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Mobile Health & Wellness Centre Application

Version 1.0

Document Revision History

Date	Version Number	Author	Approved By	Document change reference
	1.0			Initial Draft

Table of Contents

Introduction

Document Purpose

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mHWC App Comprehensive Care workflow diagram:Image Removed

Image Added

Mobile App mockup screens

Mockup for landing page Home, Dashboard and RMNCH sections:
Image RemovedImage Added

General OPD workflow diagram

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Photo of the beneficiary	Name	Beneficiary ID
	Age (years)/ Gender	Phone Number
	Village Name	ABHA ID (ABHA registration)

S. No	Data Field	Field Type	Value/ Options	Validations/ Logic
	Patient Registration	Text		Header
	Photo	Image		On clicking Tap to take photo it must enable the camera to click the photo of the Beneficiary This should have the ability to retrieve the patients data associated with the photo already registered This should have Face detection feature
	Village Name	Dropdown		Mandatory Single selection allowed This must auto fetch the dropdown values (Villages) with which the user is aligned.
	First Name	Text		Mandatory Speech to Text Feature Allow alphabets, space, hyphen
	Last Name	Text		Optional Speech to Text Feature Allow alphabets, space, hyphens Make it editable with pencil icon, if there is change in the status of woman (un married to married)
	Father's Name	Text		Mandatory if '"Status of Women"= "Adolescent", "Unmarried" Speech to Text Feature Allow alphabets, space, hyphens
	Phone number	Number		Optional Allow Numerical values only Speech to Text Feature Should be a 10 digit Mobile number starting with 6,7,8,9 number
	Date of Birth	Calendar	DD-MM-YYYY	Optional (if someone does not remember/ know their DOB as in elderlies) Calendar date picker On selecting the date of Birth it must auto calculate the age in Years Auto populate the age in Age Field
	Age	Date Picker	Years (mandatory), months and days (optional if manually filled)	Mandatory Editable by CHO/Registrar Should be auto calculated and auto filled from date of birth but if it is not available then it should have an option for the CHO to manually enter age Format should be Years, Months, Days. Years should be mandatory, months and days if filled manually can be optional.
	Gender	Drop down	Female Male Transgender	Mandatory Single selection

Default is Select

If Gender is female and Age is 10 Years to less than 15 Years then also show in Adolescent section If Gender is male and Age is 10 to 19 Years then also show in Adolescent section
	Marital Status	Dropdown	Unmarried Married Divorced Separated Widow Widower	Mandatory and single selection Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years) Show this field once above Gender is selected Editable, if there is any change in the

marital

Marital status in future.
If

marital

Marital status = "Married" then enable field "Spouse Name"
If "Unmarried" is selected hide below field "Spouse Name

Text

Mandatory
Speech to Text Feature
Allow alphabets, space, hyphens
Should be enabled if marital status = "Married"

Status of Women

Dropdown

Eligible couple (EC)
Pregnant Woman (PW)
Post Natal Mother
Elderly
Adolescent
Permanent sterilization
Not applicable

Mandatory

Should be enabled if Gender= "Female"

If marital status = "Married" and pregnancy status = "Eligible couple", move the woman in eligible couple due list

If marital status = "Married" and pregnancy status = "Pregnant Woman", move the woman in ANC due list and capture details in "Pregnancy identification and registration" module

If marital status = "Married" and pregnancy status = "Post Natal mother", move the woman in PNC due list for ASHAs and capture details in the postnatal care module.
Acceptance Criteria:

If Gender is female, Age is 10-19 Years and Marital Status = "Unmarried" enable only Adolescent Girl option

If Gender is female, Age is >=15 Years and Marital Status = "Married" enable EC, PW, Postnatal Mother and Permanently Sterilized options

If gender is female, age is 15-19 years and marital status is married then enable EC, PW, post natal mother, permanent sterilization options

If Gender is female, Age is 20-49 Years and Marital Status = "Married" show EC, PW, Postnatal Mother and Permanently Sterilized

If Gender is female, Age is

" If "Unmarried" is selected, 'Status of Woman' is based on the below condition (i.e. Adolescent/ No Applicable) Based on the 'Gender' values in this dropdown list should change as follows: In case of 'Gender' = "Female" show "Widow" and hide "Widower" In case of 'Gender' = "Male" show "Widower" and hide "Widow" If "Married" is selected, show option to add Spouse Name (Husband/ Wife) In case of "Unmarried", allow to edit this field and update, open/ add "Spouse" details
	Spouse Name	Textbox	Husband's/ Wife's Name	Mandatory Speech to Text Feature Allow alphabets Should be enabled if marital status = "Married"
	Status of Women	Dropdown	Eligible couple Pregnant Woman Postnatal Mother Elderly Woman Adolescent Permanently Sterilised Not applicable	Mandatory Should enable if Gender = "Female" The options in the "Status of Women" field should be based on Age criteria as per four conditions defined in the below table and based on 'Marital Status'. If Marital status = "Married" and 'Status of Women' = "Eligible couple", then move the woman to 'Eligible Couple' due list If Marital status = "Married" and 'Status of Women' = "Pregnant Woman", then move the woman to Pregnant Woman due list and capture details for "Pregnancy identification and registration" and move to ANC due list If Marital status = "Married" and 'Status of Women' = "Postnatal Mother", then move the woman in PNC due list and capture details in the postnatal care module. Acceptance Criteria: “Not Applicable” choice is applicable only in “unmarried” case If Age is 15-19 Years and Marital Status= “Unmarried” then default value is “Adolescent Girl” If Age is 20-49 Years and Marital Status=

"Unmarried" show only "Not Applicable"

“Unmarried” then default value is “Not Applicable”
If Age is 50 Years and above, then default value is “Elderly Woman” (Marital Status can be anything)
If Age is 15-49 Years and Marital Status= “Married” then show list as per below Condition-4
If Age is 20-49 Years and ‘Status of Women’ = “Not Applicable”, then in this case Edit of ‘Status of Women’ is allowed as per below age criteria conditions, in “Married” case
If Age is 15-19 Years then ‘Status of Women’ = “Adolescent Girl” and in this case Edit of ‘Status of Women’ is allowed as per below age criteria conditions, in “Married” case

If Gender is female and Age is 20 and above, do not show Adolescent Girl option.

ABHA ID

Textbox

Mandatory if enabled
14-digit unique numeric identifier
Accept numeric (integer) value only

If Gender is female andAge is

50 and above, show only Elderly Woman.

Does the beneficiary have ABHA ID

Yes
No

Mandatory
If yes, enable next field where ABHA number can be input
If no, show alert to counsel the beneficiary to enroll and get an ABHA (Ayushman Bharat Health Account)

15-19 Years then also show this record in Adolescent section

Cancel	Button		If cancel is selected, a pop up message "Are you Sure?" with options "Yes" and "No" will come. If selected "yes" navigate back to home page If selected "no" then do not erase the patient health data and let the page remain open so it can be submitted by CHO as sometime by mistake cancel button is clicked.
	Submit	Button		On clicking this, it must display the Pop up msg "Patient Registered successfully" This must store the data of the patient and display the required fields over the Beneficiary card This Beneficiary Card must be visible in CHO and Staff Nurse role. Ensure that data should go to server.
	Edit Edit option after Registration details of beneficiary is submitted.	Pencil Button (click to edit)		On clicking this, it must navigate to the Page filled by CHO to edit and at the end "OK" button. On clicking "OK" it must display the Pop up msg "Patient details edited successfully" Make the following fields editable with a pencil icon- Last name (If status of woman changes in future) Phone number Status of woman Age if CHO has to manually enter it instead of being auto calculated from date of birth.

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The options in the "Status of Women" field should be based on Age criteria as defined in the below 4 conditions:

Condition-1

Condition-2

Condition-3

Condition-4

Show only "Adolescent Girl" for age 15 to 19 years and 'Marital Status'= “Unmarried”

After Age 20 years, the "Adolescent Girl" option should be disabled

Elderly Women (Age 50 years and above)

Women Age 20 to 49 Years and 'Marital Status' = “Married”

If Age is 15 to 49 years and 'Marital Status' = “Married”show only below options:

Eligible Couple
Pregnant Woman
Postnatal Mother
Permanently Sterilised

Display "Elderly Woman" only for individuals age 50 years and above.

Show only below options:

Eligible Couple
Pregnant Woman
Postnatal Mother
Permanently Sterilised

List of 12 Comprehensive Primary Health Care (CPHC) Services

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S No	CPHC Services
1

Care in pregnancy and child-birth

...

.
2	Neonatal and infant health care services

...

.
3	Childhood and adolescent health care services.
4	Family planning, Contraceptive services and other Reproductive Health Care services.
5	Management of Communicable diseases including National Health Programmes.
6	Management of Common Communicable Diseases and Outpatient care for acute simple illnesses and minor ailments.
7	Screening, Prevention, Control and Management of Non-Communicable diseases.
8	Care for Common Ophthalmic and ENT problems.
9	Basic Oral health care.
10	Elderly and Palliative health care services.
11	Emergency Medical Services.
12	Screening and Basic management of Mental health ailments.

In the mHWC App with reference to the above Comprehensive Care workflow diagram, all 12 CPHC services are split in to 3 parts to easily manage the workflow and service delivery as follows:

I. General OPD services

Management of Communicable diseases including National Health Programmes.
Management of Common Communicable Diseases and Outpatient care for acute simple illnesses and minor ailments.
Emergency Medical Services.

II. Other CPHC services:

Screening, Prevention, Control and Management of Non-Communicable diseases.
Care for Common Ophthalmic and ENT problems.
Basic Oral health care.
Elderly and Palliative health care services.
Screening and Basic management of Mental health ailments.

III. RMNCH+A services:

Care in pregnancy and child-birth.
Neonatal and infant health care services.
Childhood and adolescent health care services.
Family planning, Contraceptive services and other Reproductive Health Care services.

All 12 CPHC services are handled and managed based on Gender, Age and Status of Woman.

Beneficiary record can be fetch by search or new registration and by clicking on the beneficiary card, CHO will have the option to select General OPD services or other CPHC services.
The RMNCH+A services are available under a separate section "RMNCH" tab adjacent to the home tab.
In RMNCH+A module there two sub-categories of services are available based on below condition:
- Maternal Health services: Gender is Female and Age between 15 years to 49 years
- Child Care services: Age < 15 year

Maternal Health services include:
Family Planning services
- Eligible couple Tracking
Maternal care services
- Pregnancy Identification and Registration
- Antenatal Care
- Delivery
- Postnatal Care
Child Care services include:
- Newborn Registration
- Routine Immunization
- Adolescent Care
In Other CPHC services:
- Based on Age and Gender, services are available by selecting
- Subcategory and relevant
- Reason for visit and relevant specialty screening form is enabled

Patient Visit flow

Under 'Visit Details': Category: 1. Out Patient care or 2. Other CPHC services is selected

Selecting "New Chief complaint" or "Follow up" is required

I. Out Patient care

Select "New Chief complaint" or "Follow up"
Capture Vitals
Proceed to Prescription

II. Other CPHC services

Select "New Chief complaint" or "Follow up"
Select Subcategory
Select Reason for visit
Proceed to open relevant specialty screening form
Capture Vitals
Proceed to Prescription

III. RMNCH+A services

All these services are available under RMNCH section
To avail these services go to RMNCH tab
Respective beneficiary line listing is available under relevant sub-section, after beneficiary registration or search

Other CPHC services are based on selection of items in the 'Subcategory', as follows:

1. If 'Subcategory' is

On selecting Other CPHC services:

Subcategories: Based upon age and gender, show the following list of items.

