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PRD for "Nikshay Mitra Application"- Community Screening Application


1. Document Overview

This document defines the functional requirements for the TB Screening mobile application developed under the TB Mukt Janjati Abhiyan: A community-driven TB elimination initiative targeting tribal populations across India. The application is purpose-built for field use by community volunteers in tribal areas where connectivity, literacy, and device familiarity may be limited.
The application should be simple to use, comprehensive and must work in low/no-connectivity environments.

1.1 Purpose

 
This application is developed to screen and maximize TB case detection in all age groups through active case finding, contact investigation, and community mobilization. This application helps in patient tracking throughout treatment cascade at community and facility level via Community Influencers and Nikshay Mitras. Ensure prompt referral and linkage of diagnosed individuals from community to health facilities for timely treatment initiation is the purpose of this application.

 
1.2 Users of the system


1. Volunteers- Community mobilization, screenings, camps etc.
2. Admin / Supervisory- Backend/Dashboard Access

 
1.3 In Scope Functional Modules




TB Screening modulesEnlisted in the PRD
NCD Screening modulesEnlisted in the PRD
Nikshay integrationExternal 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 indicators

Enlisted in the PRD. Can be added more as per the requirement.

 Pre Camp Work Plan Preparation Module

Subjected to requirement



1.4 Workflow


Image Modified

2. Login Page

  • Login Page Name should be "NikshayMitra Application".
  • It must be followed by "NikshayMitra" Logo.
  • It must have both Online and Offline capabilities. ("Offline capabilities feature to exchange data between Mobile devices in a closed environment in real-time without internet")
  • It must have Multilingual Feature with English, Hindi and other Indian languages enabled, and must be configurable to accommodate all the Indian languages as and when required in future.

    UI Field Name 

    Field Type 

    Options 

    Validations 

    "NikshayMitra Application" Logo 

  • <Placeholder> 
  • <Placeholder> 

     

     Image Modified

    Please Select your Language 

    Radio

  • Button 
  • Button 

  • English 
    • English 
  • Hindi 
    • Hindi 

     
     
     
     
     
     

    • The fields and labels must populate in the language selected by the
  • user 
    • user 
       
       
       

    Username 

  • Textbox 
  • Textbox 



    Password

    Textbox



    Remember Me 

  • Checkbox 
  • Checkbox 

     

    • When 'Remember Me' checkbox is selected, next time directly allow user to login just by authenticating with
  • fingerprint 
    • fingerprint 

    Powered by Piramal Foundation 

  • Text 
  • Text 

     

    • Display on the bottom of the screen

    2.1 Landing page

  • This page must have a hamburger icon (side drawer), "NikshayMitra" text, sync button, and "Language Translation" button on the Top row.
  • There should be a hamburger icon on the left side, which on clicking should have following details-
  1. Full Name (User)
  2. Username
  3. Sync Records
  4. Create ABHA ID
  5. Support
  6. Request to delete account
  7. Log out
  • Landing page should have 2 tabs- "Home" and "Dashboard".
  • In home tab floating "Registration" button on the right bottom corner.

2.2 Home Page- "Home tab" 

  • Should contain four modules/ Cards- All Beneficiaries, TB screening, NCD screening, Referrals written on these cards. 
  • On clicking "All Beneficiaries" card- open the "Beneficiary module" form documented below (section 2.2.1) for registering the beneficiary by giving the floating "Registration" button in the right corner.
  • On clicking "TB" card- open the "Tuberculosis module" (section 2.2.2). On clicking the next screen, it should have 3 cards titled "TB Screening", "Suspected TB cases" and ""Confirmed TB cases". 
  • On clicking "NCD" card- open the "Non Communicable Disease (NCD) module" (section 2.2.3). On clicking the next screen, it should have 3 cards titled "NCD eligible list", "NCD priority list", and "NCD non-eligible list".
  • On clicking "Referrals"- The next screen should have 4 cards titled "AI Cough Assessment", "Digital Chest X-ray", "Sputum Collection", "NAAT". These cards will enlist patients for a particular type of testing. 

