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Name of Data Field | Field Type | Value/ Options | Validation/ Logic/ Condition |
House Hold No. | Numeric |
| Search by household number. |
Head of Family Member Name | Text Box |
|
|
Mobile No. | Numeric |
|
|
Name | Text Box |
| Auto-populated from "Enumeration FM" First Name, Middle Name, Last Name. |
Father's Name / Husband Name | Text Box |
| If Gender = Female and Marital Status = Married, auto-populate from Spouse Name. If Gender = Male, auto-populate from Father’s Name. |
Age | Text Box |
| Auto-populated from "Enumeration FM" |
Gender | Text Box |
| Auto-populated from "Enumeration FM" |
Mobile No. | Text Box |
| Auto-populated from "Enumeration FM" |
ABHA ID | Text Box |
| Auto-populated from "Enumeration FM" |
Malaria Screening Date | Calendar Picker |
| Allow belated dates till last 3 months from todays date and Not greater than Today's Date |
| Beneficiary Status | Radio Button | Select:
| If 'Status' = "Dead" then disable all below fields and Enable only these fields Date of Death, Place of Death and Reason for Death Select default value "Not Applicable" |
| Date of Death | Calendar | If 'Status' = "Dead" then enable Mandatory Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |
| Place of Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory |
Other Place of Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above |
| Reason for Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory |
Other Reason for Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above |
Symptoms | Multi-Select Choices |
| Fever more than two weeks, Flu-like illness, Shaking chills, Headache, Muscle aches, Tiredness, Nausea, Vomiting, Diarrhea (Yes/No) Default is "No" |
Case Status | Drop Down | Option: 1.Suspected, 2. Confirmed, 3. Not Confirmed, 4. Treatment Given. | If any of the above symptoms are "Yes" then select "Suspected" First Entry: Only "Suspected" can be selected. Test id not Done but symptoms are present then Suspected Any Test is Positive, Confirmed If Test are Negative Not confirmed Color Indications for Malaria Cases:
|
| Rapid Diagnostic Test (RDT) | Radio button | Option
| If you have performed an RDT, If positive, put a plus (+) in red; If negative, put a dash (-).in green If you have not performed an RDT, put a cross X in Yellow |
| Date of Test | Calendar | Mandatory if above field RDT is selected Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |
| Malaria Slide Test Pf | Radio button | Option
| Default not performed If you have performed an Malaria Slide Test, If positive, put a plus (+) in red; If negative, put a dash (-).in green If you have not performed, put a cross X in Yellow |
| Malaria Slide Test Pv | Radio button | Option
| Default not performed If you have performed an Malaria Slide Test, If positive, put a plus (+) in red; If negative, put a dash (-).in green If you have not performed, put a cross X in Yellow |
| Date of Test | Calendar | Mandatory if above field RDT is selected Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |
Case Status | Drop Down | Option: 1.Suspected, 2. Confirmed, 3. Not Confirmed, 4. Treatment Given. | If any of the above symptoms are "Yes" then select "Suspected" First Entry: Only "Suspected" can be selected. Test id not Done but symptoms are present then Suspected Any Test is Positive ,Confirmed If Test are Negative , any No test Performed is "Not confirmed" |
Referred To | Drop Down |
| Options: Primary Health Centre, Community Health Centre, District Hospital, Medical College and Hospital, Referral Hospital, Other Private Hospital, Other, None. |
Other Referred Facility | Text Box |
| Required only if "Referred To" = "Other". |
Remarks | Text Box |
| Optional field for additional notes. |
Date of Visit by Supervisor | Calendar |
| Allow belated dates till last 3 months from todays date and Not greater than Today's Date |
Incentive Logic |
|
| For Lab Test: Malaria = X+1 for every unique confirmed case in the current month, for particular house hold "X" is a Variable |
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The Kala Azar sub-module focuses on early detection, treatment and tracking of Kala Azar cases at the village community level. It ensures accurate case status updates, referral options, treatment initiation, and structured follow-up at different points of the treatment cycle.
