Regimen Type

Radio button

1.DS-TB (6 Months)

2.Shorter Regimen (9–12 Months)

3.Longer Regimen (18–24 Months)

4.BPaL Regimen (6 Months)

5.INH Mono (6 Month)

·       If DS-TB (6 Months) selected → open TPT module.

·       Alert volunteer to screen all household members / contacts if DS-TB case is selected.

Treatment Start Date

Date picker

Date

·       Mandatory. Must be >= TB Identification and Diagnosis Visit Date. Not greater than Today's Date.

Expected Treatment Completion Date

Label (read-only)

Auto-calculated

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 SECTION —

Follow-up Date

Date picker

Date

·       Greater than or equal to Treatment Start Date or greater than Last Follow up Date

·       Mandatory

·       Minimum date is Treatment Start Date

·       Accept date greater than Last Follow up Date

·       Allow 1 Follow up visit in a month (i.e. monthly 1 Follow up)

·       Not greater than Today's Date

Monthly follow-up done

Label (read-only)

Month-1 to Month-24

Incremental based on monthly follow-up visits completed.

Adherence to Medicines

Radio button

Regular  |  Irregular

—

Any discomfort

Radio button

Yes  |  No

—

— TREATMENT COMPLETION SECTION —

Did the patient complete the full course of treatment?

Radio button

Yes  |  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

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

Date

Enabled if 'Yes' selected above. Must be > Last Follow-up Date.

TB Treatment Outcomes

Dropdown

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

If Death selected → update Beneficiary Status = Death in Beneficiary record;

Enable Date of Death, Place of Death, and Reason for Death fields.

Date of Death

Date picker

Date

Enable only if TB Treatment Outcomes = Death.

Mandatory if enabled.

Default: null. Not greater than Today's Date. >= Treatment Start Date or > Last Follow-up Date.

Place of Death

Dropdown

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

Enable only if TB Treatment Outcomes = Death.

Reason for Death

Label (read-only)

Tuberculosis

Enable only if TB Treatment Outcomes = Death. Pre-filled as 'Tuberculosis'. Read only.

Reason for non-completion of treatment

Textbox

Free text

Enable if 'No' selected for 'Did the patient complete full treatment?'

Capture Geolocation

Auto capture

—

Capture current location: latitude, longitude, address.

Submit

Button

—

Save record.

Follow-up visit history

Table (read-only)

—

Maintain and display complete follow-up visit history.

Name of the contact

Text Box

Free text

—

Age of the contact

Number input

Numeric

—

Gender

Dropdown

Male  |  Female  |  Transgender  |  Prefer not to say

Mandatory. Speech-to-text feature enabled.

Mobile Number

Number

Numeric

Optional. Speech-to-text feature enabled.

TPT Screening Status

Radio / Dropdown

Not Started  |  Pending  |  Completed

Mandatory. Single selection. Default: Pending.

Referral Facility for screening

Radio / Dropdown

HWC  |  PHC  |  CHC  |  District Hospital

Mandatory. Single selection. From here volunteer can go directly to Submit as contact must first get tested.

Screening done at the referral facility

Radio

Yes  |  No

Mandatory.

Is it confirmed TB case

Radio

Yes  |  No

If Yes → move card to Confirmed TB list. If No → continue ahead.

Are you advised to take TPT

Radio

Yes  |  No

If Yes → continue to next field. If No → go directly to Submit.

TPT initiated

Radio

Yes  |  No

Mandatory. Enable next fields if Yes.

TPT start date

Date picker

<= Today's date

Mandatory if enabled. Cannot be future date. Cannot be before date of screening.

Treatment duration of TPT

Radio / Dropdown

1 Month  |  3 months  |  6 months

—

Expected completion date

Date (read-only)

Auto-calculated

Auto-calculated = TPT start date + regimen duration. Non-editable.

Follow-up visit number

Numeric (read-only)

Auto-increment (1–6)

Non-editable. Automatically calculated by system.

Follow-up visit date

Date picker

<= Today's date

Mandatory if enabled. Cannot be future date. Cannot be before TPT start date.

TPT completion status

Radio / Dropdown

Completed

Incomplete

Lost to follow-up

Developed active TB during TPT

Died during TPT

Other

Mandatory. If 'Completed' → enable Date of completion field. If 'Developed active TB during TPT' → redirect volunteer to create new TB Suspected Case record and close this TPT case. If 'Died during TPT' → enable Date of death and Cause of death fields.

Other

Free text

—

—

Date of completion

Date picker

<= Today's date

Mandatory if TPT completion status = Completed. Cannot be future date.

Date of death

Date picker

Date

Enabled if TPT completion status = Died during TPT. Mandatory if enabled.

Cause of death

Free text

—

Enabled if TPT completion status = Died during TPT. Mandatory if enabled.

Capture Geolocation

Auto capture

—

Capture current location: latitude, longitude, address.

Submit

Button

—

Save record.