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Maintain a separate list for TB Suspected cases for further follow-ups.

Name of data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

Date

Calendar
Date Picker

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

Gender

Textbox

Auto fill from Beneficiary details
Read only

Is Sputum sample collected?

Spinner

Yes
No

Mandatory

Sputum sample submitted at

Spinner

MC

DH

TextboxButton

TB Screening Screening
* If "Yes" is selected for any one of the questions below with "*" then show a pop-up message" auto select "yes" for "Referral Required." "Refer to the nearest health facility and collect the Sputum sample".Show these beneficiaries to 'Suspected TB cases' section Show these beneficiaries to 'Referral 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 the nearest health facility and collect the Sputum sample". Show these beneficiaries to 'Referral list module in the Home' section Screen all the family members and contacts of the
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
Symptomatic Screening

Auto fill from Beneficiary details Show: First Name + Last Name Read only
Coughing More than 2 weeks *	Spinner	Yes
Age	Textbox		Auto fill from Beneficiary details Read only
Sex	Textbox		Auto fill from Beneficiary details Read only
Coughing More than 2 weeks *	Spinner	Yes No	Mandatory
Blood in Sputum *	Spinner	Yes No	Mandatory
Fever > 2 weeks *	Spinner	Yes No	Mandatory
Rise of fever in evening*	Spinner	Spinner	Yes No Yes No	Mandatory
Loss of Appetite*	Spinner	Spinner	Yes No Yes No	Mandatory
Loss of Weight *	Spinner	Yes No	Mandatory
Night Sweats *	Spinner	Yes No	Mandatory
History of TB *	Spinner	Yes No	Mandatory
Are you currently taking Anti TB drugs **	Spinner Is Mandatory	Yes Choose: No	Yes No	Inform to ANM / MPW/ MO for tracing of Family members	Mandatory
Anyone in Family Currently Suffering from TB **	Spinner	Is Mandatory Choose: Yes No	Inform to ANM / MPW/ MO for tracing of Family members	Submit	Mandatory
Asymptomatic Screening

2.2.2.b Suspected TB cases
This section should contain only Suspected TB cases.

Age more than 60	Spinner	Yes No	Mandatory Should automatically get selected based on age from the beneficiary registration.
Diabetic	Spinner	Yes No	Mandatory
Tobacco user	Spinner	Yes No	Mandatory
BMI < 18.5			Validation?? As we are not taking height and weight?
Contact with TB patient on treatment	Spinner	Yes No	Mandatory
Last 5 years history of TB	Spinner	Yes No	we are asking past history already.
Referral Required	Spinner	Yes No
Referral facility		MC DH CHC

PHC
HWC

Enable if "Yes" is selected for

'Is Sputum sample collected?

"Referral Required".
HWC= Health and Wellness Centre, PHC= Primary

Health centre

Health Centre, CHC= Community Health Centre, DH= District hospital, MC= Medical College

Nikshay ID

Submit

Textbox

Button

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

2.2.2.b Suspected TB cases
This section should contain only Suspected TB cases.

Name of data Field	Field Type	Value/ Options	Validation/ Logic/ Condition
Date	Calendar Date Picker	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
Gender	Textbox		Auto fill from Beneficiary details Read only
Symptomatic TB			To be enabled if "Yes" is selected in any "Symptomatic Screening fields"
Is Sputum sample collected?	Spinner	Yes No	Mandatory
Sputum sample submitted at	Spinner	MC DH CHC PHC HWC	Enable if "Yes" is selected for 'Is Sputum sample collected? HWC= Health and Wellness Centre, PHC= Primary Health Centre, CHC= Community Health Centre, DH= District hospital, MC= Medical College
Sputum Test result	Spinner	Positive Negative	Enable if "Yes" is selected for 'Is Sputum sample collected?' If positive, mark it as a TB confirmed case and move this case to Confirmed TB cases module.
Asymptomatic TB			To be enabled if "Yes" is selected in any "Asymptomatic Screening fields"
TB Chest X-Ray Test done		Yes No	Enable only for Asymptomatic TB case If “Yes” is selected enable ‘Nikshay Id’
Chest X-Ray Test Result		Clinically Diagnosed TB TB Not suspected	Enable only “Yes” is selected for X-Ray test Enable only for Asymptomatic TB case
Nikshay ID	Textbox		Enable if "Yes" is selected for 'Is Sputum sample collected. Enable if "Yes" is selected for "TB Chest X-ray test done"
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"
Referred to facility	Spinner	Is Mandatory Choose: Yes No
Facility Referral follow-ups	Textbox

