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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 |
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First Name | Text |
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Last Name |
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Beneficiary Status | Radio Button | · Alive · Death | · Enable only in the “Edit” Beneficiary screen · Auto-populate, if ‘Death’ is reported from any module · 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
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Place of Death |
| · Enable if “Beneficiary status”= “Death” · Mandatory if enabled
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Other Place of Death | Textbox |
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Age | Number (Years) |
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Date of Birth | Date Picker |
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Gender | Dropdown |
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Mobile Number | Number |
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Village/ Hamlet | dropdown |
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Marital Status | radio button |
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Are you pregnant |
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Husband's/ Wife's Name | Textbox |
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Father's Name | Textbox |
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Mother's Name | Textbox |
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Community | radio button |
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Religion | radio button |
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Economic Status | radio button |
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Type of Residential area | radio button |
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Other Type of Residential area | Textbox |
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Occupation | free text |
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Cancel | Button |
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Capture Geolocation |
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Submit |
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Vital Screen
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- Give a box for check mark if the volunteer wants to fill these values. If clicked on it, enable the following fields.
- Skippable and optional section
Fields | Validation |
Weight (Kgs) | - |
Height (cms) | - |
BMI=Weight/(Height/100) ² | Should be auto calculated if height and weight details are entered |
Temperature (Degree Fahrenheit) | Give predefined options (Normal range= 97-99 F) a) 97.5 b) 98.5 c) 99.5 d)>= 100 |
Pulse Rate (beats per minute) | Give predefined options (Normal range= 60-90 BPM) a) less than 60 b) 60-70 c) 70-80 d) More than 90 If "less than 60" or "more than 90" option is chosen, show alert "Refer to nearest facility" |
Systolic Blood Pressure (mm Hg) | Textbox to manually input values. If "less than 90" or "more than 140", show alert "Refer to nearest facility" |
Diastolic blood Pressure (mm Hg) | Textbox to manually input values. If "less than 60" or "more than 90", show alert "Refer to nearest facility" |
2.2.2 Module- Tuberculosis
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In this section show all beneficiaries irrespective of any age group and gender.
This module should open in continuation after beneficiary registration.
TB Screening |
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Date | Calendar | Is Mandatory |
| Symptomatic Screening |
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Coughing More than 2 weeks * | radio button |
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Blood in Sputum * | radio button |
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Fever > 2 weeks * | radio button |
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Rise of fever in evening* | radio button |
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Loss of Appetite* | radio button |
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Loss of Weight * | radio button |
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Night Sweats * | radio button |
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History of TB * | radio button |
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Are you currently taking Anti TB drugs ** | radio button |
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Anyone in Family Currently Suffering from TB ** | radio button |
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Asymptomatic Screening |
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Age more than 60 | radio button |
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Diabetic | radio button |
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Tobacco user | radio button |
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Contact with TB patient on treatment | radio button |
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Referral Required | radio button |
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Referral for |
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Capture Geolocation |
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Submit | Button |
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2.2.2.b Suspected TB cases
This section should contain all beneficiaries If "referral required "= "Yes"
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Name of data Field | Field Type | Value/ Options | Validation/ Logic/ Condition |
Date | Calendar | Mandatory |
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Name | Textbox |
| Auto fill from Beneficiary details |
Age | Textbox |
| Auto fill from Beneficiary details |
Gender | Textbox |
| Auto fill from Beneficiary details |
Is Sputum sample collected? | radio button |
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Sputum sample submitted at | radio button |
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Sputum Test result | radio button |
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Is Digital Chest X-ray conducted |
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Digital Chest X-Ray Test Result |
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AI Cough Assessment conducted |
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AI Cough Assessment result |
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NAAT conducted |
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NAAT result |
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Nikshay ID | Textbox |
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Type of suspected TB case | Radio button |
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Reason for suspected TB case | Dropdown |
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Other | textbox |
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Has the diagnosis of DR-TB been confirmed? | Radio button |
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Capture Geolocation |
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Submit | Button |
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2.2.2.c Confirmed TB cases
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Name of Data Field | Field Type | Value/ Options | Validation/ Logic/ Condition |
Regimen Type | Radio button |
| Open module 2.2.2.d (TPT- TB Prevention treatment) module if “DS-TB (6 Months)” is selected Alert to Volunteer to screen all household members/ Contacts if DS-TB case is selected.
