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Field Name	Field Type	Value/ Options	Validation/ Logic
Date of registration			Should be auto selected and updated when the volunteer logs in the application to do the screening.
Photo	Camera	Optional	Should have face detection/ Facial recognition Camera should identify & capture human face but not any objects Show an Alert if Photo is not captured, just as reminder but Not Mandatory Alert: "Do you like to Take Photo", Yes or No If "Yes", open Camera; If "No", go to next
Beneficiary Status		Alive Dead	this field should be a
First Name	Text		Mandatory Speech to text feature
Last Name			Optional Speech to text feature
Beneficiary Status	Radio Button	· Alive · Death	· Enable only in the “Edit” Beneficiary screen · Auto-populate, if ‘Death’ is reported from any module (Tuberculosis) · Default value is “Alive” · If “Death” is selected, enable below four fields and mark it mandatory- 1. Date of Death 2. Time of Death 3. Reason for Death 4. Place of Death or Other Place of Death
Date of Death	Date picker		· Enable if “Beneficiary status”= “Death” · Mandatory if enabled · By default, date is null · Not greater than Today’s Date · Accept ‘Date of Death’ after date of registration · Auto-populate, if ‘Death’ is reported from any module (Tuberculosis)
Time of Death	Time picker		· Show only if above value is “Death” · Optional
Reason for Death (Type of Death)		· Maternal Death · Natural Death · Accident · Infectious Disease · Animal Bite Death · Suicide · Undetermined	· Enable if “Beneficiary status”= “Death” · Mandatory if enabled Show only above value is “Death” and it is Mandatory If Gender is Female, and Age is 15-49 Years, show “Maternal Death” in dropdown list otherwise hide
Place of Death		Home Subcenter PHC CHC District Hospital Medical College Hospital Private Hospital In Transit Other Place of Death	· Enable if “Beneficiary status”= “Death” · Mandatory if enabled If ‘Place of Death’ is selected as “Other Place of Death” then enable below field “Other Place of Death” and is mandatory.
Other Place of Death	Textbox		Enable if “Beneficiary status”= “Death” Mandatory if enabled
Age	Number (Years)		Mandatory If DOB unknown, approximate age allowed
Date of Birth	Date Picker		Populate Age automatically if entered
Gender	Dropdown	Male Female Transgender Prefer not to say	Mandatory Speech to text feature
Mobile Number	Number		Optional Speech to text feature
Village/ Hamlet	dropdown	Mandatory
Marital Status	radio button	Unmarried Married Divorced Separated Widow Widower	Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years) Mandatory and editable Based on the 'Gender' values in this dropdown list should change as follows: In case of 'Gender' = "Female" show "Widow" and hide "Widower" In case of 'Gender' = "Male" show "Widower" and hide "Widow"
Husband's/ Wife's Name	Textbox		Input method: Speech to Text feature Conditionally mandatory- Hide this field in case of 'Marital Status' = "Unmarried" Optional in case of 'Marital Status' = "Divorced" Based on the Gender show label name as: 'Husband's' or 'Wife's Name' Accept alphabets only Character limit 50 All letter should be in caps
Father's Name	Textbox		Input method: Speech to Text feature Optional in case of 'Gender' = "Female" and 'Marital Status' = "Married" Accept alphabets only Character limit 50 All letter should be in caps
Mother's Name	Textbox		Input method: Speech to Text feature Optional in case of 'Gender' = "Female" and 'Marital Status' = "Married" Accept alphabets only Character limit 50 All letter should be in caps
Community	radio button	General SC ST OBC OC Not Given	But it should be editable
Religion	radio button	Hindu Muslim Christian Sikhism Buddhism Jainism Parsi Other Not disclosed	But it should be editable
Economic Status	radio button	APL BPL Don't know
Type of Residential area	radio button	Rural Urban Tribal Tea Garden Other
Other Type of Residential area	Textbox		Enable if other is selected above Is Mandatory if other is selected above Allow Alphanumeric Character and special Characters Character limit 100
Occupation			Default value is unknown
Cancel	Button	Yes No	If cancel is selected, a pop up message "Are you Sure?" with options "Yes" and "No" will come. If selected "yes" navigate back to home page If selected "no" then do not erase the patient health data and let the page remain open so it can be submitted by volunteer as sometime by mistake cancel button is clicked.
Capture Geolocation			Capture current location details (latitude, longitude, address)
Submit			On clicking this, it must display the Pop up msg "Patient Registered successfully" This must store the data of the patient and display the required fields over the Beneficiary card.

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TB Screening
* If "Yes" is selected for any one of the questions below with "*" auto select "yes" for "Referral Required." 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 "" "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
Symptomatic Screening
Coughing More than 2 weeks *	radio button	Yes No	Mandatory
Blood in Sputum *	radio button	Yes No	Mandatory
Fever > 2 weeks *	radio button	Yes No	Mandatory
Rise of fever in evening*	radio button	Yes No	Mandatory
Loss of Appetite*	radio button	Yes No	Mandatory
Loss of Weight *	radio button	Yes No	Mandatory
Night Sweats *	radio button	Yes No	Mandatory
History of TB *	radio button	Yes No	Mandatory
Are you currently taking Anti TB drugs **	radio button	Yes No	Mandatory
Anyone in Family Currently Suffering from TB **	radio button	Yes No	Mandatory
Asymptomatic Screening
Age more than 60	radio button	Yes No	Mandatory Should automatically get selected based on age from the beneficiary registration.
Diabetic	radio button	Yes No	Mandatory
Tobacco user	radio button	Yes No	Mandatory
BMI < 18.5	radio button	Yes No	Validation?? As we are not taking height and weight?
Contact with TB patient on treatment	radio button	Yes No	Mandatory
Last 5 years history of TB	radio button	Yes No	we are asking past history already.
Referral Required	radio button	Yes No
Referral facilityto		MC DH CHC PHC HWC	AI assisted tool (cough) Digital chest X-ray Sputum collection	Multiple option selection possible. Enable if "Yes" is selected for "Referral Required". HWC= Health and Wellness Centre, PHC= Primary Health Centre, CHC= Community Health Centre, DH= District hospital, MC= Medical College
Capture Geolocation			Capture current location details (latitude, longitude, address)
Submit	Button

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