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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 |
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Mobile No. | Numeric |
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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:
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| 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 TestRDT | 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 Slide 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 | |
| Slide No | Auto Calculate: | ||
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 |
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| 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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