Name of Data Field | Field Type | Value/ Options | Validation/ Logic/ Condition |
House Hold No. | Numeric |
| Search by household number. |
Head of Family Member Name | Text Box |
|
|
Mobile No. | Numeric |
|
|
| Data Field | Text Box | ||
| Name | Text Box | Auto-populated from "Enumeration FM" (First, Middle, Last Name) | |
| Father's/Husband's Name | Text Box | "If Gender = Female and Marital Status = Married, auto-populate from 'Spouse Name'. If Gender = Male, auto-populate from 'Father Name'" | |
| Age | Numeric | Auto-populated from "Enumeration FM" | |
| Gender | Text Box | Auto-populated from "Enumeration FM" | |
| Type of House | Text Box | Auto-populated from "Enumeration HH" | |
| Caste | Text Box | Auto-populated from "Enumeration HH" | |
| Mobile No. | Numeric | Auto-populated from "Enumeration FM" | |
| ABHA ID | Numeric | Auto-populated from "Enumeration FM" | |
| Visit Date |
Calendar |
|
Allow belated dates till last 3 months from todays date and Not greater than Today's Date |
| Beneficiary |
| Status |
| Spinner |
Suspected, Confirmed, Not Confirmed, Treatment Started
Single Select Radio Button
First time user will select "Suspected" option only and from second time the user will select either "Confirmed" or "Not Confirmed". The system will display the "Treatment Started" only if the previous status was "Confirmed".
Define variable Kala Azar Case with default value = 0 and for every unique confirmed case in the current month Kala Azar Case = Kala Azar Case +1
Options
Primary Health Centre, Community Health Centre, District Hospital, Other Private Hospital, Medical College and Hospital, Referral Hospital, Othe
If "Referred To" = "Other"
If "Kala Azar Case" = "Treatment Started"
If "Status" not equal to "Dead" in previous "Follow Up point"
1, 2, 3, 4, 5, 6
Single Select Radio Button
Disabled the option (1,2,3,4,5,6) once selected
If "Kala Azar Case" = "Treatment Started"
If "Status" not equal to "Dead" in previous "Follow Up point"
If "Status" not equal to "Dead" in previous "Follow Up point"
Recovering, Cured, Dead, Recurrence of Symptoms, Other
Single Select Radio Button
If "Status" = "Other"
If "Kala Azar Case" = "Treatment Started"
If "Status" not equal to "Dead" in previous "Follow Up point"
3.12.3 AES/JE
This sub-module facilitates the tracking and management of AES/JE cases through household searches, individual case tracking, referral management, and status updates to ensure effective case monitoring.
Select:
| If "Status" not equal to "Dead" in previous "Follow Up point" If 'Status' = "Dead" then disable all below fields and Enable only these fields Date of Death, Place of Death and Reason for Death Select default value "Not Applicable" | ||
| Date of Death | Calendar | If 'Status' = "Dead" then enable Mandatory Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |
| Place of Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory |
Other Place of Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above |
| Reason for Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory |
Other Reason for Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above |
| Kala Azar Case Status | Spinner | Select:
| First time user will select "Suspected" option only and from second time the user will select either "Confirmed" or "Not Confirmed". The system will display the "Treatment Started" only if the previous status was "Confirmed". Define variable Kala Azar Case with default value = 0 and for every unique confirmed case in the current month Kala Azar Case = Kala Azar Case +1 |
Kala Azar Rapid Diagnostic Test (RDT) | Radio button | Option
| If you have performed an RDT If positive, put a plus (+) in red If negative, put a dash (-) in green If you have not performed an RDT, put a cross X in Yellow |
| Date of Test | Calendar | Mandatory if above field RDT is selected Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |
| Follow Up Point | Spinner | Single Select 1, 2, 3, 4, 5, 6 | If "Kala Azar Case" = "Treatment Started" If "Status" not equal to "Dead" in previous "Follow Up point" Disabled the option (1,2,3,4,5,6) once selected |
| Referred To | Drop Down | Options Primary Health Centre, Community Health Centre, District Hospital, Other Private Hospital, Medical College and Hospital, Referral Hospital, Other | |
Other Referred Facility | Text Box |
| Required only if "Referred To" = "Other" |
3.12.3 AES/JE Module
This sub-module facilitates the tracking and management of AES/JE cases through household searches, individual case tracking, referral management, and status updates to ensure effective case monitoring.
