Page History

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TB Screening modules	Enlisted in the PRD
NCD Screening modules	Enlisted in the PRD
Nikshay integration	External dependency
Integration of AI assessment tool (Cough)	External technical dependency
Lab testing device integration (sputum testing)	External technical dependency
Integration of AI enabled hand- held chest Xray (digital)	External technical dependency
Dashboard FashaDashboard indicators
Pre Camp Work Plan Preparation Module	Subjected to requirement

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Name of data field	Field Type	Value/ Options	Validation/ logic/ condition
Name of the contact	Text Box
Age of the contact
Gender	Dropdown	Male Female Transgender Prefer not to say	Mandatory Speech to text feature
Mobile Number	Number		Optional Speech to text feature
TPT (TB Preventive Treatment) Screening Status		Not Started Pending Completed	Mandatory Single selection allowed Default option is Pending
Referral Facility for screening		HWC PHC CHC District Hospital	Mandatory. Single selection allowed From here it can directly go to submit option as the contact first needs to get tested and confirmed if he/ she have to take TPT.
Screening done at the referral facility		Yes No	Mandatory
Is it confirmed TB case		Yes No	If yes, move the card to confirmed TB list. If no, continue ahead.
Are you advised to take (TPT)		Yes No	If yes, continue with the next field. If no, then directly go to submit option.
TPT initiated		Yes No	Mandatory Enable next fields if selected Yes.
TPT start date	Date picker	=<Today’s date	Mandatory if enabled Cannot be future date Cannot be before the date of screening
Treatment duration of TPT		1 Month 3 month 6 month
Expected completion date	date	Auto calculated	Auto calculated= TPT start date + regimen duration Non editable
Follow up visit number	Numeric	Auto increment (1-6)	Non editable Automatic calculation by system
Follow up visit date	Date picker	=<Today’s date	Mandatory if enabled Cannot be future date Cannot be before the TPT start date
TPT completion status		Completed Incomplete Lost to follow up Developed active TB during TPT Died during TPT other	Mandatory If selected “Completed” then enable date of completion field If selected “developed active TB during TPT” then redirect ASHA to volunteer to create new case record for active TB and close the TPT case. If selected “died during TPT” then enable date of death field and cause of death field
Other	Free text
Date of completion	Date picker	=<Today’s date	Mandatory if enabled Cannot be future date
Date of death	Date picker		To be enabled if “TPT completion status” = Died during TPT Mandatory if enabled
Cause of death	Free text		To be enabled if “TPT completion status” = Died during TPT Mandatory if enabled
Capture Geolocation			Capture current location details (latitude, longitude, address)
Submit

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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)	radio button	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	radio button	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	radio button	Is Mandatory Choose: Yes No	Score Logic: If "No" then display "0" or If "Yes" then display "1"
Measurement of Waist (in cm)	radio button	Is Mandatory Condition: Show values in the radio button 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	radio button	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	radio button	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	radio button	Is Mandatory Choose: Yes No
Coughing More than 2 weeks *	radio button	Is Mandatory Choose: Yes No
Blood in Sputum *	radio button	Is Mandatory Choose: Yes No
Fever > 2 weeks *	radio button	Is Mandatory Choose: Yes No
Loss of Weight *	radio button	Is Mandatory Choose: Yes No
Night Sweats *	radio button	Is Mandatory Choose: Yes No
Are you currently taking Anti TB drugs **	radio button	Is Mandatory Choose: Yes No
Anyone in Family Currently Suffering from TB **	radio button	Is Mandatory Choose: Yes No
History of TB *	radio button	Is Mandatory Choose: Yes No
Recurrent of ulceration on Palm or Sole	radio button	Is Mandatory Choose: Yes No
Recurrent of tingling on Palm or Sole	radio button	Is Mandatory Choose: Yes No
Cloudy or Blurred Vision	radio button	Is Mandatory Choose: Yes No
Difficulty in reading	radio button	Is Mandatory Choose: Yes No
Pain in eyes lasting for more than weeks	radio button	Is Mandatory Choose: Yes No
Redness in eyes for more than weeks	radio button	Is Mandatory Choose: Yes No
Difficulty in Hearing	radio button	Is Mandatory Choose: Yes No
History of Fits	radio button	Is Mandatory Choose: Yes No
Difficulty in Opening Mouth	radio button	Is Mandatory Choose: Yes No
Ulcers in Mouth Not Healed in 2 weeks	radio button	Is Mandatory Choose: Yes No
Growth in Mouth Not Healed in 2 weeks	radio button	Is Mandatory Choose:
Any white or red Patch in Mouth Not Healed in 2 weeks	radio button	Is Mandatory Choose: Yes No
Pain while chewing	radio button	Is Mandatory Choose: Yes No
Any change in Tone of Voice	radio button	Is Mandatory Choose: Yes No
Any hypo pigmented patches or discolour lesions with loss of sensation	radio button	Is Mandatory Choose: Yes No
Any thickened skin	radio button	Is Mandatory Choose: Yes No
Any nodules skin	radio button	Is Mandatory Choose: Yes No
Any Patch or Discoloration on Skin	radio button	Is Mandatory Choose: Yes No
Recurrent numbness on palm or sole	radio button	Is Mandatory Choose: Yes No
Clawing of fingers in hand or feet	radio button	Is Mandatory Choose: Yes No
Tingling and numbness in hand / or feet	radio button	Is Mandatory Choose: Yes No
Inability to close eye lid	radio button	Is Mandatory Choose: Yes No
Difficulty in Holding Objects in hands or Fingers	radio button	Is Mandatory Choose: Yes No
Weakness in feet that cause difficulty in walking	radio button	Is Mandatory Choose: Yes No
Part B2: Women Only
Lump in the Breast	radio button	Is Mandatory Choose: Yes No
Bleeding after Menopause	radio button	Is Mandatory Choose: Yes No	If option selected selected is "Yes" then display "Inform ASHA Facilitator Facilitator."
Blood Stained Discharge from the Nipple	radio button	Is Mandatory Choose: Yes No
Bleeding after intercourse	radio button	Is Mandatory Choose: Yes No
Part B3: Elderly Specific
Feeling unsteady while standing or walking	radio button	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	radio button	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	radio button	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	radio button	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	radio button	Choose: Wood, Crop Residue, Gobar Gas, Coal, Kerosene oil, LPG
Occupational Exposure	radio button	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?	radio button	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?	radio button	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."
Capture Geolocation			Capture current location details (latitude, longitude, address)
Submit

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