In this section show all beneficiaries irrespective of any age group and gender.
Maintain a separate list for TB Suspected cases for further follow-ups.

S No

Early Detection of Tuberculosis (TB)
Ask if Patient has any of these symptoms

 

 

 

 

 

* If "Yes" is selected for any one of the questions below with "*" then show a pop-up message "Refer to MO and collect the Sputum sample".
Show these beneficiaries to 'Suspected TB cases' section

 

 

 

 

 

** If "Yes" is selected for any one of the questions below with "**" then show a pop-up message "Refer to MO or inform ANM/MPW to tracing of all family members"

 

 

 

 

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

Coughing More than 2 weeks *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

6

Blood in Sputum *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

7

Fever > 2 weeks *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

8

Loss of Weight *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

9

Night Sweats *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

10

History of TB *

Spinner

Is Mandatory
Choose:

  • Yes
  • No

 

11

Are you currently taking Anti TB drugs **

Spinner

Is Mandatory
Choose:

  • Yes
  • No

Inform to ANM / MPW/ MO for tracing of Family members

12

Anyone in Family Currently Suffering from TB **

Spinner

Is Mandatory
Choose:

  • Yes
  • No

Inform to ANM / MPW/ MO for tracing of Family members

13

Submit

Button

 



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