Name of Data Field | Field Type | Value/ Options | Validation/ Logic/ Condition | ||||
House Hold No. | Numeric |
| Search by household number. | ||||
Head of Family Member Name | Text Box |
|
| ||||
Mobile No. | Numeric |
|
| ||||
| Is there a "सुअर बाराह" near the house ? | Radio Button | Value/Options | Yes, No Single Select Radio Button | ||||
| Name | Text Box | Auto-populated from "Enumeration FM" (First, Middle, Last Name) | |||||
| Father's/Husband's Name | Text Box | "If Gender = Female and Marital Status = Married, auto-populate from 'Spouse Name'. If Gender = Male, auto-populate from 'Father Name'" | |||||
| Age | Numeric | Auto-populated from "Enumeration FM" | |||||
| Gender | Text Box | Auto-populated from "Enumeration FM" | |||||
| Type of House | Text Box | Auto-populated from "Enumeration HH" | |||||
| Caste | Text Box | Auto-populated from "Enumeration HH" | |||||
| Mobile No. | Numeric | Auto-populated from "Enumeration FM" | |||||
| ABHA ID | Numeric | - | Auto-populated from "Enumeration FM" | ||||
| Visit Date | Calendar |
| Allow belated dates till last 3 months from todays date and Not greater than Today's Date | ||||
| Beneficiary Status | Spinner | Select:
| If "Status" not equal to "Dead" in previous "Follow Up point" If 'Status' = "Dead" then disable all below fields and Enable only these fields Date of Death, Place of Death and Reason for Death Select default value "Not Applicable" | ||||
| Date of Death | Calendar | If 'Status' = "Dead" then enable Mandatory Allow belated dates till last 3 months from todays date and Not greater than Today's Date | |||||
| Place of Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory | ||||
Other Place of Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above | ||||
| Reason for Death | Drop Down | Select:
| If 'Status' = "Dead" then enable Mandatory | ||||
Other Reason for Death | Text Box |
| Applicable If 'Status' = "Dead" Enable only if "Other" is selected above | ||||
| AES / JE Case Status | Spinner | Single Select: | |||||
Name of Data Field | Field Type | Value/ Options | Validation/ Logic/ Condition | ||||
House Hold No. | Numeric |
| Search by household number. | ||||
Head of Family Member Name | Text Box |
|
| ||||
Mobile No. | Numeric |
|
| ||||
| Is there a "सुअर बाराह" near the house ? | Radio Button | Value/Options | Yes, No Single Select Radio Button | Name | Text Box | Auto-populated from "Enumeration FM" (First, Middle, Last Name) | Father's/Husband's Name | Text Box | "If Gender = Female and Marital Status = Married, auto-populate from 'Spouse Name'. If Gender = Male, auto-populate from 'Father Name'" | Age | Numeric | Auto-populated from "Enumeration FM" | Gender | Text Box | Auto-populated from "Enumeration FM" | Type of House | Text Box | Auto-populated from "Enumeration HH" | Caste | Text Box | Auto-populated from "Enumeration HH" | Mobile No. | Numeric | Auto-populated from "Enumeration FM" |
| ABHA ID | Numeric | - | Auto-populated from "Enumeration FM" | ||||
| Date | Numeric | Display Today's Date and should be non-editable | |||||
| AES / JE Case Status | Radio Button | Suspected, Confirmed, Not Confirmed, Treatment Started | First time user will select "Suspected" option only and from second time the user will select either "Confirmed" or "Not Confirmed". The system will display the "Treatment Started" only if the previous status was "Confirmed". Define variable Kala Azar AES / JE Case with default value = 0 and for every unique confirmed case in the current month Kala Azar AES / JE Case = Kala Azar AES / JE Case +1 | ||||
| Referred To | Drop Down | Primary Health Centre, Community Health Centre, District Hospital, Other Private Hospital, Medical College and Hospital, Referral Hospital, Other, None Single Select Radio Button | |||||
| Other | Text Box | If "Referred To" = "Other" | |||||
| AES / JE Case Status Date | Calendar | Mandatory | |||||
| Follow Up Point | Spinner | Single Select 1, 2, 3, 4, 5, 6 | If "AES / JE | Follow Up Point | Radio Button | If "Kala Azar Case" = "Treatment Started" If "Status" not equal to "Dead" in previous "Follow Up point"1, 2, 3, 4, 5, 6 Single Select Radio ButtonDisabled the option (1,2,3,4,5,6) once selected | |
| Follow Up Date | Calendar | If "Kala Azar Case" = "Treatment Started" If "Status" not equal to "Dead" in previous "Follow Up point" | |||||
| Status | Radio Button | If "Status" not equal to "Dead" in previous "Follow Up point" Recovering, Cured, Dead, Recurrence of Symptoms, Other | |||||
| Referred To | Drop Down | Options Primary Health Centre, Community Health Centre, District Hospital, Other Private Hospital, Medical College and Hospital, Referral Hospital, Other | |||||
Other Referred Facility | Text Box |
| Required only if "Referred To | Other | Text Box | If "Status " = "Other" | |
3.12.4 Filaria Module
The Filaria sub-module tracks filariasis cases by capturing household and individual details, home visit dates, affected body parts, medication distribution under the Mass Drug Administration (MDA) program, and any reported side effects of treatment
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