All age groups, all genders: Care for common ENT problems, Care for Common Ophthalmic problems, Basic Oral health care, Screening and Basic management of Mental health ailments.

...

"Care for common ENT problems" is selected then show the following list of items in '

...

Reason for visit'

Ear
Nose
Throat

...

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:

If Ear If ear is selected, enable Ear diagnosis and Management form
If nose Nose is selected, enable Nose diagnosis and Management form
If throat Throat is selected, enable Throat diagnosis and Management form

2. If 'Subcategory' is "Care for common ophthalmology problems" is selected then show the following list of items in '

...

Reason for visit'

Screening
Symptomatic
First aid for eye injury, traumaAfter the reason for visit is selected, then add chief complaint.

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:

If Screening is selected enable module on "Screening for blindness and refractive errors"
If Symptomatic, "Case identification" and "Treatment and follow up" fields must be completed.
If First aid for eye injury, trauma is selected, enable "Screening for Injury and Trauma"

3. If 'Subcategory' is "Basic Oral Health Care" is selected then show the following list of items in '

...

Reason for visit'

Dental

...

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:

Oral Health form

...

4. If 'Subcategory' is

- Mental Health- Age & Gender Flow

If "Screening and Basic Management of Mental Health Ailments" is selected, then show the following list of items in 'reason Reason for visit', based on age and status of the beneficiary.

...

'

Emotional or behavioural concerns- Fatigue/Sleep Disturbances/low mood
Substance use related concerns
Thoughts of self-harm or suicide
Memory loss or confusion
Seizures / fits or loss of consciousness

System Behaviour After Reason for Visit Selection

After the

reason for visit

is selected, then add

chief complaint

.

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:

- If Emotional or behavioural concerns is selected, enable PHQ 9 form.
- If Substance use related concerns is selected, enable Substance Use screening form.
- If Thoughts of self-harm or suicide is selected, enable PHQ 9 form followed by Suicide Risk screening form.
- If Memory loss or confusion is selected, enable Dementia screening checklist.
- If Seizures / fits or loss of consciousness is selected, enable Epilepsy screening checklist.
Age

&

and Gender Conditions
- If Age < 11 years, Mental Health screening forms shall not open; system shall enable referral workflow only.
- If Age 11–18 years, adolescent alcohol use mental health screening shall be enabled with referral to AFHC / RKSK as applicable
- If Age ≥ 18 years, full mental health screening shall be enabled.
- If Female and Post-partum (≤12 months), depression screening shall be auto-prompted when CMD screening is enabled.
- Suicide risk screening shall apply to all beneficiaries aged ≥11 years, irrespective of gender.
Elderly and Palliative Health- Age & Gender Flow

If 5. If 'Subcategory' is "Elderly & Palliative Health Care" is selected, then show the following list of items in 'reason Reason for visit', based on age and condition.

Reason for Visit – Elderly & Palliative Health

General geriatric complaints
Functional decline or dependency
Memory loss or confusion
Persistent pain
Distressing symptoms (breathlessness, nausea, fatigue, etc.)
Caregiver support or counselling needs

System Behaviour After Reason for Visit Selection

After the

reason for visit

is selected, then add

chief complaint

.

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:

- If General geriatric complaints are selected, enable Elderly Health Assessment form.
- If Functional decline or dependency is selected, enable Functional assessment and counselling section.
- If Memory loss or confusion is selected, enable Dementia screening checklist.
- If Persistent pain or Distressing symptoms is selected, enable Palliative care assessment and symptom management section.
- If Caregiver support or counselling needs are selected, enable Psychosocial and caregiver support section.
Age

&

and Gender Conditions
- - Elderly Health components shall be enabled only if Age ≥ 60 years, irrespective of gender.
  - Palliative Care components shall be available for all age groups and all genders, based on clinical need.
  - Referral shall be enabled if symptoms are severe or beyond CPHC scope.

Synopsis of other CPHC service: Sub Category and Reason for Visit

Condition	Sub Category	Reason for Visit
All Gender All age Group	Care for common ENT problems	Ear (E) Nose (N) Throat (T)
All Gender All age Group	Care for Common Ophthalmic problems	Screening Symptomatic First aid for eye injury, trauma
All Gender All age Group	Basic Oral health care	Dental
All Gender All age Group (except less than 11 years of age- only referral)	Basic management of Mental health ailments.	Emotional or behavioural concerns Substance use related concerns Thoughts of self-harm or suicide Memory loss or confusion Seizures / fits or loss of consciousness
Age Greater than 60 Male/Female	Elderly & Palliative Health Care	General geriatric complaints Functional decline or dependency Persistent pain Distressing symptoms Caregiver support / counselling
Age Greater than 30 Male/Female	Screening, Prevention, Control and Management of Non-Communicable Diseases (NCD)
All Gender All age Group	Management of Communicable Diseases including

National Health Programs

RMNCHA+A: Family Planning services

Eligible Couple Tracking

Name of Data Field	Field Type	Value/ Options	Validation/ Logic/ Condition
Date of Visit	Calendar Date Picker	Is Mandatory Choose the date from the calendar Format: dd-mm-yyyy	Not greater than Today's Date Accept date greater or equal to Date of EC registration should not allow to update in edit or once submitted Monthly only 1 Visit is allowed
Financial Year	Auto-populated	Default Null	Depends on Date of visit visit date based Financial Year
Visit Month	Label	Select Month Default value is current Month	Auto select current Month And should be editable
LMP Date	Calendar Date Picker		Not greater than Today's Date Accept date backing up to 6 Months
Is Pregnancy Test done?	Radio Button	Default Value null Yes No	If "Is Pregnancy Test done?" = "Yes", then the "Pregnancy Test Result" field should be enabled and made mandatory. If "Is Pregnancy Test done?" = "No", then hide the field 'Is the Woman Pregnant?' and If "Is Pregnancy Test done?" = "No" OR "Don't Know", then enable "Are you using any Family Planning Method?" field below.
Pregnancy Test Result	Radio Group	Choose: Negative Positive Default value Null	Default Value null If 'Pregnancy Test Result' = "Positive" then the field 'Is the Woman Pregnant?' set to "Yes" and then move the EC to 'Pregnant Woman' section for PW Registration. Then, 'Status of Woman' should change to "Pregnant Woman". If 'Pregnancy Test Result' = "Negative", then 'Is the Woman Pregnant?' set to "No" and hide this field and then enable "Are you using any Family Planning Method?" field below.
Is the Woman pregnant?	Radio Group	Default Value null Yes No	If "No", enable "Are you using any Family Planning Method?" field below. If "Yes", then move the EC to 'Pregnant Woman' section for PW Registration Then, Status of Woman should change to "Pregnant Woman"
Are you using any Family Planning Method? or Do you want to use any Planning Method?	Radio Group	Choose: Yes / No	Default Value null if "Yes" is chosen, enable "Method of Contraception" field below
Method of Contraception	Spinner	Self ANTRA Injection Copper T (IUCD) Condom Mala N Chaya ECP MALE STERILIZATION FEMALE STERILIZATION MiniLap Any Other Method	'No of Children' = "0", then hide these three items in the dropdown list "FEMALE STERILIZATION", "MALE STERILIZATION" and "Minilap" Default Value null Open "Any Other Method" Text Box on selection of "Any Other Method" option and is mandatory. If "ANTRA Injection" is selected, then enable three fields below 'ANTRA

Injection' "Dose", "Date of Injection" and "Due date of next

Injection

"If

On selecting "ANTRA Injection" or any "Sterilization Method" show alert box: Show an Alert! respectively as below: "Please upload MCA Card photo to claim your Incentive"
"Please upload Discharge summary photo to claim your Incentive"

Any Other Method

Edit Text Box

Default Value Null

Accept alphabets only
Character limit 50

Date of Sterilisation

Calendar

Conditionally Mandatory

Enable only

'

Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected, then update 'Status of Women' to "Permanently Sterilised" and move Women record out of EC and ECT section.

"Dose", "Date of Injection" and "Due date of next Injection"

If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected,

and is Mandatory

Not greater than Today's Date

Accept date back up to 2 months
Show an Alert! Please upload "Discharge Summary" photo copy to claim your Incentive.

then update 'Status of Women' to "Permanently Sterilised" and move Women record out of EC and ECT section. On selecting "ANTRA Injection" or any "Sterilization Method" show alert box: Show an Alert! respectively as below: "Please upload MCA Card photo to claim your Incentive" "Please upload Discharge summary photo to claim your Incentive"
Any Other Method	Edit Text Box	Default Value Null	Accept alphabets only Character limit 50
Date of Sterilisation	Calendar	Conditionally Mandatory	Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected, and is Mandatory

ANTRA Injection - Dose

Spinner

Conditionally Mandatory
Select options:

1st Dose
2nd Dose
3rd Dose
4th Dose
5th Dose to 10th Dose

Enable only "ANTRA Injection" is selected above
for first time show "Dose-1" and next "Dose-2" and next as follows for continuation of dose
Auto select the applicable Dose
If gap is more than 120 days between any 2 doses then restart form "Dose-1"; i.e. beneficiary has to start again from 1st dose

Date of ANTRA Injection

Calendar

Conditionally Mandatory

Format: dd-mm-yyyy

Enable only "ANTRA Injection" is selected above

Not greater than Today's Date
Accept date back up to 2 months

for "Dose-1" and for next Dose validate form 1st dose

Show an Alert! Please upload "

MPA Card

Discharge Summary" photo copy to claim your Incentive.

Due date of next Injection

ANTRA Injection - Dose

Spinner

Conditionally Mandatory
Select options:

1st Dose
2nd Dose
3rd Dose
4th Dose
5th Dose to 10th Dose

Label

Enable only "ANTRA Injection" is selected above

The difference between two doses should not be less than 75 days and more than 120 days.

Auto-calculate next due date & grace period

Next due date & grace period calculation formula: Next due date = Date of ANTRA Injection + 76 Days up to

for first time show "Dose-1" and next "Dose-2" and next as follows for continuation of dose
Auto select the applicable Dose
If gap is more than 120 days between any 2 doses then restart form "Dose-1"

; i.e. beneficiary has to start again from 1st dose

; i.e. beneficiary has to start again from 1st dose

Date of ANTRA Injection

+ 120 Days

MPA Card
Applicable for ANTRA Injection

Calendar

Conditionally Mandatory

Format: dd-mm-yyyy

File upload

Enable only

if 'Method of Contraception' =

"ANTRA Injection" is selected

.