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Treatment Start Date | Date picker
| Mandatory |
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Expected Treatment Completion Date | Label | Read 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 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 picker
| Mandatory |
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Monthly follow up done | Label | Month-1 to Month-24 |
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Adherence to Medicines | Radio button |
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Any discomfort | Radio button |
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Treatment Completion | |||
Did the patient complete the full course of treatment? | Radio button |
| Enable these below filed based on below conditions: 1. If ‘Regimen Type’ is “1”, “4”, “5” then enable after 5 Monthly follow up visits 2. If ‘Regimen Type’ is “2”, then enable after 9 Monthly follow up visits 3. If ‘Regimen Type’ is “3”, then enable after 18 Monthly follow up visits |
Actual Treatment Completion Date | Date picker |
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TB Treatment outcomes | Dropdown |
| If "Death" is selected, update 'Beneficiary Status' = "Death" in the Beneficiary record, with “Date of Death”, "Place of Death" and "Reason for Death” in the next fields. |
Date of Death | Date picker |
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Place of Death | Dropdown |
| Enable only if "TB Treatment outcomes" = “Death” |
Reason for Death | Label Read only | Tuberculosis | Enable only if "TB Treatment outcomes" = “Death” |
Reason for non completion of treatment | Textbox |
| Enable this field if “No” selected for “Did the patient complete full treatment?” |
Capture Geolocation |
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Submit | button |
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Follow up visit history | Table |
| Maintain a Follow up visit history of Visit |
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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 developing active TB.
- If a contact tests positive for active TB at any step (X-Ray or Sputum positive), the system 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 TB case module, “Regimen type” = “DS-TB (6 months)”
- Make this module editable as after referral of the contact for diagnostic tests, volunteer needs to enter further details once the tests are done.
Household Contact Line listing Screen-
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Name of data field | Field Type | Value/ Options | Validation/ logic/ condition |
Name of the contact | Text Box |
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Age of the contact |
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Gender | Dropdown |
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Mobile Number | Number |
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TPT (TB Preventive Treatment) Screening Status |
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Referral Facility for screening |
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Screening done at the referral facility |
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Is it confirmed TB case |
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Are you advised to take (TPT) |
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TPT initiated |
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TPT start date | Date picker | =<Today’s date |
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Treatment duration of TPT |
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Expected completion date | date |
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Follow up visit number | Numeric |
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Follow up visit date | Date picker | =<Today’s date |
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TPT completion status |
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Other | Free text | ||
Date of completion | Date picker | =<Today’s date |
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Date of death | Date picker |
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Cause of death | Free text |
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Capture Geolocation |
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Submit |
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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 |
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Date | Calendar |
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Name | Textbox |
| Auto fill from Beneficiary details |
Age | Textbox |
| Auto fill from Beneficiary details |
Sex | Textbox |
| Auto fill from Beneficiary details |
Part A: Risk Assessment |
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What is your Age? (in Age) | radio button | Is Mandatory
| Auto-populate Age from 'Beneficiary' registration: |
Do you smoke or consume smokeless products such as gutka or khaini | radio button | Is Mandatory
| Score Logic: |
Do you consume alcohol daily | radio button | Is Mandatory
| Score Logic: |
Measurement of Waist (in cm) | radio button | Is Mandatory
| Score Logic: |
Do you under take any physical activity for minimum of 150 minutes in a week | radio button | Is Mandatory
| Score Logic: |
Do you have any family history (any one of your parents or siblings) of high BP / Diabetes / Heart Disease | radio button | Is Mandatory
| Score Logic: |
Total Score | Label |
| Total Score Formula: |
Part B1: Early Detection |
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If "Yes" is selected below then display a pop-up message, "Suspected NCD case, please visit nearest HWC or call 104." |
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* 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" |
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** 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" |
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Shortness of Breath | radio button | Is Mandatory
