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Field Name | Input Type | Options / Values | Logic & Validations |
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. |
"Is beneficiary asymptomatic" | Radio button | Yes | No | Option "Yes" will be auto selected if responses to all the Previous 10 Questions are "No". Option "No" will be auto selected if responses to any of the Previous 10 Questions are "Yes", valid even for one single response as "Yes". |
Next Screen after TB Screening Questions- | This Screen will be dynamic and results should keep on auto populating after NAAT device and Digital Chest X-ray devices are integrated. Manual entries are also allowed. | ||
Referred for digital chest x-ray | Radio button | Yes | No | · Default: Yes. · Do NOT show/ Hide for pregnant women. · Mandatory. · Move · If yes, move beneficiary to Referral list titled 'Digital Chest X-ray'. |
Reason for denial to get referred for chest x-ray | dropdown |
| Enabled if Referred for digital chest x-ray= "No" Mandatory if enabled Multi select option Default option- Patient refused |
Other | free text | enabled if Reason for denial to get referred for chest x-ray= Other Mandatory if enabled | |
Is Digital Chest X-ray conducted | Radio / Auto | Yes | No | Enabled for everyone EXCEPT 'Are you pregnant = Yes' and Key Population / Risk Factors = Pregnancy. Enabled if Referred for digital chest x-ray= "Yes" Auto-populated by cross-device sync between STOP TB app and digital chest X-ray device. |
Reasons for not conducting the chest x-ray | dropdown |
| Enabled if Is Digital Chest X-ray conducted= "No" Mandatory if enabled Single Selection |
Other | free text | enabled if Reasons for not conducting the chest x-ray-ray= Other Mandatory if enabled | |
Digital Chest X-Ray Test Result | Radio / Auto | Positive | Negative | Enabled only if 'Is Digital Chest X-ray conducted = Yes'. Auto-populated by cross-device sync. If Positive → move case to Confirmed Suspected TB cases module AND show patient in NAAT referral list for further testing. |
Referred for Sputum Collection | Radio button | Yes | No | · Enabled in case of-
|
Reason for denial to get referred for sputum collection | dropdown |
| Enabled if Referred for sputum collection= "No" Mandatory if enabled Multi select option Default option- Patient refused |
Other | free text | Enabled if Reason for denial to get referred for sputum collection= Other Mandatory if enabled | |
Sputum Sample submitted at | Dropdown |
| Mandatory if Referred for Sputum Collection= "Yes" Default is TB Screening Camp |
Is NAAT test conducted | Radio / Auto | Yes | No | Enabled in case of-
|
Reasons for not conducting the NAAT test | dropdown |
| Enabled if Is NAAT test conducted= "No" Mandatory if enabled Single Selection |
Other | free text | enabled if Reasons for not conducting the NAAT test= Other Mandatory if enabled | |
NAAT test result | Radio button / Auto | Positive | Negative | Enabled only if 'Is NAAT conducted = Yes'. Auto-populated by cross-device sync. If Positive → move case to Confirmed TB cases module. |
Recommended for liquid culture test | Radio | Yes | No | Enabled only if History of TB = Yes AND Currently on Anti-TB drugs = Yes. |
Liquid Culture test result | Radio button | Positive | Negative | If Positive → move case to Confirmed TB cases module. Option to edit/select after form submission as results come after 40-45 days. | 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 |
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Other | free text | ||
Submit | Button | — | Continue to General OPD module. If skipped → move directly to Diagnostics Results screen. |
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