT)Puducherry (UT) Pin code Contact Ethnic group Mother tongue Religion Diet—Please choose an option—VegetarianMixed Hospital of birth Timing of cleft diagnosis—Please choose an option—Antenatalat birthwithin 72hrswithin 1 weeklater Cleft details—Please choose an option—Isolated cleft lipIsolated cleft palateUnilateral cleft lip and palateBilateral cleft lip and palate Birth Order—Please choose an option—1st2nd3rd4th5th Gestational age .in weeks Weight at birth .in kgs Prenatal history: Mother any history of diabetesYesNo If yes then: Timing of diagnosisPre pregnancy1st trimesterLater Medications taken Average Blood sugar values Mothers history of blood pressureYesNo If yes then: Timing of diagnosisPre pregnancy1st trimesterLater Medications taken Average Blood sugar values History of Antibiotic intakeYesNo If yes Type of antibiotic Duration Timing—Please choose an option—Conception1st trimester Folic acid supplementsYesNo If yes Duration timing—Please choose an option—Conception1st trimester Any infectionYesNoIf yes, then type of infection History of Antibiotic/ medication intakeYesNo Duration Timimg—Please choose an option—Conception1st trimester Haemoglobin levelsAvailableNA If Available Values Timing—Please choose an option—Conception1st trimester Maternal History: If working Work status—Please choose an option—House wifeWorking Educational status—Please choose an option—10th Standard12th StandardGraduatePostgraduate above Average BMI of mother Dermatoglyphic pattern: upload image of right hand Marriage history—Please choose an option—consanguineousnon consanguineous If yes degree of consanguinity—Please choose an option—1st2nd3rd4th Mothers age at pregnancy in years History of miscarriageYesNo History of EpilepsyYesNo Timing of diagnosis Medications taken Family History Family history of cleftYesNo If yes: pedigree charting Fathers Occupation Socio economic status—Please choose an option—Upper classUpper middle classMiddle classlower middle classlower class Mother Alcohol intakeYesNo If yes, Average intake per weeks TobaccoYesNo If yes, Average per day SmokingYesNo If yes, Average per day