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Coughing More than 2 weeks * | radio button | Is Mandatory
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Blood in Sputum * | radio button | Is Mandatory
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Fever > 2 weeks * | radio button | Is Mandatory
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Loss of Weight * | radio button | Is Mandatory
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Night Sweats * | radio button | Is Mandatory
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Are you currently taking Anti TB drugs ** | radio button | Is Mandatory
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Anyone in Family Currently Suffering from TB ** | radio button | Is Mandatory
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History of TB * | radio button | Is Mandatory
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Recurrent of ulceration on Palm or Sole | radio button | Is Mandatory
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Recurrent of tingling on Palm or Sole | radio button | Is Mandatory
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Cloudy or Blurred Vision | radio button | Is Mandatory
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Difficulty in reading | radio button | Is Mandatory
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Pain in eyes lasting for more than weeks | radio button | Is Mandatory
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Redness in eyes for more than weeks | radio button | Is Mandatory
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Difficulty in Hearing | radio button | Is Mandatory
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History of Fits | radio button | Is Mandatory
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Difficulty in Opening Mouth | radio button | Is Mandatory
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Ulcers in Mouth Not Healed in 2 weeks | radio button | Is Mandatory
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Growth in Mouth Not Healed in 2 weeks | radio button | Is Mandatory |
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Any white or red Patch in Mouth Not Healed in 2 weeks | radio button | Is Mandatory
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Pain while chewing | radio button | Is Mandatory
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Any change in Tone of Voice | radio button | Is Mandatory
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Any hypo pigmented patches or discolour lesions with loss of sensation | radio button | Is Mandatory
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Any thickened skin | radio button | Is Mandatory
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Any nodules skin | radio button | Is Mandatory
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Any Patch or Discoloration on Skin | radio button | Is Mandatory
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Recurrent numbness on palm or sole | radio button | Is Mandatory
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Clawing of fingers in hand or feet | radio button | Is Mandatory
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Tingling and numbness in hand / or feet | radio button | Is Mandatory
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Inability to close eye lid | radio button | Is Mandatory
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Difficulty in Holding Objects in hands or Fingers | radio button | Is Mandatory
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Weakness in feet that cause difficulty in walking | radio button | Is Mandatory
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Part B2: Women Only |
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Lump in the Breast | radio button | Is Mandatory
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Bleeding after Menopause | radio button | Is Mandatory
| If option selected is "Yes" then display "Inform ASHA Facilitator." |
Blood Stained Discharge from the Nipple | radio button | Is Mandatory
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Bleeding after intercourse | radio button | Is Mandatory
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Part B3: Elderly Specific |
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Feeling unsteady while standing or walking | radio button | Is Mandatory
| 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
| 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
| 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
| If option selected is "Yes" then display "Send the patient to MOIC of nearest health center for treatment " |
Part C: Risk factor for COPD |
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Type of Fuel Used for Cooking | radio button | Choose: |
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Occupational Exposure | radio button | Choose: |
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Part D: PHQ2 |
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Over the last two weeks bothered by the following problem? |
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Little interest or pleasure in doing things? | radio button | Choose:
| Score Logic: |
Feeling down, depressed or hopeless? | radio button | Choose:
| Score Logic: |
Total Score | Label |
| Total Score formula: Sum of all the above score |
Capture Geolocation |
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Submit |
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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-
- 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
| 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 | Card must be yellow in colour | It must auto populate based on the filter selected. | |
Total TB suspected cases | Card must be yellow in colour | It must auto populate based on the filter selected. | |
Total TB confirmed cases | Card must be yellow in colour | It must auto populate based on the filter selected. | |
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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