2.2.1 Module - Beneficiary Registration

  • On clicking Registration button the user will be navigated to Beneficiary Registration Page
  • Show a pop up for Consent form "I have been explained, the purpose for which the information and findings is being collected from me, in a language I understand and I give my consent to collect the information and findings on my personal health profile."
  • This page has "All Beneficiaries" Text displayed on top with "Home" Icon on the right corner to Navigate to Home page in the 1st row
  • The card below should be visible after the registration of beneficiary.
  • If the beneficiary does not have ABHA ID, give one clickable button on the ABHA ID area of the card to initiate ABHA ID generation.


Photo of the beneficiary

Name

Beneficiary ID


Age (Years)

Village Name-


Phone Number

ABHA ID (ABHA registration)- Clickable


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

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 (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 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 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
  • optional
  • 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
  • Optional
  • 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
  • Accept alphabets only
  • Character limit 50
  • All letter should be in caps

Mother's Name

Textbox


  • Input method: Speech to Text feature
  • Optional
  • Accept alphabets only
  • Character limit 50
  • All letter should be in caps

Community

radio button

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


  • should be editable
  • optional

Religion

radio button

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


  • should be editable
  • optional

Economic Status

radio button

  • APL
  • BPL
  • Don't know
  • optional

Type of Residential area

radio button

  • Rural
  • Urban
  • Tribal
  • Tea Garden
  • Other
  • optional

Other Type of Residential area

Textbox


  • Enable if other is selected above
  • Allow Alphanumeric Character and special Characters
  • Character limit 100

Occupation

free text


  • 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.


Lists Sections
Different types of lists are created based on the beneficiary registrations. These are defined in the following data fields: "Age" and "CBAC Score".

  • All Beneficiaries List- All beneficiaries Should be visible in "All beneficiaries" and "TB Screening" modules.
  • NCD Eligible List: All Beneficiaries both Male and Female whose age > = 30 years and excluding Pregnant Women; with CBAC Form access. 
  • NCD Priority List: Beneficiary age > = 30 years and CBAC assessment score is greater than 4
  • NCD Non-Eligible List: Beneficiary age > = 30 years and CBAC assessment score is less or equals to 4


2.2.2 Module- Tuberculosis

2.2.2.a TB Screening 

In this section show section show all beneficiaries irrespective beneficiaries irrespective of any age group and gender. 

 

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 as per the test selected ("AI Cough Assessment", "Digital Chest X-ray", "Sputum Collection", "NAAT")

 

 

 

** 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 as per the test selected ("AI Cough Assessment", "Digital Chest X-ray", "Sputum Collection", "NAAT")

Screen all the family members and contacts of the beneficiary

 

 

 Date 

Date 

Calendar Calendar 
Date
Picker Picker 

Is Mandatory Mandatory 

  • Default value Today's
  • Date 
  • Date 
  • Not greater than Today's
  • Date 
  • Date 
  • Accept date greater or equal to Date of beneficiary
  • registration 
  • registration 
  • should not allow to update in edit or once
  • submitted 
  • submitted 

Symptomatic Screening

 

  

Coughing More than 2 weeks * 

radio button button 

  •  Yes 
  • No 
  •  Yes 
  • No 
  •  Mandatory

Blood in Sputum * 

radio button button 

  •  Yes 
  • No 
  •  Yes 
  • No 
  •  Mandatory

Fever > 2 weeks * 

radio button button 

  •  Yes 
  • No 
  •  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 button 

  •  Yes 
  • No 
  •  Yes 
  • No 
  •  Mandatory

Night Sweats * 

radio button button 

  •  Yes 
  • No 
  •  Yes 
  • No 
  •  Mandatory

History of TB * 

radio button button 

  •  Yes 
  • No 
  •  Yes 
  • No 
  •  Mandatory

Are you currently taking Anti TB drugs ** 

radio button button 

    Yes 
  • Yes 
  • No 
  • No 
  •  Mandatory
  •  Mandatory

Anyone in Family Currently Suffering from TB ** 

radio button button 

    Yes 
  • Yes 
  • No 
  • No 
  •  Mandatory
  •  Mandatory

Asymptomatic Screening

 

 

 

Age more than 60 60 

radio button button 

    Yes 
  • Yes 
  • No 
  • No 
  • Mandatory
  • Should automatically get selected based on age from the beneficiary registration.

