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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.

Beneficiary ID (AMRIT ID)

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

·       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

Mobile Number

Number

• Mandatory
• Speech to text feature

Whose mobile number

dropdown

Marital Status

dropdown

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

• Mandatory and single selection allowed
• 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"

Are you pregnant

 radio button

• Yes
• No

• Should be enabled if "age" is 15 years and above, "gender" = "female" and if "Marital status"= "Married"
• Mandatory if enabled
• If ""Are you pregnant"= "Yes", then referral to TrueNAT

Husband's/ Wife's Name

Textbox

• Input method: Speech to Text feature
• Optional
• Should be enabled if "Marital status"= Married
• 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

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

• Optional

Village/ Hamlet

dropdown

• Single selection allowed
• This must auto fetch the dropdown values (Villages) with which the user is aligned.

Sub Centre

dropdown

Capture Geolocation

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

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.

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.

TB Screening

Date 

Calendar 
Date Picker 

Is Mandatory 

TB Screening

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 

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

Referred for

• True NAT
Default option
• "Digital Chest X-ray",
• True NAT

• Default option "Digital Chest X-ray" will be selected for everyone except if
" will be selected for everyone except if "age=< 5 years" and "are you pregnant= yes"."True NAT" will be the default option for 
• "age=< 5 years" and "are you pregnant=
yes".
• Based on the option auto chosen, show beneficiaries in "Digital Chest X-ray", "True NAT", "Health and Wellness Centre" cards present in referral module.

Capture Geolocation

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

Submit 

Button 

• yes".
• "True NAT" will be the default option for "age=< 5 years" and "are you pregnant= yes".
• Based on the option auto chosen, show beneficiaries in "Digital Chest X-ray", "True NAT", "Health and Wellness Centre" cards present in referral module.

Capture Geolocation

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

Submit 

Button 

Name of data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition 

Date 

Calendar 
Date Picker 

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 

Name 

Textbox 

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

Age 

Textbox 

Auto fill from Beneficiary details 
Read only 

Gender

Textbox 

Auto fill from Beneficiary details 
Read only 

Is Sputum sample collected? 

radio button 

• Yes 
• No 

• To be enabled if "Referral for" = "Sputum Collection"
•  Mandatory if enabled
• If “Yes” is selected enable ‘Nikshay Id’ 

Sputum Test Result

TrueNAT

• Positive
• Negative

• Option to edit/ select after submission of the form

Liquid Culture

• Positive
• Negative

• Option to edit/ select after submission of the form
  

Is Digital Chest X-ray conducted

• Yes
• No 

• To be enabled if "Referral for" = "Digital Chest X-ray"

• If “Yes” is selected enable ‘Nikshay Id’ 

Digital Chest X-Ray Test Result 

• Clinically Diagnosed TB 

• TB Not suspected 

• Enable only if "Digital Chest X-ray conducted"=“Yes”
• If "Clinically diagnosed TB" is selected, move this case to Confirmed TB cases module.

TrueNAT conducted

• Yes
• No 

• To be enabled if "Referral for" = "NAAT"

TrueNAT result

• Positive 
• Negative 

• Enable if "Yes" is selected for "NAAT conducted?" 

• If positive, move this case to Confirmed TB cases module.

Nikshay ID 

Textbox 

• Enable if "Yes" is selected for 'Is Sputum sample collected.
• Enable if "Yes" is selected for "Digital Chest X-ray conducted"
• Enable if "Yes" is selected for "AI Cough Assessment conducted"
• Enable if "Yes" is selected for "NAAT conducted"

Name of data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition 

Date 

Calendar 
Date Picker 

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 

Name 

Textbox 

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

Age 

Textbox 

Auto fill from Beneficiary details 
Read only 

Gender

Textbox 

Auto fill from Beneficiary details 
Read only 

Is Sputum sample collected? 

radio button 

• Yes 
• No 

• To be enabled if "Referral for" = "Sputum Collection"
•  Mandatory if enabled
• If “Yes” is selected enable ‘Nikshay Id’ 

Sputum sample submitted at 

radio button 

• 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 

radio button 

• Positive 
• Negative 

• Enable if "Yes" is selected for 'Is Sputum sample collected?' 

• If positive, move this case to Confirmed TB cases module.

Is Digital Chest X-ray conducted

• Yes
• No 

• To be enabled if "Referral for" = "Digital Chest X-ray"

• If “Yes” is selected enable ‘Nikshay Id’ 

Digital Chest X-Ray Test Result 

• Clinically Diagnosed TB 

• TB Not suspected 

• Enable only if "Digital Chest X-ray conducted"=“Yes”
• If "Clinically diagnosed TB" is selected, move this case to Confirmed TB cases module.

AI Cough Assessment conducted

• Yes
• No 

• To be enabled if "Referral for" = "AI Cough Assessment"

AI Cough Assessment result

• Positive 
• Negative 

• Enable if "Yes" is selected for 'AI Cough Assessment conducted?' 

• If positive, move this case to Confirmed TB cases module.

NAAT conducted

• Yes
• No 

• To be enabled if "Referral for" = "NAAT"

NAAT result

• Positive 
• Negative 

• Enable if "Yes" is selected for "NAAT conducted?" 

• If positive, move this case to Confirmed TB cases module.

Nikshay ID 

Textbox 

• Enable if "Yes" is selected for 'Is Sputum sample collected.
• Enable if "Yes" is selected for "Digital Chest X-ray conducted"
• Enable if "Yes" is selected for "AI Cough Assessment conducted"
• Enable if "Yes" is selected for "NAAT conducted"

Type of suspected TB case 
 

Radio button 

• New case of TB 

• Previously treated TB case 

• DR-TB case 

• Mandatory 

Reason for suspected TB case 

Dropdown 

• Treatment failure 

• TB Relapse/ Recurring symptoms 

• Contact with DR-TB case 

• Treatment after LFU (Lost to Follow-up) 

• Other 

• Enable this field only if “Type of TB case” is “Previously treated TB case” or “DR-TB case” 

Other 

textbox 

• Mandatory if enabled 

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

Has the diagnosis of DR-TB been confirmed? 

Radio button 

• Yes  

• No  

• Enable this field only if “type of  suspected TB case”= “Previously treated TB case” or “DR-TB 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 

Button