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Field Name

Input Type

Options / Values

Logic & Validations

Pulse Rate (beats per minute)

Free textbox

Numeric (BPM)

·       Free textbox for manual entry.


·       If value < 60 or > 90 BPM → show alert 'Refer to Health and Wellness Centre' and flag in Referral card on Home. Auto-sets 'Referral to HWC needed' = Yes.

Systolic Blood Pressure (mmHg)

Free textbox

Numeric (mmHg)

·       SBP and DBP fields placed side by side with their units.

·       Free textbox for manual entry.


·       If >= 140 mmHg (High) or < 90 mmHg (Low) → alert 'Refer to Health and Wellness Centre'. Auto-sets 'Referral to HWC needed' = Yes.

Diastolic Blood Pressure (mmHg)

Free textbox

Numeric (mmHg)

·       SBP and DBP placed side by side.

·       Free textbox for manual entry.

·       If >= 90 mmHg (High) or < 60 mmHg (Low) → alert 'Refer to Health and Wellness Centre'. Auto-sets 'Referral to HWC needed' = Yes.

Random Blood Sugar (mg/dl)

Free textbox

Numeric (mg/dl)

·       Free textbox for manual entry.

·       If >= 100 mg/dl → alert 'Refer to Health and Wellness Centre'. Auto-sets 'Referral to HWC needed' = Yes.

Pallor

Radio Button

Present  |  Absent

·       Optional.

Icterus

Radio Button

Present  |  Absent

·       Optional.

Cyanosis

Radio Button

Present  |  Absent

·       Optional.

Clubbing

Radio Button

Present  |  Absent

·       Optional.

Lymphadenopathy

Radio Button

Present  |  Absent

·       Optional.

Oedema

Radio Button

Present  |  Absent

·       Optional.

Key Population / Risk Factors*

Checkbox (multi-select)

Pregnancy

Lactating mother

Anti-TNF treatment

Bronchial Asthma

Cancer

Cardiovascular Disorder

Contact of Known TB Patients

COPD

COVID recovered patients

Diabetes

Dialysis

Health Care Worker

Hypertensive

Liver Impairment

Migrant

Miner

Palliative Care

Patient on immunosuppressants

Prison

Illegal Immigrant

Renal Impairment

Transplantation

Urban Slum

H/o Adult BCG Vaccination

Undernourished / Malnourished (BMI <18.5 kg/m²)

Elderly (age >60 years)

Workplace settings (coal/sandblasting/brick kiln)

Tea garden worker

Construction site worker

Congregate settings

Attendees of de-addiction centers

Person exposed to indoor air pollution

Marginalized populations at risk of HIV

LGBTQAI++

Substance abuse (alcoholic/intravenous drug users)

Tobacco/smoker

Silica exposure/silicosis

Other

Not Applicable

·       Mandatory.

·       Multi-select.

  • Default- Not applicable

·       If 'Not Applicable' selected → all other options are disabled.

  • Auto selection to "Pregnancy" if "Are you Pregnant"= "Yes"

HIV Status*

Radio

Positive  |  Reactive  |  Negative  |  Unknown

·       Mandatory.

·       Default: Unknown.

Referral to HWC needed

Auto + manual

Yes  |  No

·       Auto-set to 'Yes' if: Pulse < 60 or > 90 BPM; OR Systolic BP >= 140 or < 90 mmHg; OR Diastolic BP >= 90 or < 60 mmHg; OR Random Blood Sugar >= 100 mg/dl.

·       Show all such beneficiaries in the Referral → Health and Wellness Centre card on Home.

·       If all vitals fall in the normal range then 'Referral to HWC needed' remains No and the beneficiary does NOT appear in the HWC Referral card.


Submit

Button

Proceed to TB Screening screen.

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