Diabetic Diabetic 

radio button button 

    Yes 
  • Yes 
  • No 
  • No 
  • Mandatory

Tobacco user user 

radio button button 

    Yes 
  • Yes 
  • No 
  • 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. 

Contact with TB patient on treatment 

radio button 

  • Yes 
  • No 
  • Mandatory

Referral Required

radio button 

  • Yes 
  • No 

Referral to


  • AI Cough Assessment",
  • "Digital Chest X-ray",
  • "Sputum Collection",
  • "NAAT

Referral Required

radio button 

  • Yes 
  • No 

Referral to

 

  • AI assisted tool (cough)
  • Digital chest X-ray
  • Sputum collection
  • Multiple option selection possible.
  • Mandatory if "Referral required"= "Yes"

Capture Geolocation



  • Capture current location details (latitude, longitude, address)

Submit Submit Button 

Button 

 

 

 

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

 

Name of data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition Date 

Date 

Calendar Calendar 
Date
Picker Picker Mandatory 

Mandatory 

  • Default value Today's
  • Date 
  • Date 
  • Not greater than Today's
  • Date 
  • Date 
  • Accept date greater or equal to Date of beneficiary
  • registration 
  • registration 
  • should not allow to update in edit or once
  • submitted 
  • submitted 

Name Name Textbox 

Textbox 

 

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

Age Age Textbox 

Textbox 

 

Auto fill from Beneficiary details details 
Read
only only 

Gender

Textbox Textbox 

 

Auto fill from Beneficiary details details 
Read
only only 

Symptomatic TB 

 

 To be enabled if "Yes" is selected in any "Symptomatic Screening fields"

Is Sputum sample Is Sputum sample collected? 

radio button button 

    Yes 
  • Yes 
  • No 
  • No 
  •  Mandatory

Sputum sample submitted at sample submitted at 

radio button button 

    MC 
  • 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 result 

radio button button 

    Positive 
  • Positive 
  • Negative 
  • Negative 
  • Enable if "Yes" is selected for 'Is Sputum sample collected?' 
  • If positive, 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 
  • No 

 

  • Enable only for Asymptomatic TB case 
  • If “Yes” is selected enable
  • ‘Nikshay Id’ 
  • ‘Nikshay Id’ 

Chest X-Ray Test Result Ray Test Result 

 

  • Clinically Diagnosed
  • TB 
  • TB 
  • TB Not
  • suspected 
  • suspected 
  • Enable only “Yes” is selected for X-
  • Ray test 
  • Ray test 
  • Enable only for Asymptomatic TB case 
  • If "Clinically diagnosed TB" is selected, move this case to Confirmed TB cases module.

Nikshay ID ID Textbox 

Textbox 

 

  • Enable if "Yes" is selected for 'Is Sputum sample collected.
  • Enable if "Yes" is selected for "TB Chest X-ray test done"

Type of suspected TB case case 
 

Radio button button 

  • New case of
  • TB 
  • TB 
  • Previously treated TB
  • case 
  • case 
  • DR-TB
  • case 
  • case 
  • Mandatory 
  • Mandatory 

Reason for suspected suspected TB case case Dropdown 

Dropdown 

  • Treatment
  • failure 
  • failure 
    TB Relapse
  • TB Relapse/ Recurring
  • symptoms 
  • symptoms 
  • Contact with DR-TB
  • case 
  • case 
  • Treatment after LFU (Lost to Follow-up) 
    Other 
  • Other 
  • Enable this
  • field only if “Type of TB case” is Previously
  • field only if “Type of TB case” is “Previously treated TB case” or “DR-TB
  • case 
  • case” 

Other 

textbox 

Other 

textbox 

  •  
  • Mandatory if
  • enabled 
  • enabled 
  • To be enabled if “Reason for suspected TB
  • case”
  • case” =
  • “Other” 
  • “Other” 

Has the diagnosis of DR-TB been confirmed? 

