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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
Submit	Button

Fields	ValidationAnthropometric
Anthropometric (Optional)
Weight (Kgs)	-
Height (cms)	-
BMI=Weight/(Height/100) ²	Should be auto calculated if height and weight details are entered
Vitals (Optional)
Temperature (Degree Fahrenheit)	Give predefined options (Normal range= 97-99 F) a) 97.5 b) 98.5 c) 99.5 d)>= 100 If option d)>= 100 is chosen, show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home
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 Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

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Scenario 2- If any symptom or symptoms reported "yes" then show the case here even if chest x-ray/ TrueNAT True NAT is negative.

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 Digital Chest X-ray conducted		Yes No	To be enabled if "Referred for" = "Digital Chest X-ray"
Digital Chest X-Ray Test Result		Positive Negative	Enable only if "Digital Chest X-ray conducted"=“Yes” If "Positive" is selected, move this case to Confirmed TB cases module.
Sputum Test			To be enabled in the following conditions- a) If "Digital Chest X-Ray Test Result"= "Positive" b) If "History of TB" = "Yes" c) If "Age=< 5 years" d) If "Are you pregnant= yes"
Is Sputum sample collected?	radio button	Yes No	Single selection Mandatory
Is TrueNAT conducted	radio button	Yes No	To be enabled if "Referred for" = "TrueNAT" To be enabled if and "Sputum Sample Collected" = "Yes"
TrueNATTrue NAT test result	radio button	Positive Negative	Enable only if "TrueNAT conducted"=“Yes” Option to edit/ select after submission of the form If "Positive" is selected, move this case to Confirmed TB cases module.
Is Liquid culture conducted	radio button	Yes No	To be enabled only if "History of TB" = "Yes" and if and "Sputum Sample Collected" = "Yes"
Liquid Culture	radio button	Positive Negative	If "Positive" is selected, move this case to Confirmed TB cases module. Option to edit/ select after submission of the form
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 "NAAT conducted"
Capture Geolocation			Capture current location details (latitude, longitude, address)
Submit	Button

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