MPA Card

View Image

Option to view images

Enable only if 'Method of Contraception' = "ANTRA Injection" is selected.

Discharge Summary
Applicable for Sterilization Method

File upload

Option to upload 2 images

Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected

Discharge Summary

View Image

Option to view images

Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected

above Not greater than Today's Date Accept date back up to 2 months for "Dose-1" and for next Dose validate form 1st dose
Due date of next Injection	Label	Enable only "ANTRA Injection" is selected above The difference between two doses should not be less than 75 days and more than 120 days. If gap is more than 120 days between any 2 doses then restart form "Dose-1"; i.e. beneficiary has to start again from 1st dose Auto-calculate next due date & grace period Next due date & grace period calculation formula: Next due date = Date of ANTRA Injection + 76 Days up to Date of ANTRA Injection + 120 Days
Submit	Button	If "ANTRA Injection" dose is selected and submitted, then in line listing on the Beneficiary card Indicate with "ANTRA" label and Next due date. If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" is selected, then update 'Status of Women' to "Permanently Sterilised" and move Women record out of EC and ECT section. 'Is the Woman pregnant?' is "Yes", then update 'Status of Woman' to "Pregnant Woman" and navigate to 'Pregnant Woman' registration section, else continue in EC Tracking
ANTRA Injection Details	Table	Applicable only for Beneficiaries "ANTRA Injection" is taken Show under "view" visit details screen Show following details in the tabular format: Dose, Date, Next due date for every Injection dose

Pregnancy Identification & Registration

Should be captured once on the first visit and not every ANC visit.
This should open if the Gender= "Female", Marital Status= "Married", Status of woman= "Pregnant Woman"
Lock it/ No changes allowed once the Woman fills her 1^st ANC visit form, till then edit option to be made available for this form..

S No

Data Field

Field Type

Value/Options

Validation / Logic

RCH ID No. of Woman

Text Box

Default as 0

· Auto-populate from beneficiary details, if id is available or enter here and update in the beneficiary record/ table

· 12-digit unique number

· Accept numeric (integer) value only

· Character limit up to 12

...

Is the pregnancy test conducted at facility?

Dropdown

· Yes

· No

...

· If

...

“yes” enable next question

· If

...

“No”- show alert to conduct UPT (urine pregnancy test)

...

Result of UPT

Dropdown

· Positive

· Negative

...

· If positive → enable LMP and EDD fields

· If negative → take the woman to Eligible couple tracking form

...

LMP

Date

DD/MM/YYYY

· Mandatory if enabled

· LMP is Last Menstrual Period

· Cannot be future date

· Should be within last 42 weeks

...

EDD

Auto-calculated

LMP+ 280 days

· Mandatory if enabled

· Cannot be past or current date, will always be in future.

· Should be auto calculated

· EDD is Expected Date of delivery

· Based on

...

Naegele’s rule (First day of LMP + 9 months + 7 days) i.e (LMP+280 days)

...

Blood Group

Spinner

Choose:

· A +ve

· B +ve

· AB +ve

· O +ve

· A -ve

· B -ve

· AB -ve

· O -ve

...

Gestational Age (Weeks)

Auto-calculated

Display as

"X weeks Y days"

· Mandatory

· Auto-calculated

· Current date minus LMP date

Trimester

Auto-selection

· First

· Second

· Third

...

· Auto-calculated based on gestational age

· Should be classified based on the gestational age in weeks above i.e.

Ø First to be chosen if gestational age is in between 0-12 weeks

Ø Second to be chosen if gestational age is in between 13-26 weeks

Ø Third to be chosen if gestational age is in between 27-40 weeks

Gravida

Number

Numeric

· Mandatory

· Total number of pregnancies including current

· Minimum value will be 1

...

Para

Number

Numeric

· Mandatory

· Cannot exceed gravida

· Auto select

...

“0” if Gravida is 1

· Para is number of deliveries if the fetus reaches a viable gestational age of ≥ 20–24 weeks regardless of the fetus was born alive or stillborn

...

History of abortions

Number

· Yes

· No

...

· Mandatory

· Enable if gravida is more than 1 otherwise the field will be disabled

· If Yes → show alert for HRP (High Risk Pregnancy)

History of previous LSCS

Radio

· Yes

· No

...

· Mandatory

· Enable if gravida is more than 1 otherwise the field will be disabled

· If Yes → show alert for HRP (High Risk Pregnancy)

Any complications in previous pregnancy

Dropdown

· Gestational Diabetes

· Pre-eclampsia

· Eclampsia

· Hemorrhage

· Preterm Birth

· Stillbirth

· None

...

· Mandatory

· Multiple selection

· If selected

...

“None” then only single selection should be enabled. · Show alert for HRP (High Risk Pregnancy) if any option is selected except none · Enable if gravida is more than 1 otherwise the field will be disabled · If Yes → show alert for HRP (High Risk Pregnancy)
	Height (cm)	Number	Numeric Value	· Mandatory · Range to be kept = 100-220 cm · Use for BMI calculation · If <145 cm → show alert for HRP (High Risk Pregnancy
	Weight (Kgs)	Number	Decimal Value	· Mandatory · Range 30-150 kg · Use for BMI calculation
	BMI	Auto calculated and single selection	· Under weight · Normal · Overweight · Obese

...

· Single selection of the option

· Auto-calculated using formula

Weight/(Height/100) ²

· Weight is in Kgs

· Height is in cms

· Display category according :

Ø Underweight (<18.5)

Ø Normal (18.5-24.9) Overweight (25-29.9)

Ø Obese (≥30)

...

Pre-existing conditions

Multi-select

· Hypertension

· Diabetes Mellitus

· Thyroid

· Heart disease

· Epilepsy

· Tuberculosis

· HIV

· Sexually transmitted Infections

· Severe Malnutrition

· Kidney disease

· Auto Immune disorders

...

· Mandatory

· Any selection → show alert for HRP (High Risk Pregnancy)

...

VDRL/RPR Test result

Spinner

Choose:

· Reactive

· Non-Reactive

· Test Not Done

...

· Mandatory

· Reactive → show alert for HRP (High Risk Pregnancy)

...

Date of VDRL/RPR Test done

Calendar

· Choose the date from the calendar

· Date Format: dd-mm-yyyy

...

· Accept date equal to or greater than Date of PW Registration.

· Accept Date of PW registration minus one year

· Not greater than Today's Date

· Disable if "Test Not Done"

...

HIV Test result

Spinner

Choose:

· Reactive

· Non-Reactive

· Test Not Done

...

· Mandatory

· Reactive → show alert for HRP (High Risk Pregnancy)

Date of HIV Test done

Calendar

· Choose the date from the calendar

· Date Format: dd-mm-yyyy

...

· Accept date equal to or greater than Date of PW Registration.

· Not greater than Today's Date

· Disable if "Test Not Done"

· Accept Date of PW registration minus one year

...

HBsAg Test result

Spinner

Choose:

· Positive

· Negative

· Test Not Done

...

· Mandatory

· Reactive → show alert for HRP (High Risk Pregnancy)

Date of HBsAg Test done

Calendar

· Choose the date from the calendar

· Date Format: dd-mm-yyyy

...

· Accept date equal to or greater than Date of PW Registration.

· Not greater than Today's Date

· Disable if "Test Not Done"

· Accept Date of PW registration minus one year

...


	High-Risk Conditions Present?	Auto selected	· Yes

...

· No	· Auto-selection based on algorithm

...

· HRP if any of the condition is present: age <18 yrs or >35 yrs, Height <145 cm, History of abortion, Previous LSCS, Any pre-existing condition selected

Next Button

· Proceed to vital screen and prescription.

After the pregnancy is registered in the app, beneficiary should be added to ASHA's due list for tracking and follow up.
ANC schedule (4 visits minimum as per WHO) should be auto generated after the pregnancy is registered.

...

Antenatal CareVisit

This module should be enabled after the woman is identified as a pregnant woman and registered in the application.
Lock the previous ANC visit form once new ANC visit form is started and give the option to "View" previous ANC visit form. Till the time new ANC visit form is not started the previous form can be edited.
This form will be enabled whenever the woman comes for her ANC visit which is minimum 4 times in her pregnancy.

...

Each visit entry should automatically timestamp the completed ANC and update her status in the application.