Radio button button 

  • Yes  
  • Yes  
  • No  
  • Enable this
  • field only
  • field only if “type of  suspected
  • TB case”= Previously
  • TB case”= “Previously treated TB case” or “DR-TB
  • case” 
  • case” 
  • Default value is “No”
  • If “Yes” is selected then move this case to Confirmed TB cases module.

Capture Geolocation



  • Capture current location details (latitude, longitude, address)

Submit Submit Button 

Button 

 

 

 

2.2.2.c Confirmed TB cases

Treatment and follow up of TB confirmed cases. 

Name of Data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition Regimen Type 

Regimen Type 

Radio button button 

  1. DS-TB (6 Months)
  2. Shorter Regimen (9–12 Months)
  3. Longer Regimen (18–24 Months)
  4. BPaL Regimen
  5. BPaL Regimen (6 Months)
  6. INH Mono (6 Month) 

 

Open module 2.2.2.d (TPT- TB Prevention treatment) module if “DS“DS-TB (6 Months)” is selected

Alert to Volunteer to screen all household members/ Contacts if DS-TB case is selected.

 

Treatment Start Date  Start Date  

Date picker picker 

 Mandatory 

Mandatory 

  • Should be greater than or equals to TB (
  • Identification and
  • Identification and Diagnosis) Visit
  • Date 
  • Date 
  • Not greater than Today's
  • Date 
  • Date 

Expected Treatment Completion Date  Date  Label  

Label  

Read only only 

Auto calculate this date based on below condition form ‘Treatment Start Date’: 

1. If ‘Regimen Type’ is “1”, “4”, “5” then add 6 months months 

2. If ‘Regimen Type’ is “2”, then, Treatment duration is 9–12 months (show 9–12 range dates) 

3. If ‘Regimen Type’ is “3”, then, Treatment duration is 18–24 months (show 18–24 range dates) 

Follow-up & Adherence 

Follow up Date Date 

Date picker picker 

 

Mandatory 

Mandatory 

  • Greater than or
  • Greater than or
  • equal to Treatment
  • Start Date or greater than Last Follow up Date 
  • Start Date or greater than Last Follow up Date 
  • Minimum date is Treatment
  • Start Date 
  • Start Date 
  • Accept date greater than
  • Last Follow up Date 
  • Last Follow up Date 
  • Allow 1 Follow up visit in a month (i.e. monthly 1 Follow up) 
  • Not greater than Today's
  • Date 
  • Date 

Monthly follow up done done Label  

Label  

Month-1 to Month-24 24 

  • Should be incremental based on monthly Follow
  • up 
  • up 

Adherence to Medicines to Medicines 

Radio button button 

    Regular 
  • Regular 
  • Irregular 
  • Irregular 

 

Any discomfort discomfort 

Radio button button 

  • Yes
  • No 
  • No 

 

Treatment Completion 

Did the patient complete the full course of treatment? 

Radio button button 

  • Yes
  • No 
  • No 

Enable these below filed based on below conditions: 

1. If ‘Regimen Type’ is “1”, “4”, “5” then enable after 5 Monthly follow up visits follow up visits 

2. If ‘Regimen Type’ is “2”, then enable after 9 Monthly follow up visits follow up visits 

3. If ‘Regimen Type’ is “3”, then enable after 18 Monthly follow up visits follow up visits 

Actual Treatment Completion Date Date 

Date picker picker 

 

  • Enable this filed if “Yes” is selected
  • above 
  • Greater than Last Follow up Date 
  • above 
  • Greater than Last Follow up Date 

TB Treatment outcomes 

Dropdown 

  • Cured 
  • Failed 

TB Treatment outcomes 

Dropdown 

  • Cured 
    Failed 
  • Lost to Follow-up (LFU) 
  • Death 
  • Death 

If "Death" is selected, update 'Beneficiary Status' = "Death" in the Beneficiary record, with “Date of Death”Death”, "Place of Death" and "Reason for Death” in the next fields. 