Submit	Button

2.2.2.c Confirmed TB cases

2.2.3 Module- Non Communicable Disease (NCD) Screening

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Name of Data Field	Field Type	Value/ Options	Validation/ Logic/ Condition
CBAC Form
Date	Calendar Date Picker	Is Mandatory Choose the date from the calendar Format: dd-mm-yyyy 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
Part A: Risk Assessment
What is your Age? (in Age)	Spinner	Is Mandatory Choose: 30 – 39 40 - 49 50 – 59 60 and Above	Auto-populate Age from 'Beneficiary' registration: Score Logic: "Score" is a variable whose Default Score value is "0". If 30 <= Age <= 39 then display "1"If 40 <= Age <= 49 then display "2"If 50 <= Age <= 59 then display "3"If 60 <= Age then display "4"
Do you smoke or consume smokeless products such as gutka or khaini	Spinner	Is Mandatory Choose: Never Used to consume in the past sometime now Daily	Score Logic: If option selected "Never" then display "0"If option selected "Used to consume in the past sometime now" then display "1"If option selected = "Daily" then display "2"
Do you consume alcohol daily	Spinner	Is Mandatory Choose: Yes No	Score Logic: If "No" then display "0" or If "Yes" then display "1"
Measurement of Waist (in cm)	Spinner	Is Mandatory Condition: Show values in the Spinner based on Gender: For Male: Choose: 90 cm or less 91 - 100 cm More than 100 cm For Female: Choose: 80 cm or less 81 - 90 cm More than 90 cm	Score Logic: If "Gender" = "Female" and "Waist length" <= 80 then display "0"If "Gender" = "Female" and 81 <= "Waist length" <= 90 then display "1"If "Gender" = "Female" and "Waist length" > 90 then display "2"If "Gender" = "Male" and "Waist length" <= 90 then display "0"If "Gender" = "Male" and 91 <= "Waist length" <= 100 then display "1"If "Gender" = "Male" and "Waist length" > 100 then display "2"
Do you under take any physical activity for minimum of 150 minutes in a week	Spinner	Is Mandatory Choose: At least 150 min in a week Less than 150 min in a week	Score Logic: If "At least 150 min in a week" then display "0" or If "Less than 150 min in a week" then display "1"
Do you have any family history (any one of your parents or siblings) of high BP / Diabetes / Heart Disease	Spinner	Is Mandatory Choose: Yes No	Score Logic: If "No" then display "0" or If "Yes" then display "2"
Total Score	Label		Total Score Formula: Sum of all above score. Based on the "Total Score" display a message in pop-up as show below: If score is > 4 "Refer to NCD screening day / VHSND/ HWC for NCD screening (Priority)" If score is < = 4 "Refer to NCD screening day / VHSND/ HWC for NCD screening (Less Priority)"
Part B1: Early Detection Ask if Patient has any of these symptoms
If "Yes" is selected below then display a pop-up message, "Suspected NCD case, please visit nearest HWC or call 104."
* 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"
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"
Shortness of Breath	Spinner	Is Mandatory Choose: Yes No
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
Loss of Weight *	Spinner	Is Mandatory Choose: Yes No
Night Sweats *	Spinner	Is Mandatory Choose: Yes No
Are you currently taking Anti TB drugs **	Spinner	Is Mandatory Choose: Yes No
Anyone in Family Currently Suffering from TB **	Spinner	Is Mandatory Choose: Yes No
History of TB *	Spinner	Is Mandatory Choose: Yes No
Recurrent of ulceration on Palm or Sole	Spinner	Is Mandatory Choose: Yes No
Recurrent of tingling on Palm or Sole	Spinner	Is Mandatory Choose: Yes No
Cloudy or Blurred Vision	Spinner	Is Mandatory Choose: Yes No
Difficulty in reading	Spinner	Is Mandatory Choose: Yes No
Pain in eyes lasting for more than weeks	Spinner	Is Mandatory Choose: Yes No
Redness in eyes for more than weeks	Spinner	Is Mandatory Choose: Yes No
Difficulty in Hearing	Spinner	Is Mandatory Choose: Yes No
History of Fits	Spinner	Is Mandatory Choose: Yes No
Difficulty in Opening Mouth	Spinner	Is Mandatory Choose: Yes No
Ulcers in Mouth Not Healed in 2 weeks	Spinner	Is Mandatory Choose: Yes No
Growth in Mouth Not Healed in 2 weeks	Spinner	Is Mandatory Choose:
Any white or red Patch in Mouth Not Healed in 2 weeks	Spinner	Is Mandatory Choose: Yes No
Pain while chewing	Spinner	Is Mandatory Choose: Yes No
Any change in Tone of Voice	Spinner	Is Mandatory Choose: Yes No
Any hypo pigmented patches or discolour lesions with loss of sensation	Spinner	Is Mandatory Choose: Yes No
Any thickened skin	Spinner	Is Mandatory Choose: Yes No
Any nodules skin	Spinner	Is Mandatory Choose: Yes No
Any Patch or Discoloration on Skin	Spinner	Is Mandatory Choose: Yes No
Recurrent numbness on palm or sole	Spinner	Is Mandatory Choose: Yes No
Clawing of fingers in hand or feet	Spinner	Is Mandatory Choose: Yes No
Tingling and numbness in hand / or feet	Spinner	Is Mandatory Choose: Yes No
Inability to close eye lid	Spinner	Is Mandatory Choose: Yes No
Difficulty in Holding Objects in hands or Fingers	Spinner	Is Mandatory Choose: Yes No
Weakness in feet that cause difficulty in walking	Spinner	Is Mandatory Choose: Yes No
Part B2: Women Only
Lump in the Breast	Spinner	Is Mandatory Choose: Yes No
Bleeding after Menopause	Spinner	Is Mandatory Choose: Yes No	If option selected is "Yes" then display "Inform ASHA Facilitator."
Blood Stained Discharge from the Nipple	Spinner	Is Mandatory Choose: Yes No
Bleeding after intercourse	Spinner	Is Mandatory Choose: Yes No
Part B3: Elderly Specific
Feeling unsteady while standing or walking	Spinner	Is Mandatory Choose: Yes No	If option selected is "Yes" then display "Send the patient to MOIC of nearest health center for treatment "
Suffering from any physical disability that restrict movement	Spinner	Is Mandatory Choose: Yes No	If option selected is "Yes" then display "Send the patient to MOIC of nearest health center for treatment "
Needing help from others to perform every day activities such as eating, getting dressed, grooming, bathing, walking, or using the toilets	Spinner	Is Mandatory Choose: Yes No	If option selected is "Yes" then display "Send the patient to MOIC of nearest health center for treatment "
Forgetting names of yours, near ones or your own home address	Spinner	Is Mandatory Choose: Yes No	If option selected is "Yes" then display "Send the patient to MOIC of nearest health center for treatment "
Part C: Risk factor for COPD
Type of Fuel Used for Cooking	Spinner	Choose: Wood, Crop Residue, Gobar Gas, Coal, Kerosene oil, LPG
Occupational Exposure	Spinner	Choose: Crop residue burning / burning of garbage – leaves/working in industries with smoke, gas and dust exposure such as brick kilns and glass factories etc.
Part D: PHQ2
Over the last two weeks bothered by the following problem?
Little interest or pleasure in doing things?	Spinner	Choose: Not at all several days more than half the days nearly every day	Score Logic: If option selected is "Not at all" then display "0"If option selected is "several days" then display "1"If option selected is "more than half the days" then display "2"If option selected is "nearly every day" then display "3"
Feeling down, depressed or hopeless?	Spinner	Choose: Not at all several days more than half the days nearly every day	Score Logic: If option selected is "Not at all" then display "0"If option selected is "several days" then display "1"If option selected is "more than half the days" then display "2"If option selected is "nearly every day" then display "3"
Total Score	Label		Total Score formula: Sum of all the above score If "Total Score" is more than "3" then display pop up message "Refer the person to MOIC for treatment."