Data Field	Field Type	Value/Options	Validation / Logic
Date of ANC Visit	Date	dd-mm-yyyy (to be chosen from calendar)	Mandatory Cannot exceed current date Default date should be null Format dd-mm-yyyy Accept Date after 5 weeks from LMP Date Date less than 4 weeks from Last ANC Date must not be allowed. Accept date greater than Last ANC Date. And not greater than Date "42 weeks of Pregnancy"; i.e. maximum Date is 42 weeks from LMP Date
ANC Visit Number	Auto	1^st visit 2^nd visit 3^rd visit 4^th visit	Mandatory Auto-populated based on the time when data entry happens as it should calculate the number of visit based on prior history but it should be editable. Default Value is auto select based on below conditions Display ANC 1, if "ANC Date" is within 12 weeks from LMP Date. Display ANC 2, if "ANC Date" is between 14- 26 weeks from LMP Date. Display ANC 3, if "ANC Date" is between 28-36 weeks from LMP Date. Display ANC 4, if "ANC Date" is between 36 weeks up to EDD from LMP Date.
Gestational Age (Weeks)	Auto-calculated	Display as "X weeks Y days"	Auto-calculated and mandatory Current date minus LMP date
Weight	Number	Number- kg	Mandatory Accept numbers only Values from 30 to 200 Character limit 3
BP(Systolic)	Number	Numeric- mmHg	Mandatory Accept numeric (integer) value only Values from 50 to 300 Default value 0 If value is < 90 or ≥140 mmHg → show alert for HRP (High Risk Pregnancy)
BP(Diastolic)	Number	Numeric- mmHg	Mandatory Accept numeric (integer) value only Values from 30 to 200 Default Value 0 If value is < 60 or >= 90 mm Hg → show alert for HRP (High Risk Pregnancy)
Blood Sugar (Fasting)	Number	Numeric- mg/dl	Mandatory Range 40-400 mg/dL Show alert if >95mg/dl
Urine Sugar	Dropdown	Negative Trace + ++ +++	Mandatory If selected negative or trace, move to the next question without any alert. + or more → show alert for HRP (High Risk Pregnancy)
Fundal Height	Custom Number Picker	Must accept numeric (integer) value only Character limit 2 Default value null	Disable field up to 12 Weeks of Pregnancy. Accept numeric (integer) value only Accept values up to 2 digits Do not allow decimals
Fetal Heart Rate (FHR)	Number	BPM	Accept decimal numbers only, up to one decimal place Accept values up to 3 digits Allow range minimum 40.0 to maximum 200.0 bpm If FHR<110 bpm→ show alert for bradycardia If FHR>160 bpm→ show alert for tachycardia If <110 or >160 → show alert for HRP (High Risk Pregnancy)
Urine Albumin	Dropdown	Negative Trace + ++ +++	Mandatory If selected negative or trace, move to the next question without any alert. + or more → show alert for HRP (High Risk Pregnancy)
Hb Level	Number	g/dL	Mandatory If <7 → Severe Anemia → show alert for HRP (High Risk Pregnancy)
Date of TD dose 1	Date Picker	dd-mm-yyyy Choose the date from the calendar	TD= Tetanus Diphtheria Format dd-mm-yyyy Accept date between 5 weeks from LMP Date up to 36 Week of LMP Not greater than Today's Date Default Value: to be null if no data is entered. Disable this data field if "TD dose 2" or '"Date of TT Booster Dose" is entered in the Last ANC Visit.
TD dose 2 given	Date Picker	dd-mm-yyyy Choose the date from the calendar	Enable only if TD dose 1 date is documented Accept date after 4 weeks from TD dose 1 given to date up to 36 weeks of LMP Enable this data field if "Date of TD 1^st Dose" is entered in the Last ANC Visit. If "TD 2^nd Dose" is given in the Last ANC Visit, then display a message "All TD doses are given" Not greater than Today's Date Disable this data field if "Date of TD Booster Dose" is entered in the Last ANC Visit. If "TD 2^nd Dose" is given in the Last ANC Visit, then message as "All TD doses have been given" must appear alongside the data field.
TT booster dose given	Date Picker	dd-mm-yyyy Choose the date from the calendar	Mandatory Enable only if TT dose 2 given date is documented Accept date between 5 weeks from LMP Date up to up to 36 Week of LMP Not greater than Today's Date Default Value: to be null if no data is entered. Disable this data field if "Date of TD 1^st Dose" is entered in the Last ANC Visit. If "Date of TD Booster Dose" is entered in the Last ANC Visit, then message as "All TD doses have been given" must appear alongside the data field.
No. of IFA tabs given	Custom Number Picker	Must accept numeric (integer) value only Default Value 0	Disable field up to 12 Weeks of Pregnancy. Default Value: to be null if no data is entered Accept value up to 400
Calcium Given	Custom Number Picker	Must accept numeric (integer) value only Default Value 0	Disable field up to 14 Weeks of Pregnancy. Default Value: to be null if no data is entered Accept value up to 400
Danger Signs	Multi-select	Vaginal Bleeding Swelling of hands, feet or face Severe Headache Blurred Vision Convulsions/ seizures Severe abdominal pain Fever > 38°C Painful urination/ Burning Reduced fetal movement Vaginal fluid leakage Persistent vomiting Breathlessness/ chest pain	Mandatory Multiple selection should be possible On any selection→ show alert for HRP (High Risk Pregnancy)
Counselling Provided	Dropdown	Yes No	If "Yes"→ enable next question
Which counselling was provided?		Nutrition Birth Preparedness and Complication readiness Identification of danger signs Medication compliance (IFA/ Calcium/ other medications) Immunization Hygiene and Infection Prevention	Mandatory if enabled Multiselect Should be enabled if above question is "Yes"
Next ANC Visit Date	Calendar	Choose the date from the calendar Format: dd-mm-yyyy	Greater than Today's Date Should be < = EDD
Next Button			Proceed to vital screen and prescription.

Delivery Outcome

...

Data Field
Field Type
Value/Options
Validation / Logic
Name of the woman
Auto-populated
From pregnancy registration
Auto populate
Display only (non-editable)
Should show: Name, Age, Case ID
Should link to full ANC history
Date of Delivery
Date picker
dd/mm/yyyy
Mandatory
Cannot be future date
Must be ≥ EDD minus 4 weeks (premature) and ≤ EDD plus 2 weeks (post-term)
If >14 days from EDD → Show alert: "Post-term delivery"
If <37 weeks gestation → Auto-flag as "Preterm delivery"
Time of Delivery
Time picker
HH:MM (12-hour format)

Gestational Age at Delivery
Auto-calculated
Weeks + Days (e.g., 38w 5d)
Auto-calculated from LMP/EDD
Non editable
Display only
Based on the classification below show alert-

<28 weeks: Extremely Preterm
28-32 weeks: Very Preterm
32-37 weeks: Moderate to Late Preterm
37-42 weeks: Term
>42 weeks: Post-term
Place of Delivery
Dropdown (Single select)
Sub-Centre
Primary Health Centre (PHC)
Community Health Centre (CHC)
District Hospital (DH)
Medical College Hospital
Referral/Tertiary Hospital
Private Hospital
Home delivery
On the way to facility
Mandatory
If "Home delivery" → Show alert: "Home delivery occurred. Provide counselling on risks. Ensure immediate PNC visit."
If "Private Hospital" → Enable field for hospital name
If "Home delivery" or "On the way" → Show alert for urgent PNC home visit within 24 hours
If Private Hospital, specify name
Text field
text
Enable only if place of delivery = "Private Hospital"
Optional
Free text (100 char limit) -
Delivery conducted by
Dropdown
Doctor (MBBS/Specialist)
Nurse/ANM
CHO
Skilled Birth Attendant (SBA)
Dai/TBA (Traditional Birth Attendant)
Family member
Self/Unassisted
Mandatory
Single selection
If "Dai/TBA", "Family member", or "Self" → Show alert: "Unskilled delivery. High-risk PNC needed."
Mode of Delivery
Dropdown
Normal Vaginal Delivery (NVD)
Vacuum/ Forceps Assisted
Lower Segment Cesarean Section (LSCS)
Emergency LSCS
Vaginal Birth After Cesarean (VBAC)
Mandatory
Single selection
If LSCS/ emergency LSCS/ Assisted→ Enable "Indication for LSCS" field
Indication for LSCS/Emergency LSCS/Assisted
Multi-select checkbox
Fetal distress
Cephalopelvic disproportion (CPD)
Previous LSCS
Malpresentation (Breech/Transverse)
Prolonged/Obstructed labor
Antepartum hemorrhage (APH)
Pre-eclampsia/Eclampsia
Cord prolapse
Failed induction
Multiple pregnancies
Maternal request
Other (specify)
Enable only if Mode of Delivery = LSCS/Assisted
Mandatory if enabled
Multiple selections allowed
If "Other" → Enable text field (200 char)
Mother's Condition Immediately Post-Delivery
Radio button
Healthy/ Stable
Complication (specify)
Critical/ICU admission
Maternal Death
Mandatory
If selected "Complications" or "Critical" → Enable maternal complications field.
If "Maternal Death" → open maternal death audit form
If "Maternal Death" → Show alert "Inform District Nodal Officer" automatically
Maternal Complications
Multi-select checkbox
Post-Partum Hemorrhage (PPH)
Retained placenta
Perineal tear (1st/2nd degree)
Perineal tear (3rd/4th degree)
Uterine rupture
Sepsis/ Infection
Pre-eclampsia/Eclampsia
Blood transfusion required
Hysterectomy performed
Anesthesia complication
Other
Mandatory if enabled
Enable if Mother's Condition Immediately Post-Delivery= "Complications" or "Critical"
Multiple selections allowed
If "PPH" or "Uterine rupture" → show alert for PNC monitoring
If "Hysterectomy" → Automatic family planning counseling adjustment (permanent method done) or take in eligible couple tracking form
Make it editable, for cases if any further complications occur in future.
Mother currently admitted?
Radio button
Yes (Still in hospital)
No (Discharged)

If "No" → Enable discharge date field
Date of Discharge
Date picker
DD/MM/YYYY
To be enabled if Mother currently admitted? = "No"
Mandatory if discharged
Cannot be before delivery date
Should be used to calculate first PNC home visit timing
Next Button

Proceed to vital screen and prescription.

Postnatal Care

...

Condition
This module will open only when the date of discharge is filled in the delivery outcome module and woman will be moved to PNC due list.
This module will be enabled if marital status = "Married" and status of woman = "Post Natal mother", then move the woman in PNC due list for ASHAs and capture details in the post-natal care module.
...
PNC1: 24-48 hours post-delivery (Within 2 days)
PNC2: Day 3 post-delivery
PNC3: Day 7 post-delivery
PNC4: Day 14 post-delivery (2 weeks)
PNC5: Day 21 post-delivery (3 weeks)
PNC6: Day 28 post-delivery (4 weeks)
PNC7: Day 42 post-delivery (6 weeks - Final checkup)

S.No.
Name of Data Field
Field Type
Value/ Options
Validation/ Logic/ Condition
1
Name
Auto-populated
From delivery outcome

Auto-populate form Delivery outcome
Display only
Links to ANC & Delivery history
Non-editable.
2
Date of Delivery
Auto-populated
From delivery outcome
Auto-populate form Delivery outcome
Non editable
3
PNC Visit
Spinner
1st Day
3rd Day
7th Day
14th Day
21st Day
28th Day
42nd Day/ 6th Week
Mandatory
Single selection
If any 'Visit Day' or previous visit is submitted, then don't show that 'Visit Day' in the spinner for next visit. eg- if last PNC visit was done on 3^rd day, remove options 1^st and 3^rd day when next PNC visit is conducted.
Selection should be incremental i.e. 1,3,7,14,21,28,42 days
4
PNC Visit Date
Calendar picker
Format: dd-mm-yyyy
Auto-populate this due date by calculating using below logic
After selecting above 'PNC Visit' and calculate this date from 'date of Delivery'
Not greater than Today's Date
Not less than Date of Delivery
Date of 'next visit' should be incremental
Date of 'next visit' should not be less than 'previous visit' date (always should be greater than 'previous visit' date)

1st Day - Accept date equal to Date of Delivery
3rd Day – date should be equal to 3^rd day after delivery
7th Day – date should be between Delivery + 7 (-3 and +3 ) in days
14th Day - date should be between Delivery + 14 (-3 and +3) in days.
21st Day - date should be between Delivery + 21 (-3 and +3 ) in days.
28th Day - date should be between Delivery + 28 (-3 and +3 ) in days
42nd Day - date should be between Delivery + 42 (-3 and +3 ) in days
5
Maternal Death
Radio Button
Yes
No
Mandatory
Default value is "No"
If "Yes" is selected, enable Q.6 to Q.10 and close the case by directly going to the submit option.
If "No" is selected, disable Q.6 to Q.10 and enable from Q.11 onwards
If "Yes" is selected, enable below three fields and mark it mandatory
Probable Cause of Death
Date of Death
Place of Death
If "Yes" is selected, update 'Beneficiary Status' = "Death" in the Beneficiary record, with "Death Date", "Place of Death" and "Reason for Death" in Beneficiary table and sync to AMRIT
If "Yes" is selected, then disable below fields from S. No. 11 to 20 (are Not applicable)
6
Date of Death
Date Picker
Choose the date from the calendar
Format: dd-mm-yyyy
Mandatory if enabled
Enable if 'Maternal Death' = "Yes"
Not greater than Today's Date
Not less than Delivery Date
7
Cause of maternal death
Spinner
Eclampsia
Hemorrhage (PPH)
Anaemia
High fever
Sepsis
Accident
Other
Mandatory if enabled
Enable if 'Maternal Death' = "Yes"
Open "Other Death Cause" Text Box on selection of "Any Other" option and is mandatory.
If "Accident" is selected mark it as "Non-maternal death"
8
Other
Text