Date of Death Death 

Date picker picker 

 

  • Enable only if "TB Treatment outcomes" =
  • “Death” and
  • “Death” and it is
  • Mandatory 
  • Mandatory 
  • By default, date is
  • null 
  • null 
  • Not greater than Today’s
  • Date 
  • Date 
  • Greater than or
  • Greater than or
  • equal to Treatment
  • Start Date or greater than Last Follow up Date 
  • Start Date or greater than Last Follow up Date 

Place of Death Death Dropdown 

Dropdown 

    Home 
  • Home 
  • Subcenter 
  • Subcenter 
    PHC 
  • PHC 
  • CHC 
  • CHC 
  • District
  • Hospital 
  • Hospital 
  • Medical College
  • Hospital 
  • Hospital 
  • Private
  • Hospital 
  • Hospital 
  • Other Place 
  • Other Place 

Enable only Enable only if "TB Treatment outcomes" = “Death” “Death” 

Reason for Death for Death Label 

Label 

Read only only Tuberculosis 

Tuberculosis 

Enable only Enable only if "TB Treatment outcomes" = “Death” “Death” 

Reason for non completion of treatment

Textbox Textbox 

 

Enable this field if “No” selected for “Did the patient complete full treatment? ” 

Capture Geolocation



  • Capture current location details (latitude, longitude, address)

Submit  Submit  button 

button 

 

 

Follow up visit history  history  Table 

Table 

 

Maintain a Follow up visit history of Visit Visit 

 2.2.2.d Tuberculosis Preventive Treatment

Tuberculosis Preventive Treatment (TPT)

    

  • TPT is the preventive treatment given to close contacts of confirmed Drug-Sensitive TB (DS-TB) cases who are
  • at high risk of
  • at high risk of developing active TB.
  •   
  •   
  • If a contact tests positive for active TB at any step (X-Ray or Sputum positive), the system
  • must immediately redirect
  • must immediately redirect the volunteer to create a new TB Suspected Case record for that contact — bypassing the TPT flow. 
  • This module should open when
  • in Confirmed
  • in Confirmed TB case module,
  • “Regimen type = DS
  • “Regimen type” = “DS-TB (6 months)” 
  • Make this module editable as
  • after referral of the
  • after referral of the contact for
  • diagnostic tests, volunteer needs
  • diagnostic tests, volunteer needs to enter further details once the tests are done. 

 

Household Contact Line listing ScreenLine listing Screen- 

 

Name of data field 

Field Type 

Value/ Options 

Validation/ logic/ condition 

Name of the contact contact 

Text Box 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 Status 

 

  • Not
  • Started  
  • Started  
  • Pending 
  • Pending 
    Completed 
  • Completed 
  • Mandatory 
  • Single selection allowed 
  • Default option is Pending 
  • Mandatory 
  • Single selection allowed 
    Default option is Pending 

 

Referral Facility for screening screening 

 

    HWC 
  • HWC 
  •  PHC 
  •  PHC 
    CHC 
  • CHC 
  • District
  • Hospital 
  • Hospital 
  • Mandatory.
  •   
  •   
  • Single selection allowed 
  • 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
  • she have to take TPT.
  •   
  •   

 

 

Screening done at the referral facility facility 

 

    Yes 
  • Yes 
  • No  
  • No  
    Mandatory  
  • Mandatory  

Is it confirmed TB case case 

 

    Yes 
  • Yes 
  • No 
  • No 
  • If yes, move the card
  • to confirmed TB
  • to confirmed TB list. 
    If no
  • If no, continue ahead. 

Are you advised to take to take (TPT)    

 

    Yes 
  • Yes 
  • No 
  • No 
  • If yes, continue with the next field. 
    If no, then directly go to submit option
  • If no, then directly go to submit option. 

TPT initiated initiated 

 

    Yes 
  • Yes 
  • No 
  • No 
    Mandatory 
  • Mandatory 
  • Enable next fields
  • if selected
  • if selected Yes. 

