Page History

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 the nearest health facility and collect the Sputum sample". 
Show these beneficiaries to 'Suspected TB casesReferral list module in the Home' 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" the nearest health facility and collect the Sputum sample". 
Show these beneficiaries to 'Referral list module in the Home' section 

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 

Name 

Textbox 

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

Age 

Textbox 

Auto fill from Beneficiary details 
Read only 

Sex 

Textbox 

Auto fill from Beneficiary details 
Read only 

Coughing More than 2 weeks * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Blood in Sputum * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Fever > 2 weeks * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Rise of fever in evening

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Loss of Appetite 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Loss of Weight * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Night Sweats * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

History of TB * 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

Are you currently taking Anti TB drugs ** 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

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

Anyone in Family Currently Suffering from TB ** 

Spinner 

Is Mandatory 
Choose: 

• Yes 

• No 

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

Submit 

Button