Enable only if "cause of maternal death" = "Other"
Accept alphabets only
Character limit 50
9
Place of Death
Spinner
Home
Subcenter
PHC
CHC
District Hospital
Medical College Hospital
Private Hospital
In Transit
Other
Mandatory if enabled.
Enable if 'Maternal Death' = "Yes"
If 'Place of Death' is selected as "Other" then enable next field, otherwise don't.
10
Other Place of Death
Textbox

Mandatory if enabled.
Enable If 'Place of Death' = "Other"
Accept alphabets only
Character limit 50
11
Maternal Symptoms
Dropdown
Excessive bleeding
Foul-smelling discharge
Fever
Severe abdominal pain
Breast pain
Painful urination
Severe headache
Dizziness
Difficulty breathing
Swelling
Wound pain
Mood changes
None
Other
Mandatory.
Multiple selection
If 2 or more symptoms selected → show alert for referral to facility
If "other" is selected enable next field, otherwise don't.
12
Other maternal symptoms
Text

To be enabled if "Maternal Symptoms" = "Other"
Accept alphabets only
Character limit 50
13
Pallor (Anemia check)
Dropdown
None
Mild
Moderate
Severe

If pallor= "Severe" → show alert for referral to facility
14
Vaginal Bleeding
Dropdown
Normal
Heavy bleeding
Foul-smelling discharge
Scanty
Stopped

Heavy bleeding or foul smell → show alert for referral to facility
15
Family planning method used by the couple after delivery to avoid pregnancy?
Spinner
Choose:
Post partum iucd (PPIUCD)
Condom
Male sterilization
Female sterilization
Post partum sterilization (PPS)
Minilap
None
Other
Default value is select
If "Other" is selected then enable " Other contraception method " Text Box below and is mandatory.
If 'Method of Contraception' = "MALE STERILIZATION" or "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap", then from next PNC visits fields 'Any Method of Postpartum Contraception (PPC)', 'Method of Contraception' and 'Date of Sterilisation' should be disables and show last visit details.
If 'Method of Contraception' is "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap" is selected, then update 'Status of Women' to "Permanently Sterilized" after submission of 42nd Day PNC visit or after 60 Days from Date of Delivery
16
Other contraception method
Text Box

Mandatory if enabled
Accept alphabets, numeric and special character
Character limit 50
17
Date of Sterilization
Calendar
dd-mm-yyyy
Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" or "POST PARTUM STERILIZATION (PPS)"
Mandatory
Not greater than Today's Date
Accept date not less than Date of Delivery
18
No. of IFA Tablets given
Custom Number Picker

Default value 0
IFA supplementation- 180 days postpartum recommended
Accept numeric (integer) value only
Accept value greater than 0
Accept value up to 400
19
Calcium supplementation
Custom Number Picker

Must accept numeric (integer) value only
Default Value 0
Default Value: to be null if no data is entered
Accept value up to 400
20
Next Button

Proceed to vital screen and prescription.

Neonatal Outcome

S. No.	Data Field	Field Type	Value/Options	Validation / Logic
1	Number of neonates	Dropdown	Single (1) Twins (2) Triplets (3) Quadruplets+ (4+)	Mandatory If >1 → Duplicate baby outcome section for each baby Multiple births flagged for special PNC attention This module should be filled separately for each live neonate and generate unique ID for each neonate linked to the same Delivery ID
2	Outcome at Birth	Radio button	Live Birth Still Birth (Macerated) Still Birth (Fresh) Died during delivery	Mandatory If stillbirth/died → open stillbirth audit form and disable remaining fields If stillbirth/ died → Skip growth parameters, go to complications section
3	Sex	Radio button	Male Female Ambiguous	Mandatory If "Ambiguous" → Show alert for pediatric specialist referral
4	Cried immediately after birth?	Radio button	Immediate cry Cried after resuscitation Not applicable (Stillbirth)	To be enabled if Q.2 = "Live Birth" Mandatory If "cried after resuscitation" enable "type of resuscitation" field.
5	Type of resuscitation	Dropdown	Stimulation Suctioning Bag and mask ventilation Oxygen Intubation Chest compressions Medications	Mandatory if enabled To be enabled if Q.4 = "cried after resuscitation" Multiple selections allowed
6	Birth Weight	Number	Capture in grams	Mandatory Validation: Must be between 500-6000g If <2500g → show alert for "Low Birth Weight (LBW)" If <1500g → show alert for "Very Low Birth Weight (VLBW)" If <1000g → show alert for "Extremely Low Birth Weight (ELBW)" If >4000g → show alert

for
for "Macrosomia" (flag for maternal GDM screening)
7
Any congenital anomaly detected?
Radio button
Yes
No
Suspected (under evaluation)

If "Yes" or "Suspected" → Enable type of congenital anomaly field
8
Type of congenital anomaly
Dropdown
Neural tube defect (Spina bifida/Anencephaly)
Cleft lip/palate
Club foot
Down syndrome (suspected)
Congenital heart defect (suspected)
Limb defects
Abdominal wall defect
Genital abnormality
Other
Mandatory if enabled
To be enabled if Q7. = "Yes" or "Suspected"
Multiple selections to be allowed
Enable text field for "Other" specification
9
Other
Textbox
Free text (300 character limit)
Mandatory if enabled
To be enabled if type of congenital anomaly= "Other"
10
Newborn Complications
Dropdown
Birth asphyxia
Respiratory distress
Neonatal jaundice (visible at birth)
Sepsis (suspected)
Hypothermia
Hypoglycemia
Bleeding
Convulsions
None

Multiple selections allowed
Any complication → show alert for immediate pediatric/ specialist review
11
Current Status of Baby
Radio button
Healthy and with mother
Admitted (SNCU/NICU)
Admitted (General ward)
Died
Mandatory
If "Died" → open neonatal death audit form
If "Died" enable Q.12 and disable Q.14 to Q.18
If admitted → show alert for PNC counseling
If "Healthy and with mother" enable directly Q. 14
12
If baby died, cause of death
Multi-select checkbox
Birth asphyxia
Prematurity
Low birth weight complications
Sepsis
Congenital anomaly
Respiratory distress
Unknown
Other (specify)
Enabled if Current Status of Baby

= "Died"
Mandatory if enabled
Multiple causes can contribute
Enable text field for "Other" specification
13
Other
Textbox
Free text (300 character limit)

To be enabled if cause of death of baby= "Other"
14
Birth dose vaccines given?
Dropdown
BCG
Hepatitis B (Birth dose)
OPV-0
None
Mandatory
Multiple selections allowed
If "None" → enable Q.15 to capture the reason for not giving birth dose vaccines
15
Reason for not giving birth dose vaccines
Text field
Free text (200 char)
Mandatory if enabled
To be enabled if Q14 = "None"
Common reasons: Baby unstable, SNCU admission, vaccine unavailable
16
Vitamin K injection given?
Radio button
Yes
No
Mandatory
If "No" → Enable Q.17 to capture reason for not giving Vitamin K injection
17
Reason for not giving Vitamin K injection
Text field
Free text (200 char)
To be enabled if Q16 = "No"
Mandatory if enabled
Common reasons: Baby unstable, SNCU admission, vaccine unavailable
18
Birth Certificate issued?
Radio button
Yes
In process
No (Not applied)
Mandatory
If "No (Not applied)" → show alert to provide information to family stating that birth registration is a legal requirement
19
Next Button

Proceed to vital screen and prescription.

Other CPHC Services

Ear Diagnosis and Management Module

To be enabled if ear related chief complaint.if 'Reason for visit' is "Ear Diagnosis and Management"

Data Field	Field Type	Values / Options	Validation / Logic
Difficulty Hearing		Yes No	Mandatory If Difficulty Hearing= "yes" then enable next field "Whisper test response"
Whisper Test Response	Dropdown	Correct Incorrect	Mandatory if enabled To be enabled if Difficulty Hearing= "yes".
Hearing Test Outcome	Dropdown	Normal Slight Loss Moderate Severe Deaf	Any option other than normal is selected show alert for referral to specialist at the secondary level.
Earache/Ear Pain		Yes No	Mandatory
Ear Discharge Present		Yes No	Mandatory
Foreign Body present in Ear		Yes (superficial) Yes (Deep) No	Optional If selected Yes (Deep) then show alert for referral to specialist at the secondary level.
Type of Ear Condition	Dropdown	Otomycosis Otitis Externa Acute Ear Discharge Chronic Ear Discharge Ear Wax	Mandatory Multiple selection
Congenital Ear Malformation		Yes No	Optional If selected Yes then show alert for referral to specialist at the secondary level.
Next Button			Proceed to vital screen and prescription.

Nose diagnosis and Management Module

To be enabled if

...

'Reason for visit' is "Nose diagnosis and Management"

Data Field	Field Type	Values / Options	Validation / Logic
Difficulty in breathing		Yes No	Mandatory If Yes, show alert to diagnose URI/rhinitis/sinusitis and refer to specialist if not manageable at HWC.
Open Mouth Breathing		Yes No	Mandatory If Yes, show alert to diagnose URI/rhinitis/sinusitis and refer to specialist if not manageable at HWC.
Nose Bleed (Epistaxis)		Yes No	If Yes, enable fields, "Systolic BP" and "Diastolic BP"
Systolic BP	Textbox	mmHg	To be enabled if nose bleed= "yes" Mandatory if enabled If more than 120 mm Hg then show alert for referral to specialist at the secondary level.
Diastolic BP	Textbox	MmHg	To be enabled if nose bleed= "yes" Mandatory if enabled If more than 80 mm Hg then show alert for referral to specialist at the secondary level.
Foreign Body Nose	Yes/No	Yes (anterior visible) Yes (posterior visible) No	Optional If Yes (posterior visible) is selected show alert for referral to specialist at the secondary level.
Sinusitis		Yes (facial pain/tenderness)/ No	Mandatory show alert for referral to specialist at the secondary level for chronic cases.
Next Button			Proceed to vital screen and prescription.

Throat Diagnosis and Management

To be enabled if

...

'Reason for visit' is "Throat Diagnosis and Management"

S No

Data Field

Field Type

Values / Options

Validation / Logic

Symptoms

· Pain

· Soreness

· Cold

· Itching

· Hoarseness

...

· Mandatory

· Multiple selection

...

Swelling in the neck (thyroid)

· Yes

· No

...

· Optional

· If yes show alert for referral to specialist at the secondary level

...

Difficulty in swallowing

· Yes

· No

...

· Optional

· If yes show alert for referral to specialist at the secondary level

...

Tonsillitis

· Yes

· No

...

· Optional

...

Pharyngitis

· Yes

· No

...

· Optional

...

Laryngitis

· Yes

· No

...

· Optional

...

Sinusitis

· Yes

· No

...

· Optional

...

Cleft lip

· Yes

· No

...