TPT start date date 

Date picker picker 

=<Today’s date date 

  • Mandatory if
  • enabled 
  • enabled 
  • Cannot be future
  • date 
  • date 
  • Cannot be before the date of
  • screening 
  • screening 

Treatment duration of TPT TPT 

 

  • 1
  • Month 
  • month 
  • Month 
  • 3 month 
  • 6 month 
  • month 

 

Expected completion date date date 

date 

  • Auto
  • calculated 
  • calculated 
  • Auto calculated= TPT start date + regimen
  • duration 
  • duration 
  • Non
  • editable 
  • editable 

Follow up visit number number Numeric 

Numeric 

  • Auto increment (1-6) 
  • Non
  • editable 
  • editable 
  • Automatic calculation by
  • system 
  • system 

Follow up visit date date 

Date picker picker 

=<Today’s date date 

  • Mandatory if
  • enabled 
  • enabled 
  • Cannot be future
  • date 
  • date 
  • Cannot be before the TPT start
  • date 
  • date 

TPT completion status status 

 

    Completed 
  • Completed 
  • Incomplete 
  • Incomplete 
  • Lost to follow
  • up 
  • up 
  • Developed active TB during
  • TPT 
  • TPT 
  • Died during
  • TPT 
  • TPT 
  • other 
  • other 
    Mandatory 
  • Mandatory 
  • If selected “Completed” then enable date of completion
  • field 
  • field 
  • If selected “developed active TB during TPT” then redirect volunteer to
  • create new case
  • create new case record for
  • active TB  and close
  • active TB  and close the TPT case. 
  • If selected “died during TPT” then enable date of death field and cause of death
  • field  
  • field  

Other Other 

Free text text 

  •  
  •  

Date of completion completion 

Date picker picker 

=<Today’s date date 

  • Mandatory if
  • enabled 
  • enabled 
  • Cannot be future
  • date 
  • date 

 

Date of death death 

Date picker picker 

 

  • To be enabled if “TPT completion status” = Died during
  • TPT 
  • TPT 
  • Mandatory if
  • enabled 
  • enabled 

Cause of death death 

Free text text 

 

  • To be enabled if “TPT completion status” = Died during
  • TPT Mandatory if enabled 
  • TPT 
  • Mandatory if enabled 

Capture Geolocation



  • Capture current location details (latitude, longitude, address)

Submit Submit 

 

 

 


2.2.3 Module- Non Communicable Disease (NCD) Screening

Note: The common questions in CBAC Part B1 and TB screening form, if either of the form is filled and submitted first, then responses in the other form should be automatically selected.

Community Based Assessment Checklist (CBAC) Form 

NCD (Non-Communicable Diseases) Eligible List: 
Show all Beneficiary both Male and Female whose age > = 30 years and excluding Pregnant Women. 
And this CBAC
Form is applicable to Form is applicable to screen these Beneficiaries. 
This CBAC Form, assessment check should be done yearly once, Maintain the history of submitted CBAC Form for viewing, year
wise wise 

Name of Data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition 

 

CBAC Form 

 

 

 Date 

Date 

Calendar Calendar 
Date
Picker Picker 

  • Is
  • Mandatory 
  • Mandatory 
  • Choose the date from the
  • calendar 
  • calendar 
  • Format: dd-mm-
  • yyyy 
  • yyyy 
  • Default value Today's
  • Date 
  • Date 
  • Not greater than Today's
  • Date 
  • Date 
  • Accept date greater or equal to Date of beneficiary
  • registration 
  • registration 
  • should not allow to update in edit or once
  • submitted 
  • submitted 

Name Name Textbox 

Textbox 

 

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

Age Age Textbox 

Textbox 

 

Auto fill from Beneficiary details details 
Read
only only 

Sex Sex Textbox 

Textbox 

 

Auto fill from Beneficiary details details 
Read
only only 

Part A: Risk Assessment 

 

 

 

What is your Age? (in Age) 

radio button button 

 Is MandatoryMandatory 
Choose: 

  • 30 –
  • 39 
  • 39 
  • 40 -
  • 49 
  • 49 
  • 50 –
  • 59 
  • 59 
  • 60 and
  • Above 
  • 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  Age then display "4" 

Do you smoke or consume smokeless products such as gutka or khaini khaini 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Never 
  • Never 
  • Used to consume in the past sometime
  • now 
  • now 
  • Daily
     
  • 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 daily 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

Score Logic: 
If "No" then display "0" or If "Yes" then display "1" 

Measurement of Waist (in cm) 

radio button button 

 Is MandatoryMandatory 
Condition: 
Show values in the radio button based on Gender: 
For Male: 
Choose: 