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2.2.4 Module - Referrals

2.3 Home Page- Dashboard

Flip feature between "Home" and "Dashboard".
Put a field for filter with 2 selection options-

Time Period- based on "today and previous months" This filter should show all the data cards in the dashboard pertaining to the time period selected. (eg: today, Jan, Feb etc)
Village Name- Dropdown options to be populated with names of village/ hamlets

Module cards should be placed below the filter selection option.

Field Name	Field Type	Options	Validation
Filter/ Selection option	Dropdown	The Dropdown Values are Today January February March April May June July August September October November December	If this filter is selected, then show all the values of the dashboard indicators pertaining to the time period selected.
Filter/ Selection option	Dropdown	Village/ Hamlet names to be put here	If this filter is selected, then show all the values of the dashboard indicators pertaining to the particular village selected.
Total TB screenings Male Female Children (<15 yrs) Others		Card must be yellow in colour	It must auto populate based on the filter selected. Total number should be shown in bold with sex aggregated data- male, female, Children, others
Total TB suspected cases Male Female Children (<15 yrs) Others		Card must be yellow in colour	It must auto populate based on the filter selected. Total number should be shown in bold with sex aggregated data- male, female, Children, others
Total TB confirmed cases Male Female Children (<15 yrs) Others		Card must be yellow in colour	It must auto populate based on the filter selected. Total number should be shown in bold with sex aggregated data- male, female, Children, others
NIKSHAY IDs		Card must be yellow in colour	Total number of NIKSHAY IDs made in the selected time period or Village
ABHA IDs		Card must be yellow in colour	Total number of ABHA IDs made in the selected time period or Village

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Old Version 35

New Version 36

Key

2.2.3 Module- Non Communicable Disease (NCD) Screening

2.2.4 Module - Referrals

2.3 Home Page- Dashboard