· Optional

· If yes show alert for referral to specialist at the secondary level

...

Cleft palate

· Yes

· No

...

· Optional

· If yes show alert for referral to specialist at the secondary level

...


	Next Button			· Proceed to vital screen and prescription.

Care for common ophthalmology problems

Screening for Blindness and Refractive Errors

To be enabled if

...

'Reason for visit' is "Screening"

S No	Name of Data Field	Field Type	Value / Options	Validation / Logic
	Is the patient diabetic?		Yes No	Mandatory If Yes, enable "Screening Performed for Diabetic Patient". If No, go directly to Visual acuity chart used field.
	Screening Performed for Diabetic Patient		Yes No	Mandatory if enabled If Yes, distance Visual Acuity right eye and left eye is mandatory to be filled even if no other complaint.
	Visual Acuity Chart Used	Dropdown	Snellen's distance chart Near vision chart	To be enabled if Is the patient diabetic= "No" Mandatory Single selection
	Distance Visual Acuity – Right Eye	Dropdown	6/6 6/9 6/12 6/18 6/24 6/36 6/60 <6/60	Will be enabled if Is the patient diabetic= "Yes" and if Visual acuity chart used= "Snellen's distance chart" Mandatory Single selection If 6/18 or above options are selected, show alert for "suspected visual impairment", enable module on case identification
	Distance Visual Acuity – Left Eye	Dropdown	6/6 6/9 6/12 6/18 6/24 6/36 6/60 <6/60	Will be enabled if Is the patient diabetic= "Yes", if Visual acuity chart used= "Snellen's distance chart" Mandatory Single selection If 6/18 or above options are selected, show alert for "suspected visual impairment", enable module on case identification
	Near Visual Acuity	Dropdown	N6 N8 N10 N12	Will be enabled if Visual acuity chart used= "Near Vision chart" Mandatory Single selection if reduced near vision with otherwise normal eye exam in adults, enable module on case identification
	Next Button			Proceed to vital screen and prescription only if case identification module is not enabled by any of the fields in this module.

Case Identification Module

To be enabled if Symptomatic is selected as reason for visit
To be enabled if Distance visual acuity for left eye and right eye is 6/18 or above in the Screening for Blindness and Refractive Errors module.
To be enabled if near visual acuity is reduced in the Screening for Blindness and Refractive Errors module.

To be enabled if 'Reason for visit' is "Symptomatic"

S No	Name of Data Field	Field Type	Value / Options	Validation / Logic
	Case Identification and Condition (s)	Multi-select	Cataract Glaucoma Diabetic retinopathy Presbyopia Trachoma Corneal disease Conjunctivitis/Acute red eye Dry eye/ xerophthalmia Eye allergy	Mandatory if visit type= "symptomatic", Visual acuity >= 6/18
	Cataract symptoms		Yes No	Enabled if Case Identification and conditions= "Cataract" If yes= show alert for referral to Ophthalmologist at the secondary level.
	Glaucoma symptoms		Yes No	Enabled if Case Identification and conditions= "Glaucoma" If yes= show alert for referral to Ophthalmologist at the secondary level.
	Diabetic retinopathy symptoms		Yes No	Enabled if Case Identification and conditions= "Diabetic retinopathy" If yes= show alert for referral to Ophthalmologist at the secondary level.
	Presbyopia Symptoms		Yes No	Enabled if Case Identification and conditions= "Presbyopia" If yes then can qualify for presbyopia management (e.g., reading glasses) as per service scope of CHO.
	Trachoma Status	Dropdown	Suspected active trachoma Suspected TT/TI No trachoma	Enabled if Case Identification and conditions= "Trachoma" If suspected active trachoma or Suspected TT/TI is selected, show alert for referral to Ophthalmologist at the secondary level
	Corneal Disease Type	Dropdown	Corneal opacity Corneal ulcer suspected Other corneal pathology	Enabled if Case Identification and conditions= "Corneal disease" Any selection- show alert for referral to Ophthalmologist at the secondary level
	Vitamin A Deficiency symptoms / Bitot's Spot Identified		Yes No	Enabled if Case Identification and conditions= "Dry eye/ xerophthalmia " If Yes, Vitamin A prophylaxis to be given and show alert for referral to Ophthalmologist at the secondary level
	Next Button			Proceed to vital screen and prescription.

Screening for Injury and Trauma Module

...

To be enabled if 'Reason for visit' is "First aid for eye injury/ trauma
...
"
S No
Name of Data Field
Field Type
Value / Options
Validation / Logic

Injury Type
Multi-select
Mechanical foreign body
Blunt trauma
Penetrating injury suspected
Chemical (acid/alkali/other)
Mandatory
.

Foreign Body Removal Attempted
Dropdown
Not attempted
Attempted from conjunctival sac
Foreign body lodged in cornea
Optional
If selected Foreign body lodged in cornea - show alert for referral to Ophthalmologist at the secondary level.

Chemical Exposure – Thorough Wash Performed

Yes
No
Show alert for referral to Ophthalmologist at the secondary level.

Next Button

Proceed to vital screen and prescription.

Oral Health

...

Care

If 'Reason for visit' is "Dental"

S No	Data Field	Field type	Value/ Options	Validation/ Logic
	Tooth Decay Present		Yes No	Mandatory If selected Yes, enable the field "Symptoms of tooth decay"
	Symptoms of tooth decay	Dropdown	Black spot Discoloration of tooth Cavity Hole in the tooth Sensitivity to hot and cold, sweet and sour Food lodgment in the cavity/ between teeth Pain Swelling Pus discharge	To be enabled if Tooth Decay present= "Yes" Multiple selection Mandatory if enabled If yes, Show alert show for referral to Dentist at the secondary level.
	Gum Diseases Present		Yes No	Mandatory If selected Yes, enable the field "Symptoms of Gum diseases"
	Symptoms of Gum diseases	Dropdown	Foul smell Bleeding gums Deposits and discoloration of tooth Loose teeth Widening gap between teeth Swollen gums	To be enabled if Gum diseases present= "Yes" Multiple selection Mandatory if enabled Show alert for referral to Dentist at the secondary level.
	Irregular Teeth/Jaws		Yes No	Optional If yes, Show alert for referral to Dentist at the secondary level.
	Abnormal Growth/Ulcer		Yes No	Optional If yes, Show alert for referral to Dentist at the secondary level.
	Cleft Lip/Palate		Yes No	Optional If yes, Show alert for referral to Dentist at the secondary level.
	Dental Fluorosis		Yes No	Optional If yes, Show alert for referral to Dentist at the secondary level.
	Dental Emergency	Dropdown	Pain Abscess Swelling Tooth Injury Avulsion Non-Healing Ulcer Uncontrolled Bleeding Trauma (Fractured jaw/mobile teeth)	Optional Show alert for referral to Dentist at the secondary level.
	Next Button			Proceed to vital screen and prescription.

Mental Health Screening

...

and Basic Management

...

Other CPHC services >> Screening and Basic Management of Mental Health Ailments
S. No
.
Data Field
Field Type
Value / Options
Validation / System Logic
1
Emotional or behavioural concerns present
Radio
Yes / No
Mandatory

System Behaviour
Auto
—
If Yes → Enable PHQ9 screening
2
Substance use related concerns present
Radio
Yes / No
Mandatory

System Behaviour
Auto
—
If Yes → Enable Substance Use Screening & Brief Intervention
3
Thoughts of self-harm or suicide present
Radio
Yes / No
Mandatory

System Behaviour
Auto
—
If Yes → Immediately enable PHQ 9 form and then Suicide Risk Screening
4
Memory loss or confusion present
Radio
Yes / No
Mandatory

System Behaviour
Auto
—
If Yes → Enable Dementia Screening Checklist
5
Seizures, fits, or loss of consciousness present
Radio
Yes / No
Mandatory

System Behaviour
Auto
—
If Yes → Enable Epilepsy Screening Checklist
6
Post-partum woman (≤12 months after delivery)
Auto (from RMNCH+A)
Yes / No
Auto-derived

System Behaviour
Auto
—
If Yes → Auto-prompt Depression Screening (PHQ-9) for Post-partum Depression
Please note: Please refer to Annexure for details about chief complaints for each sub-section. (Table number No. 2)
PHQ-9 Depression Screening (Auto-enabled)
S No
Data Field
Field Type
Value / Options
Validation / Logic

PHQ-9 Question 1–9
Radio (each question)
Not at all (0), Several days (1), More than half the days (2), Nearly every day (3)
Mandatory

PHQ-9 Total Score
Auto
0–27
Auto-calculated as sum of Q1–Q9

Depression Severity
Auto
Minimal / Mild / Moderate / Moderately Severe / Severe
Derived from total score

System Action
Auto
Psychoeducation / Counselling / Referral
Triggered based on severity category

Referral Alert
System alert
—
If PHQ-9 ≥10 → Refer to MO/PHC; if PHQ-9 ≥15 → Urgent referral; if PHQ-9 ≥20 → Emergency referral

Post-partum Depression Screening Trigger
Auto (RMNCH+A linkage)
≤12 months after delivery
If Yes → PHQ-9 screening is mandatory irrespective of chief complaint
Please note: Please refer to Annexure for details about PHQ-9 questionnaire. (Table number No. 3)
Suicide Risk Screening (after PHQ 9 form screening)
S No
Data Field
Field Type
Value / Options
Validation / System Logic

Thoughts of self-harm or suicide
Radio
Yes / No
Mandatory

Previous suicide attempt
Radio
Yes / No
Mandatory if "Thoughts of self-harm or suicide" = Yes

Current intent or plan
Radio
Yes / No
Mandatory if "Thoughts of self-harm or suicide" = Yes

Access to means
Radio
Yes / No
Mandatory if "Thoughts of self-harm or suicide" = Yes

CHO assesses immediate risk
Radio
Yes / No
Mandatory; based on CHO clinical judgement

Suicide Risk Level
Auto
Low / Moderate / High
Auto-derived from responses and CHO judgement

Referral alert
System alert
—
Mandatory referral if risk level = Moderate or High
...
Alcohol Use Identification (Screening & CategorisationCategorization)
S. No
.
Data Field
Field Type
Value / Options
Validation
1
Current alcohol use
Radio
Yes / No
Mandatory
2
Frequency of alcohol use
Dropdown
Occasional / Regular / Daily
Mandatory if Current alcohol use = Yes
3
Loss of control over drinking
Radio
Yes / No
Mandatory if Current alcohol use = Yes
4
Impact on daily functioning (health, family, work)
Radio
Yes / No
Mandatory if Current alcohol use = Yes
5
Symptoms suggestive of withdrawal
Radio
Yes / No
Mandatory if Current alcohol use = Yes
6
CHO assessment of problematic alcohol use
Radio
Yes / No
Mandatory
7
Alcohol use classification
Auto
Problematic / Non-problematic
System-derived
8
System action
Auto
Brief intervention / Referral
Based on classification