  • 90
  • cm or less 
  • cm or less 
  • 91 -
  •  100 cm 
  •  100 cm 
     
  • More
  • than 100 cm
  • than 100 cm 

  •  
    For Female: 
    Choose: 
  • 80
  • cm or less 
  • cm or less 
  • 81 -
  •  90 cm 
  •  90 cm 
  • More
  • than 90 cm 
  • 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 you under take any physical activity for minimum of 150 minutes in a week of 150 minutes in a week 

radio button button 

 Is MandatoryMandatory 
Choose: 

  • At least 150 min in a
  • week 
  • week 
  • Less than 150 min in a
  • week 
  • week 

 Score Logic: 
If "At least 150 min in a week" then display "0"
or 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 Disease 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 Score Logic: 
If "No" then display "0" or If "Yes" then display "2" 

Total Score Score Label 

Label 

 

Total Score Formula: 
Sum of all
above score 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 Breath 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Coughing More than 2 weeks * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Blood in Sputum * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Fever > 2 weeks * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Loss of Weight * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Night Sweats * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Are you currently taking Anti TB drugs ** 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Anyone in Family Currently Suffering from TB ** 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

History of TB * 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Recurrent of ulceration on Palm or Sole Sole 

radio button button 

 Is MandatoryMandatory 
Choose:
 

Yes

 

  • Yes 
    No 
  • No 

 

Recurrent of tingling on Palm or Sole Sole 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Cloudy or Blurred Vision Vision 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Difficulty in reading reading 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Pain in eyes lasting for more than weeks weeks 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Redness in eyes for more than weeks weeks 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Difficulty in Hearing Hearing 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

History of Fits Fits 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Difficulty in Opening Mouth Mouth 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Ulcers in Mouth Not Healed in 2 weeks weeks 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Growth in Mouth Not Healed in 2 weeks weeks 

radio button button 

 Is MandatoryMandatory 
Choose: 

 

Any white or red Patch in Mouth Not Healed in 2 weeks weeks 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Pain while chewing chewing 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Any change in Tone of Voice Voice 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Any hypo pigmented patches or discolour lesions or discolour lesions with loss of sensation sensation 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Any thickened skin skin 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Any nodules skin skin 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Any Patch or Discoloration on Skin Skin 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Recurrent numbness on palm or sole sole 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Clawing of fingers in hand or feet feet 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Tingling and numbness in hand / or feet feet 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Inability to close eye lid lid 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Difficulty in Holding Objects in hands or Fingers Fingers 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Weakness in feet that cause difficulty in walking walking 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

 

Part B2: Women Only 

 

 

 

Lump in the Breast Breast 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Bleeding after Menopause Menopause 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

If optionIf option selected is "Yes" then display "Inform ASHA FacilitatorASHA Facilitator." 

Blood Stained Discharge from the Nipple Nipple 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

Bleeding after intercourse intercourse 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • No 

 

 

Part B3: Elderly Specific 
    

 

 

 

Feeling unsteady while standing or walking walking 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • 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 movement 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • 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 perform every day activities such as eating, getting dressed, grooming, bathing, walking, or using the toilets toilets 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • 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 address 

radio button button 

 Is MandatoryMandatory 
Choose: 

    Yes 
  • Yes 
  • No 
  • 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 Cooking 

radio button button 

Choose: 
 
Wood, Crop Residue, Gobar Gas, Coal, Kerosene oil,
LPG LPG 

 

Occupational Exposure Exposure 

 radio button 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 button 

Choose: 

  • Not at
  • all 
  • all 
  • several
  • days 
  • days 
  • more than half the
  • days 
  • days 
  • nearly every
  • day 
  • 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 button 

Choose: 

  • Not at
  • all 
  • all 
  • several
  • days 
  • days 
  • more than half the
  • days 
  • days 
  • nearly every
  • day 
  • 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 Score Label 

Label 

 

Total Score formula: Sum of all the above score 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

 

 

 


2.2.4 Module - Referrals

This module should contain the list of names/ cases referred to health facilities.

2.3 Home Page- Dashboard

  • Flip feature between "Home" and "Dashboard".
  • Put a field for filter with 2 selection options-
  1. 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)
  2. 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