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Fields

Validation

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) 

  • Also give free textbox for manual entry.
  • 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) 

  • Also give free textbox for manual entry.

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

 

 

 

 

Referred for

Auto selection 
  • "Digital Chest X-ray",
  • True NAT
  • Default option "Digital Chest X-ray" 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" cards in Referral section.

2.2.2.b Suspected TB cases  
This section should contain all beneficiaries in the following scenario-

Scenario 1- If not a single symptom is presented in a beneficiary but chest x-ray is positive, show the case here.

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

 

Systolic Blood Pressure

  •  Give space to write measurement

  • If >=140 mmHg (High BP) or <90 mmHg (low BP) show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

 Diastolic Blood Pressure

  • Give space to write measurement

  • If >=90 mmHg (High BP) or <60 mmHg (low BP) show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

Random Blood sugar

  • Give space to write measurement

  • If >=100 mm/dl show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

 

Skip Button

 

Submit Button

 

Referred for

Auto selection 
  • "Digital Chest X-ray",
  • True NAT
  • Default option "Digital Chest X-ray" 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" cards in Referral section.


2.2.2.b Suspected TB cases  
This section should contain all beneficiaries in the following scenario-

Scenario 1- If not a single symptom is presented in a beneficiary but chest x-ray is positive, show the case here.

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

 

Name of data Field 

Field Type 

Value/ Options 

Validation/

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 

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"

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" and "Sputum Sample Collected" = "Yes"

True 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", "Currently on Anti-TB drugs" = "Yes" "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

Capture Geolocation



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

Submit 

Button 

 

 

...

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 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 

 

 

 

2.2.3 Module- Non Communicable Disease (NCD) Screening

Should be enabled for beneficiaries aged 30 years and above

Optional Module. 

...

Name of data field

...

Field type

...

Options/ values

...

Validation/ Logic

...

Hypertension Screening

...

Have you ever been diagnosed with high blood pressure?

...

·       Yes

·       No

·       Don’t Know

·       Single selection allowed

·       Optional

...

Are you currently taking medication for blood pressure?

...

·       Yes

·       No

·       Stopped recently

...

·       To be enabled if “Have you ever been diagnosed with high blood pressure” = “Yes”

·       Optional

...

Does anyone in your family have high blood pressure

...

·       Yes

·       No

·       Don’t Know

·       Single selection allowed

·       Optional

...

Have you experienced any of the following symptom/ symptoms

...

·       Dizziness

·       Swollen legs

·       Frequent headaches

·       None

...

·       Optional

·       Multiple selection possible

·       'None' selection should deselect all others

...

Systolic BP

...

Number-

...

Values to be captured in (mmHg)

...

·       Optional

·       If "less than 90" or "more than 140", show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

...

Diastolic BP

...

Number

...

Values to be captured in (mmHg)

...

·       Optional

·       If "less than 60" or "more than 90", show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

  • 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 

 

 

 

...

Diabetes Screening

...

Have you been diagnosed with diabetes or pre-diabetes?

...

·       Yes

·       No

·       Don’t Know

·       Single selection allowed

·       Optional

...

Are you currently on medication or insulin for diabetes?

...

·       Yes

·       No

·       Stopped recently

...

·       To be enabled if “Have you been diagnosed with diabetes or pre-diabetes?” = “Yes”

·       Optional

...

Have you experienced any of the following symptom/ symptoms in the past 3 months

...

·       Excessive thirst

·       Frequent urination

·       Unexplained weight loss

·       Blurred vision

·       Tingling/numbness in feet

·       Fatigue

·       Slow-healing wounds

·       None

...

·       Optional

·       Multiple selection possible

·       'None' selection should deselect all others

...

Random Blood Sugar

...

Number

...

Values to be captured in (mg/dl)

...

·       Optional

·       If >= 100 mg/dl then show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

...

Module - Referrals

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

...