Page History

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Separate Kitchen

Spinner

Is Mandatory
Choose:

·       Yes

·       No

2

Type of Fuel used for cooking

Spinner

Is Mandatory
Choose:
Firewood, Crop Residue, Cow Dung Cake, Coal, Kerosene, LPG, Other

3

Other type of fuel used for cooking

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

4

Primary Source of water

Spinner

Is Mandatory
Choose:
Tap Water, Handpump Inside House, Handpump Outside House, Well, Tank, River, Pond, Other

5

Other Source of Water

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

6

Availability of Electricity

Spinner

Is Mandatory
Choose:
Electricity Supply, Generator, Solar Power, Kerosene Lamp, Other

7

Other Availability of electricity

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

8

Availability of Toilet

Spinner

Is Mandatory
Choose:
Flush Toilet with Running Water, Flush Toilet without Water, Pit Toilet with Running Water Supply, Pit Toilet without Water Supply, Other, None

9

Other Availability of Toilet

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

After Household registration is completed, show below alert in pop:
"Do you want to proceed with registration of Head of the family"; "Yes" or "No"
If "Yes", navigate to the Beneficiary Registration
If "No", land back to Household list screen

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 Do not show any 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

Village*

Dropdown

• Required. 
• Cascaded from block
• Default value selected from location screen or selection to change the village is given from the dropdown list if a beneficiary is from another village. 

Caste*

Radio

·       SC

·       ST

·       Other

·       Mandatory

• Single select

Area*

Radio

·       Tribal-NPVTG

·       Tribal-PVTG

·       Rural

·       Urban

·       Urban Slum

·       Unknown

·       Mandatory

Default Unknown.

Marital Status*

Radio

·       Single

·       Married

·       Unknown

·       Mandatory

·       Should be made selectable (Blank) so that user can ask and fill this detail by asking beneficiary.

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.