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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 is reported from any module (eg: 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 is reported from any module (eg: 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

Marital Status

radio button

• Unmarried
• Married
• Divorced
• Separated
• Widow
• Widower

• Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years)
• 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

Community

radio button

• General
• SC
• ST
• OBC
• OC
• Not Given

• should be editable

Religion

radio button

• Hindu
• Muslim
• Christian
• Sikhism
• Buddhism
• Jainism
• Parsi
• Other
• Not disclosed

• 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.