Field Name

Input Type

Options / Values

Logic & Validations

Date of Registration

• Should be auto selected and updated when the volunteer logs in the application to do the screening.

Beneficiary ID (AMRIT ID)

• Unique ID auto generated by the system

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

I want to add a person from*

Radio

·       Public Sector

• Private Sector

This field is not visible in the form/ screen. Will be handled in the backend.       

Mandatory

·       Single select

• Default: Public Sector selected. 

Type of Case Finding*

Radio

·       Passive (Routine programme)

• Active (Active Case Finding)

·This field is not visible in the form/ screen. Will be handled in the backend.          

Mandatory

·       Single select

• Default:

• Active selected.

First Name*

Text Input

·       Free text

·       Mandatory

·       Only English letters

• No numbers/special characters.

Middle & Last Name*

Text Input

• Free text

·       Mandatory

·       Only English letters

• No numbers/special characters.

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)

• Tuberculosis
• 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 Input

1–99

·       Required.

·       Numeric. Min 1 Max 99 in years

• Either Age or DOB required.

Date of Birth

Date Picker

• Populate automatically if entered

• Auto Calculate 'Date of Birth' based on the Age entered

Gender*

Radio

·       Male

·       Female

·       Transgender

·       Mandatory

• Single select

Mobile number not available

Checkbox

• If this check box is selected, disable mobile number field.

Primary Phone*

Number

• Mandatory
• In case mobile number is not available, consider this number (9999999999) as mobile number (Will be handeled by default in the backend)

• Exactly 10 digits.

Whose mobile number

dropdown

·       Self

·       Husband

·       Mother

·       Father

·       Family Head

• Other

•  Default select "Self" option.

Address*

Text

• Free text

• Required. Max 2000 chars. Only English letters.
• Default value to be considered as "Village" name

State*

Dropdown

• Required. 
• Default value selected from location screen

Block*

Dropdown

• Required.
• Cascades from district.
• Default value selected from location screen

Dropdown

• Required.
• Cascades from State.
• Default value selected from location screen

Village*

Dropdown

• Required. 
• Cascaded from block
• Default value selected from location screen or selection to change the village is given

TU*

Dropdown

• Required. Cascades from District.
• Default value selected from location screen

Health Facility*

Dropdown

Caste*

Radio

·       SC

·       ST

·       Other

·       Mandatory

• Single select

Religion

radio button

• Hindu
• Muslim
• Christian
• Sikhism
• Buddhism
• Jainism
• Parsi
• Other
• Not disclosed

• should be editable

• optional

Area*

Radio

·       Tribal-NPVTG

·       Tribal-PVTG

·       Rural

·       Urban

·       Urban Slum

·       Unknown

·       Mandatory

Default Unknown.

Marital Status*

Radio

·       Single

·       Married

·       Unknown

·       Mandatory

·       Default Unknown.

Are you Pregnant*

 radio button

• Yes
• No

• Enabled if "Marital status"= "Married", "Age">= "15 years" and “Gender”= “Female”
• Mandatory
• If ""Are you pregnant"= "Yes", then referral to NAAT and not digital chest x-ray.

Husband's/ Wife's Name

Textbox

·       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

·        

• Optional
• Accept alphabets only
• Character limit 50

• All letter should be in caps

Mother's Name

Textbox

·        

• Optional
• Accept alphabets only
• Character limit 50

• All letter should be in caps

Occupation*

Dropdown

·       Unknown

·       Student

·       Unemployed

·       Homemaker

·       Farmer

·       Laborer / Daily Wage Worker

·       Self-employed / Business

·       Government Employee

·       Private Employee

·       Health Care Worker

·       Retired / Pensioner

·       Other

·       Mandatory

·       Default Unknown.

Socioeconomic Status*

Radio

·       APL

·       BPL

·       Unknown

·       Mandatory

• Default Unknown.

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.

 Continue next to "Anthropometry" Screen

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"
• Do not show "Pregnancy"  and "Lactating mother" option if Gender= "Male"

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.

Date

Calendar / Date Picker

Date

Mandatory. Default: Today's Date.

Not greater than Today's Date. Accept date >= Date of beneficiary registration.

Not editable 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.

Next Screen

Referred for digital chest x-ray

Radio button

Yes  |  No

·       Default: Yes.

·       Do NOT show for pregnant women.

·       Mandatory.

·       Move beneficiary to Referral list titled 'Digital Chest X-ray'.

Referred for Sputum Collection

Radio button

Yes  |  No

·       Enabled in case of-

• History of TB = Yes
• Currently taking Anti-TB drugs = Yes
• Are you pregnant = Yes
• Key Population / Risk Factors = Pregnancy
•  Default: Yes (when enabled).
• Mandatory when enabled.

Sputum Sample submitted at

Dropdown

• TB Screening Camp
• DMC 
• TU
• DH
• CHC
• PHC

·       Optional.

·       Kept available in case NAAT device is non-functional.

Recommended for NAAT test

Radio button

Yes  |  No

·       Enabled if Referred for Sputum Collection = Yes.

·       Mandatory if enabled.

·       Move beneficiary to Referral list titled 'NAAT'.

Recommended for liquid culture test

Radio button

Yes  |  No

·       Enabled if: Referred for Sputum Collection = Yes AND History of TB = Yes AND Currently on Anti-TB drugs = Yes.

·       Mandatory if enabled.

·       Move beneficiary to Referral list titled 'Liquid Culture'.

Reason for denial for getting tested

Dropdown (multi-select)

·       Fear and anxiety

·       Misconceptions

·       Social stigma

·       Cultural and gender-related barriers

·       Prior negative experiences with healthcare staff

·       Privacy concerns

·       Long waiting times at the camp

·       Loss of daily wages

·       Lack of trust in government programs or camp organizers

·       Others

·       Multi-select.

·       Optional.

Other

free text

Submit

Button

—

Continue to General OPD module. If skipped → move directly to Diagnostics Results screen.