Versions Compared

Old Version 5

changes.mady.by.user Madhava Ramu N

Saved on

compared with

New Version Current

changes.mady.by.user Madhava Ramu N

Saved on

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

...

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

...

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

...

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
  • 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 status in future.
  • If Marital status = "Married" then enable field "Spouse Name"
  • If "Unmarried" is selected hide below field "Spouse Name"
  • 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” 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 andAge is 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.


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

Condition-1Condition-2Condition-3Condition-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 disabledElderly 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

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

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

II. Other CPHC services:

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

III. RMNCH+A services:

  1. Care in pregnancy and child-birth

...

  1. .
  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.

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
  • Maternal services include:
  • Family Planning services
    • Eligible couple Registration
    • Eligible couple Tracking
  • Maternal Health services
    • Pregnancy Identification and Registration
    • Antenatal Care
    • Delivery
    • Postnatal Care
  • Child Care services include:
    • Newborn Registration
    • HBNC Services
    • HBYC Services
    • Routine Routine Immunization
    • Adolescent Care
  • In Other CPHC services:
      Subcategories:
    • Based
      • upon
    • on Age and
      • Gender, show the following list of items.
    • for 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.
    • 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 "Care for common ENT problems" is selected then show the following list of items in 'reason Reason for visit'

  • Ear
  • Nose
  • Throat

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 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 Reason for visit'

  • Screening
  • Symptomatic
  • First aid for eye injury, trauma

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 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  If 'Subcategory' is "Basic Oral Health Care" is selected then show the following list of items in 'reason 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 "Screening and Basic Management of Mental Health Ailments" is selected, then show the following list of items in 'reason Reason for visit'

  • 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

Based on the selection of above item in the 'Reason for visit', below relevant specialty screening form opens:After the reason for visit is selected, then add chief complaint.

    • 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 SelectionAfter 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 '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.
  • 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
  • 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.

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" photo copy to claim your Incentive.

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

MPA Card
Applicable for ANTRA Injection

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

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 1st 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

  • 1st visit
  • 2nd visit
  • 3rd visit
  • 4th 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 1st Dose" is entered in the Last ANC Visit.
  • If "TD 2nd 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 2nd 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 1st 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 3rd day, remove options 1st and 3rd 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)


  1. 1st Day - Accept date equal to Date of Delivery
  2. 3rd Day – date should be equal to 3rd day after delivery
  3. 7th Day – date should be between Delivery + 7 (-3 and +3 ) in days
  4. 14th Day - date should be between Delivery + 14 (-3 and +3) in days.
  5. 21st Day - date should be between Delivery + 21 (-3 and +3 ) in days.
  6. 28th Day - date should be between Delivery + 28 (-3 and +3 ) in days
  7. 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
    1. Probable Cause of Death
    2. Date of Death
    3. 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

...