Embedded Classification Logic
Classify as "No problematic alcohol use identified" IF:
...
Please note: Upon completion of screening, the system shall navigate the CHO to a mandatory decision screen with two selectable actions:
(a) "Provide Psychosocial Intervention" or
(b) "Initiate Referral".
The CHO must select one option to proceed further.
Epilepsy & Dementia Screening Checklist (Screen & Refer Only)

Data Field
Field Type
Value / Options
Validation / Logic

Episodes of loss of consciousness
Checkbox
Yes
Optional

Recurrent jerky movements / fits
Checkbox
Yes
Optional

Progressive memory loss
Checkbox
Yes
Optional

Confusion / disorientation
Checkbox
Yes
Optional

Functional decline (daily activities)
Checkbox
Yes
Optional

Screening Outcome
Auto
Suspected / Not suspected
If ANY checkbox selected → Suspected

Referral Required
Auto
Yes / No
Mandatory if suspected

Psychosocial Intervention (on the prescription screen)
Based on screening outcome, the system shall prompt the CHO to either provide psychosocial intervention at HWC level or initiate referral to an appropriate facility.
S No
Data Field
Field Type
Value / Options
Validation / Logic

Psychosocial intervention provided
Radio
Yes / No
Mandatory

Type of intervention
Multi-select
Psychoeducation, Counselling, Stress management, Family counselling
Mandatory if Yes

Session date
Date
dd-mm-yyyy
Cannot exceed current date

Duration (minutes)
Numeric
10–60
Mandatory

Remarks
Text
250 chars
Optional
Referral Management (on the prescription screen)

Data Field
Field Type
Validation / Logic

Referral required
Radio
Yes / No

Referral level
Dropdown
PHC / DMHP / De-addiction centre

Reason for referral
Dropdown
Alcohol dependence suspected, Withdrawal symptoms, Medical complications

Referral date
Auto
System generated
...
Functional impairment present
Withdrawal symptoms suspected
CHO assesses need beyond brief intervention
Follow-Up & Closure

Data Field
Field Type
Value / Options
Validation / Logic

Follow-up required
Radio
Yes / No
Mandatory

Follow-up date
Date
dd-mm-yyyy
Mandatory if Yes

Improvement noted
Radio
Improved / Same / Worse
Mandatory

Repeat PHQ-9
Same as baseline
—
As applicable

Referral escalation required
Radio
Yes / No
Mandatory

Case closure reason
Dropdown
Recovered / Referred / Lost to follow-up / Death
Mandatory on closure
Please note: Please refer to Annexure for details about each sub-section. (Table number #)

Elderly & Palliative Health

...

(Single Module – Two Care Pathways)
Section A: Elderly Health Assessment
(Enabled only if Age ≥ 60 years)

Data Field
Field Type
Value / Options
Validation / Logic

General geriatric complaints present
Radio
Yes / No
Mandatory

Multiple chronic conditions
Checkbox
Yes
Optional

Recent falls
Checkbox
Yes
Optional

Difficulty in walking / balance
Checkbox
Yes
Optional

Visual or hearing difficulty
Checkbox
Yes
Optional

Functional decline / difficulty in daily activities (ADL)
Radio
Yes / No
Mandatory

If Functional decline = Yes
Auto
—
Enable Functional Assessment section

Memory loss or confusion
Radio
Yes / No
Mandatory

If Memory loss = Yes
Auto
—
Enable Dementia Screening Checklist

Referral alert
System Alert
—
Show alert if functional decline or memory loss present

Section B: Dementia Screening Checklist
(Enabled only if Age ≥ 60 years; Screening only – No diagnosis or treatment at CHO level)

Data Field
Field Type
Value / Options
Validation / Logic

Progressive memory loss
Checkbox
Yes
Optional

Disorientation (time/place/person)
Checkbox
Yes
Optional

Behavioural changes
Checkbox
Yes
Optional

Decline in self-care / routine activities
Checkbox
Yes
Optional

Screening Outcome
Auto
Suspected / Not suspected
Suspected if ANY one selected

Referral Required
Auto
Yes / No
Mandatory if suspected

Section C: Palliative Care Identification
(Enabled for all age groups, all genders)

Data Field
Field Type
Value / Options
Validation / Logic

Persistent pain present
Radio
Yes / No
Mandatory

If Pain present = Yes
Auto
—
Enable Pain Assessment section

Distressing symptoms present
Checkbox
Breathlessness / Nausea / Fatigue / Weakness / Other
Optional

Bedridden or severely dependent
Radio
Yes / No
Mandatory

Life-limiting or chronic illness known
Radio
Yes / No
Mandatory

Caregiver support required
Radio
Yes / No
Mandatory

If ANY of the above = Yes
Auto
—
Enable Palliative Care Assessment

Section D: Pain & Symptom Assessment (Palliative)

Data Field
Field Type
Value / Options
Validation / Logic

Pain severity
Dropdown
Mild / Moderate / Severe
Mandatory

Pain duration
Dropdown
<1 month / 1–6 months / >6 months
Mandatory

Other symptoms severity
Dropdown
Mild / Moderate / Severe
Mandatory if symptoms present

Immediate relief provided
Radio
Yes / No
Mandatory

Referral alert
System Alert
—
Show alert if pain = Severe or symptoms uncontrolled

Section E: Psychosocial & Caregiver Support

Data Field
Field Type
Value / Options
Validation / Logic

Psychosocial counselling provided
Radio
Yes / No
Mandatory

Caregiver counselling provided
Radio
Yes / No
Mandatory

Caregiver distress identified
Checkbox
Yes
Optional

Counselling remarks
Text
250 characters
Optional

Section F: Referral & Follow-up

Data Field
Field Type
Value / Options
Validation / Logic

Referral required
Radio
Yes / No
Mandatory

Referral level
Dropdown
PHC / CHC / District Hospital / Palliative Care Unit
Mandatory if Yes

Reason for referral
Dropdown
Severe pain / Functional dependence / Dementia suspected / End-of-life care
Mandatory

Follow-up required
Radio
Yes / No
Mandatory

Follow-up date
Date
dd-mm-yyyy
Mandatory if follow-up required

Section G: Case Closure

Data Field
Field Type
Value / Options
Validation / Logic

Case status
Dropdown
Under care / Referred / Stable / Death
Mandatory

Date of death (if applicable)
Date
dd-mm-yyyy
Mandatory if status = Death

Remarks
Text
250 characters
Optional

Annexure

Table 1: In the chief complain section, CHO will select Chief Complaints related to ENT

Affected Body Part	Chief Complaint
Ear	Ear Pain Ear discharge Difficulty in hearing Ear wax Congenital Ear Malformation Foreign body in ear.
Nose	Pain Nasal discharge Difficulty in breathing open mouth breathing Sinusitis Nosebleed Foreign body in nose.
Throat	Neck swelling Dysphagia Hoarseness Cleft lip Cleft palate Tonsillitis Pharyngitis Laryngitis Sinusitis.
Eye/ Ophthalmic	Diabetic retinopathy Glaucoma Cataract Presbyopia Trachoma Corneal disease Conjunctivitis/Acute red eye Dry eye/ xerophthalmia Eye allergy Eye injuries from blunt trauma, penetrating injury to eye, Chemical exposure (acid/ alkali/other), Foreign body lodged in the eye
Oral Health	Dental Decay Gum diseases Irregular arrangement of teeth and jaws Abnormal growth, patch or ulcers Cleft lip/ palate Dental Fluorosis Dental Emergencies

Table 2: Mental Health – Chief Complaints (for Case Entry)

Category	Condition	Chief Complaints
Common Mental Disorders (CMD)	Depression	Persistent sadness or low mood; Loss of interest in daily activities; Fatigue or low energy; Sleep disturbances; Poor appetite or overeating; Feelings of worthlessness or guilt; Difficulty concentrating
	Anxiety / Panic Disorders	Excessive worry or fear; Restlessness; Palpitations; Shortness of breath; Chest tightness; Trembling or sweating; Sudden panic episodes
	Somatisation Disorders	Multiple body pains without clear cause; Headache; Back pain; Abdominal pain; Generalised weakness; Repeated physical complaints despite normal reports
Severe Mental Disorders (SMD) (Screen & Refer)	Schizophrenia	Hearing voices; Seeing things others cannot see; Suspiciousness or fear without reason; Talking irrelevantly; Social withdrawal; Poor self-care
	Bipolar Disorder	Episodes of extreme happiness or irritability; Reduced need for sleep; Excessive talking or activity; Risk-taking behaviour; Alternating low mood and high energy
	Severe Depression	Persistent low mood with inability to function; Marked withdrawal; Poor self-care; Hopelessness; Suicidal thoughts
Substance Use Disorders (SUD)	Alcohol Use Disorder	Regular alcohol consumption; Loss of control over drinking; Morning drinking; Family or work problems due to alcohol; Tremors or withdrawal symptoms
	Tobacco Use Disorder	Daily smoking or tobacco chewing; Craving for tobacco; Inability to quit despite advice; Health complaints linked to tobacco use
Suicide Risk / Ideation	—	Thoughts of self-harm; Thoughts of ending life; Previous suicide attempt; Expressed hopelessness; Statements about being a burden
Neurological Conditions (Screen & Refer)	Epilepsy	Fits or seizures; Loss of consciousness; Jerky movements; Tongue bite or incontinence during episode; Confusion after episode
	Dementia	Progressive memory loss; Forgetting recent events; Disorientation to time/place; Difficulty managing daily activities; Behavioural changes
Maternal Mental Health	Post-partum Depression	Persistent sadness after childbirth; Excessive crying; Irritability; Difficulty bonding with baby; Sleep problems unrelated to infant care; Feelings of inadequacy

Table 3: PHQ-9 Questions

S. No.	PHQ-9 Question	Field Type	Response Options
1	Little interest or pleasure in doing things	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
2	Feeling down, depressed, or hopeless	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
3	Trouble falling or staying asleep, or sleeping too much	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
4	Feeling tired or having little energy	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
5	Poor appetite or overeating	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
6	Feeling bad about yourself — or that you are a failure or have let yourself or your family down	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
7	Trouble concentrating on things, such as reading the newspaper or watching television	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
8	Moving or speaking so slowly that other people could have noticed, or being unusually restless	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)
9	Thoughts that you would be better off dead or of hurting yourself in some way	Radio Button	Not at all (0) / Several days (1) / More than half the days (2) / Nearly every day (3)

Note: These must be individual radio-button questions, not a single composite field. Scoring Logic (Backend): PHQ9_TOTAL_SCORE = Q1 + Q2 + ... + Q9; Range: 0–27

Table 4. Severity Classification & System Action

Score	Severity	System Action
0–4	Minimal	Psychoeducation
5–9	Mild	Counselling + follow-up
10–14	Moderate	Refer to MO
15–19	Moderately Severe	Urgent referral
20–27	Severe	Emergency referral

Table 5. HRP conditions

High Risk Pregnancy (HRP) Conditions that warrant immediate referral to the higher centre.

