...
Field Name | Input Type | Options / Values | Logic & Validations |
Counselling Date | Date picker | Date | Mandatory. Default: Today. Not > Today. Must be >= Registration date. |
Counselling Officer Name | Auto-filled (read-only) | Logged-in user | Auto-filled from logged-in Counselling Officer account. Read only. |
— PATIENT HEADER (AUTO-FILLED, READ-ONLY) — | |||
Beneficiary Name | Textbox (read-only) | Auto-filled | First Name + Last Name from beneficiary record. |
Beneficiary ID (AMRIT ID) | Textbox (read-only) | Auto-filled | From beneficiary record. |
Nikshay ID | Textbox (read-only) | Auto-filled | From Diagnostics screen. Read only. |
Age / Gender | Textbox (read-only) | Auto-filled | Age (years) and Gender from beneficiary record. |
Diagnosis | Textbox (read-only) | Auto-filled | X-ray Result | NAAT Result | Liquid Culture Result — populated from diagnostic records. Read only. |
SECTION A: DISEASE AWARENESS | |||
TB disease explained to patient | Radio button | Yes/ No | Mandatory. Must be checked before proceeding. Confirms counsellor has explained TB to the patient. |
Transmission route explained | Radio button | Yes/ No | Mandatory. |
Symptoms explained | Radio button | Yes/ No | Mandatory. |
Treatment duration explained | Radio button | Yes/ No | Mandatory. |
Disease awareness notes | Free text | — | Optional. Max 500 chars. |
SECTION B: DO'S AND DON'TS | |||
Cover mouth while coughing — advised | Radio button | Yes/ No | Mandatory. |
Complete full treatment course — advised | Radio button | Yes/ No | Mandatory. |
Regular follow-up attendance — advised | Radio button | Yes/ No | Mandatory. |
Nutritional guidance provided | Radio button | Yes/ No | Mandatory. |
No smoking / alcohol — advised | Radio button | Yes/ No | Mandatory. |
Isolation precautions explained | Radio button | Yes/ No | Mandatory. |
Do's & Don'ts notes | Free text | — | Optional. Max 500 chars. |
SECTION C: GOVERNMENT SCHEMES | |||
Nikshay Poshan Yojana (NPY) eligibility explained | Radio button | Yes/ No | NPY: DBT of Rs. 5001000/month for duration of treatment. |
DOTS free treatment explained | Radio button | Yes/ No | Confirm patient understands treatment is free under NTEP. |
Schemes notes | Free text | — | Optional. Max 300 chars. |
SECTION D: TREATMENT REGIMEN | |||
Regimen explained to patient | Radio button | Yes/ No | Mandatory. |
Medication names explained | Radio button | Yes/ No | Mandatory. |
Side effects explained | Radio button | Yes/ No | Mandatory. |
Importance of adherence explained | Radio button | Yes/ No | Mandatory. |
Treatment regimen notes | Free text | — | Optional. Max 300 chars. |
SECTION E: COUNSELLING COMPLETION | |||
Counselling completion status | Radio button | Complete | Refused | Mandatory. Make all the above sections obsolete if “Counselling completion status” = “Refused” If Refused → enable 'Reason for refusal' field. |
Reason for refusal | Free text | — | Mandatory if Counselling status = Refused. Max 300 chars. |
Counsellor remarks | Free text | — | Optional. Max 500 chars. |
SECTION E: Follow Up to TU | To be done within 15 days Editable | ||
Has the patient started the prescribed TB treatment regimen? | Radio button | Yes/ No | If No is selected, then enable “Reason for not starting the prescribed TB treatment regimen” |
Reason for not starting the prescribed TB treatment regimen | Free text | To be enabled if “Has the patient started the prescribed TB treatment regimen” = “No” Up to 500 characteristics | |
Has the patient visited the DOTS centre / referred health facility for treatment collection? | Radio button | Yes/ No | |
Has the patient reported side effects to the treating doctor or DOTS centre? | Radio button | Yes/ No | |
Submit | Button | — | Save counselling record. If status = Complete → Nikshay record updated; case marked 'Counselled'. |
...