Suspected TB cases

S. No

Name of data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Date

Calendar
Date Picker

Is Mandatory

• Default value Today's Date
  
• Not greater than Today's Date
  
• Accept date greater or equal to Date of beneficiary registration
  
• should not allow to update in edit or once submitted

2

Name

Textbox

Auto fill from Beneficiary details
Show: First Name + Last Name
Read only

3

Age

Textbox

Auto fill from Beneficiary details
Read only

4

Sex

Textbox

Auto fill from Beneficiary details
Read only

5

Is Sputum sample collected?

Spinner

Is Mandatory
Choose:

• Yes
  
• No

6

Sputum sample submitted at

Spinner

Choose:

• DMC
  
• SC
  
• PHC

Enable if "Yes" is selected for 'Is Sputum sample collected?'

7

Nikshay ID

Textbox

Enable if "Yes" is selected for 'Is Sputum sample collected?'

8

Sputum Test result

Spinner

Choose:

• Positive
  
• Negative

Enable if "Yes" is selected for 'Is Sputum sample collected?'

If Test is positive refer to MO
Show alert Message: "Refer to MO"

9

Referred to facility

Spinner

Is Mandatory
Choose:

• Yes
  
• No

10

Facility Referral follow-ups

Textbox

11

Submit

Button