History of abortions

Any complications in previous pregnancy

Gestational Diabetes
Pre-eclampsia
Eclampsia
Hemorrhage
Preterm Birth
Stillbirth

Height if <145 cm

Pre-existing conditions

Hypertension
Diabetes Mellitus
Thyroid
Heart disease
Epilepsy
Tuberculosis
HIV
Sexually transmitted Infections
Severe Malnutrition
Kidney disease
Auto Immune disorders
Hepatitis B

Danger Signs

Vaginal Bleeding
Swelling of hands, feet or face
Severe Headache
Blurred Vision
Convulsions/ seizures
Severe abdominal pain
Fever > 38°C
Painful urination/ Burning
Reduced fetal movement
Vaginal fluid leakage
Persistent vomiting
Breathlessness/ chest pain

...

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Key

Introduction

Document Purpose

Patient Visit flow

RMNCHA+A: Family Planning services

Eligible Couple Tracking

Pregnancy Identification & Registration

Antenatal CareVisit

Delivery Outcome

Postnatal Care

Neonatal Outcome

Other CPHC Services

Ear Diagnosis and Management Module

Nose diagnosis and Management Module

Throat Diagnosis and Management

Care for common ophthalmology problems

Screening for Blindness and Refractive Errors

Screening for Injury and Trauma Module

Oral Health

Care

Mental Health Screening

and Basic Management

Elderly & Palliative Health

Annexure

Table 1: In the chief complain section, CHO will select Chief Complaints related to ENT

Table 2: Mental Health – Chief Complaints (for Case Entry)

Table 3: PHQ-9 Questions

Table 4. Severity Classification & System Action

Table 5. HRP conditions

S.No.	Name of Data Field	Field Type	Value/ Options	Validation/ Logic/ Condition
1	Name	Auto-populated	From delivery outcome	Auto-populate form Delivery outcome Display only Links to ANC & Delivery history Non-editable.
2	Date of Delivery	Auto-populated	From delivery outcome	Auto-populate form Delivery outcome Non editable
3	PNC Visit	Spinner	1st Day 3rd Day 7th Day 14th Day 21st Day 28th Day 42nd Day/ 6th Week	Mandatory Single selection If any 'Visit Day' or previous visit is submitted, then don't show that 'Visit Day' in the spinner for next visit. eg- if last PNC visit was done on 3^rd day, remove options 1^st and 3^rd day when next PNC visit is conducted. Selection should be incremental i.e. 1,3,7,14,21,28,42 days
4	PNC Visit Date	Calendar picker	Format: dd-mm-yyyy	Auto-populate this due date by calculating using below logic After selecting above 'PNC Visit' and calculate this date from 'date of Delivery' Not greater than Today's Date Not less than Date of Delivery Date of 'next visit' should be incremental Date of 'next visit' should not be less than 'previous visit' date (always should be greater than 'previous visit' date) 1st Day - Accept date equal to Date of Delivery 3rd Day – date should be equal to 3^rd day after delivery 7th Day – date should be between Delivery + 7 (-3 and +3 ) in days 14th Day - date should be between Delivery + 14 (-3 and +3) in days. 21st Day - date should be between Delivery + 21 (-3 and +3 ) in days. 28th Day - date should be between Delivery + 28 (-3 and +3 ) in days 42nd Day - date should be between Delivery + 42 (-3 and +3 ) in days
5	Maternal Death	Radio Button	Yes No	Mandatory Default value is "No" If "Yes" is selected, enable Q.6 to Q.10 and close the case by directly going to the submit option. If "No" is selected, disable Q.6 to Q.10 and enable from Q.11 onwards If "Yes" is selected, enable below three fields and mark it mandatory Probable Cause of Death Date of Death Place of Death If "Yes" is selected, update 'Beneficiary Status' = "Death" in the Beneficiary record, with "Death Date", "Place of Death" and "Reason for Death" in Beneficiary table and sync to AMRIT If "Yes" is selected, then disable below fields from S. No. 11 to 20 (are Not applicable)
6	Date of Death	Date Picker	Choose the date from the calendar Format: dd-mm-yyyy	Mandatory if enabled Enable if 'Maternal Death' = "Yes" Not greater than Today's Date Not less than Delivery Date
7	Cause of maternal death	Spinner	Eclampsia Hemorrhage (PPH) Anaemia High fever Sepsis Accident Other	Mandatory if enabled Enable if 'Maternal Death' = "Yes" Open "Other Death Cause" Text Box on selection of "Any Other" option and is mandatory. If "Accident" is selected mark it as "Non-maternal death"
8	Other	Text		Enable only if "cause of maternal death" = "Other" Accept alphabets only Character limit 50
9	Place of Death	Spinner	Home Subcenter PHC CHC District Hospital Medical College Hospital Private Hospital In Transit Other	Mandatory if enabled. Enable if 'Maternal Death' = "Yes" If 'Place of Death' is selected as "Other" then enable next field, otherwise don't.
10	Other Place of Death	Textbox		Mandatory if enabled. Enable If 'Place of Death' = "Other" Accept alphabets only Character limit 50
11	Maternal Symptoms	Dropdown	Excessive bleeding Foul-smelling discharge Fever Severe abdominal pain Breast pain Painful urination Severe headache Dizziness Difficulty breathing Swelling Wound pain Mood changes None Other	Mandatory. Multiple selection If 2 or more symptoms selected → show alert for referral to facility If "other" is selected enable next field, otherwise don't.
12	Other maternal symptoms	Text		To be enabled if "Maternal Symptoms" = "Other" Accept alphabets only Character limit 50
13	Pallor (Anemia check)	Dropdown	None Mild Moderate Severe	If pallor= "Severe" → show alert for referral to facility
14	Vaginal Bleeding	Dropdown	Normal Heavy bleeding Foul-smelling discharge Scanty Stopped	Heavy bleeding or foul smell → show alert for referral to facility
15	Family planning method used by the couple after delivery to avoid pregnancy?	Spinner	Choose: Post partum iucd (PPIUCD) Condom Male sterilization Female sterilization Post partum sterilization (PPS) Minilap None Other	Default value is select If "Other" is selected then enable " Other contraception method " Text Box below and is mandatory. If 'Method of Contraception' = "MALE STERILIZATION" or "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap", then from next PNC visits fields 'Any Method of Postpartum Contraception (PPC)', 'Method of Contraception' and 'Date of Sterilisation' should be disables and show last visit details. If 'Method of Contraception' is "FEMALE STERILIZATION" or "POST PARTUM STERILIZATION (PPS)" or "Minilap" is selected, then update 'Status of Women' to "Permanently Sterilized" after submission of 42nd Day PNC visit or after 60 Days from Date of Delivery
16	Other contraception method	Text Box		Mandatory if enabled Accept alphabets, numeric and special character Character limit 50
17	Date of Sterilization	Calendar	dd-mm-yyyy	Enable only If 'Method of Contraception' is "FEMALE STERILIZATION" or "MALE STERILIZATION" or "Minilap" or "POST PARTUM STERILIZATION (PPS)" Mandatory Not greater than Today's Date Accept date not less than Date of Delivery
18	No. of IFA Tablets given	Custom Number Picker		Default value 0 IFA supplementation- 180 days postpartum recommended Accept numeric (integer) value only Accept value greater than 0 Accept value up to 400
19	Calcium supplementation	Custom Number Picker		Must accept numeric (integer) value only Default Value 0 Default Value: to be null if no data is entered Accept value up to 400
20	Next Button			Proceed to vital screen and prescription.

for "Macrosomia" (flag for maternal GDM screening)
7	Any congenital anomaly detected?	Radio button	Yes No Suspected (under evaluation)	If "Yes" or "Suspected" → Enable type of congenital anomaly field
8	Type of congenital anomaly	Dropdown	Neural tube defect (Spina bifida/Anencephaly) Cleft lip/palate Club foot Down syndrome (suspected) Congenital heart defect (suspected) Limb defects Abdominal wall defect Genital abnormality Other	Mandatory if enabled To be enabled if Q7. = "Yes" or "Suspected" Multiple selections to be allowed Enable text field for "Other" specification
9	Other	Textbox	Free text (300 character limit)	Mandatory if enabled To be enabled if type of congenital anomaly= "Other"
10	Newborn Complications	Dropdown	Birth asphyxia Respiratory distress Neonatal jaundice (visible at birth) Sepsis (suspected) Hypothermia Hypoglycemia Bleeding Convulsions None	Multiple selections allowed Any complication → show alert for immediate pediatric/ specialist review
11	Current Status of Baby	Radio button	Healthy and with mother Admitted (SNCU/NICU) Admitted (General ward) Died	Mandatory If "Died" → open neonatal death audit form If "Died" enable Q.12 and disable Q.14 to Q.18 If admitted → show alert for PNC counseling If "Healthy and with mother" enable directly Q. 14
12	If baby died, cause of death	Multi-select checkbox	Birth asphyxia Prematurity Low birth weight complications Sepsis Congenital anomaly Respiratory distress Unknown Other (specify)	Enabled if Current Status of Baby = "Died" Mandatory if enabled Multiple causes can contribute Enable text field for "Other" specification
13	Other	Textbox	Free text (300 character limit)	To be enabled if cause of death of baby= "Other"
14	Birth dose vaccines given?	Dropdown	BCG Hepatitis B (Birth dose) OPV-0 None	Mandatory Multiple selections allowed If "None" → enable Q.15 to capture the reason for not giving birth dose vaccines
15	Reason for not giving birth dose vaccines	Text field	Free text (200 char)	Mandatory if enabled To be enabled if Q14 = "None" Common reasons: Baby unstable, SNCU admission, vaccine unavailable
16	Vitamin K injection given?	Radio button	Yes No	Mandatory If "No" → Enable Q.17 to capture reason for not giving Vitamin K injection
17	Reason for not giving Vitamin K injection	Text field	Free text (200 char)	To be enabled if Q16 = "No" Mandatory if enabled Common reasons: Baby unstable, SNCU admission, vaccine unavailable
18	Birth Certificate issued?	Radio button	Yes In process No (Not applied)	Mandatory If "No (Not applied)" → show alert to provide information to family stating that birth registration is a legal requirement
19	Next Button			Proceed to vital screen and prescription.

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Old Version 3

New Version Current

Key

Introduction

Document Purpose

Patient Visit flow

RMNCHA+A: Family Planning services

Eligible Couple Tracking

Pregnancy Identification & Registration

Antenatal CareVisit

Delivery Outcome

Postnatal Care

Neonatal Outcome

Other CPHC Services

Ear Diagnosis and Management Module

Nose diagnosis and Management Module

Throat Diagnosis and Management

Care for common ophthalmology problems

Screening for Blindness and Refractive Errors

Screening for Injury and Trauma Module

Oral Health

Care

Mental Health Screening

and Basic Management

Elderly & Palliative Health

Annexure

Table 1: In the chief complain section, CHO will select Chief Complaints related to ENT

Table 2: Mental Health – Chief Complaints (for Case Entry)

Table 3: PHQ-9 Questions

Table 4. Severity Classification & System Action

Table 5. HRP conditions