Date

Version Number

Author

Approved By

Document change reference

General NCD Screening module (Vital check-up)

General OPD module

Dashboard indicators

 Pre Camp Work Plan Preparation Module

UI Field Name 

Field Type 

Options 

Validations 

"

STOP TB" Application

Logo 

<Placeholder> 

Please Select your Language 

Radio

Button 

• English 

• Hindi 

• The fields and labels must populate in the language selected by the

• user 

Username 

Textbox 

Password

Textbox

Remember Me 

Checkbox 

• When 'Remember Me' checkbox is selected, next time directly allow user to login just by authenticating with

• fingerprint 

Powered by Piramal Foundation 

Text 

• Display on the bottom of the screen

Field Name

Field Type

Value/ Options

Validation/ Logic

Date of registration

Should be auto selected and updated when the volunteer logs in the application to do the screening.

Beneficiary ID (AMRIT ID)

Photo

Camera

Optional

• Should have face detection/ Facial recognition
• Camera should identify & capture human face but not any objects
• Show an Alert if Photo is not captured, just as reminder but Not Mandatory
• Alert: "Do you like to Take Photo", Yes or No If "Yes", open Camera; If "No", go to next

First Name

Text

• Mandatory
• Speech to text feature

Last Name

• Optional
• Speech to text feature

Beneficiary Status

Radio Button

·       Alive

·       Death

·       Enable only in the “Edit” Beneficiary screen

·       Auto-populate, if ‘Death’ is reported from any module

·       Default value is “Alive”

·       If “Death” is selected, enable below four fields and mark it mandatory-

1. Date of Death

2. Time of Death

3. Reason for Death

4. Place of Death or Other Place of Death

Date of Death

Date picker

·       Enable if “Beneficiary status”= “Death”

·       Mandatory if enabled

·       By default, date is null

·       Not greater than Today’s Date

·       Accept ‘Date of Death’ after date of registration

·       Auto-populate, if ‘Death’ is reported from any module (eg: Tuberculosis)

Time of Death

Time picker

·       Show only if above value is “Death”

·       Optional

Reason for Death

(Type of Death)

·       Maternal Death

·       Natural Death

·       Accident

·       Infectious Disease

·       Animal Bite Death

·       Suicide

·       Undetermined

·       Enable if “Beneficiary status”= “Death”

·       Mandatory if enabled

• Show only above value is “Death” and it is Mandatory
• If Gender is Female, and Age is 15-49 Years, show “Maternal Death” in dropdown list otherwise hide

Place of Death

• Home
• Subcenter
• PHC
• CHC
• District Hospital
• Medical College Hospital
• Private Hospital
• In Transit
• Other Place of Death

·       Enable if “Beneficiary status”= “Death”

·       Mandatory if enabled

• If ‘Place of Death’ is selected as “Other Place of Death” then enable below field “Other Place of Death” and is mandatory. 

Other Place of Death

Textbox

• Enable if “Beneficiary status”= “Death”
•  Mandatory if enabled

Age

Number (Years)

• Mandatory
• If DOB unknown, approximate age allowed

Date of Birth

Date Picker

• Populate automatically if entered
• Auto Calculate 'Date of Birth' based on the Age entered

Gender

Dropdown

• Male
• Female
• Transgender
• Prefer not to say

• Mandatory

Mobile Number

Number

• Mandatory
• Speech to text feature

Whose mobile number

dropdown

Marital Status

dropdown

• Unmarried
• Married
• Divorced
• Separated
• Widow
• Widower

• Conditionally Mandatory if gender= female, age>= 15 years and single selection allowed
• Not Applicable for Newborn/ Child/ Adolescent (Age 0 to less than 15 Years)

• 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"

Are you Pregnant

 radio button

• Yes
• No

• Enabled if "Marital status"= "Married"
• Mandatory if enabled
• If ""Are you pregnant"= "Yes", then referral to Truenat and not digital chest x-ray.

Husband's/ Wife's Name

Textbox

• Input

• method: Speech to Text feature
• Optional
• Should be enabled if "Marital status"= Married
• Based on the Gender show label name as: 'Husband's' or 'Wife's Name'
• Accept alphabets only
• Character limit 50
• All letter should be in caps

Father's Name

Textbox

• Input method: Speech to Text feature
• Optional
• Accept alphabets only
• Character limit 50
• All letter should be in caps

Mother's Name

Textbox

Community

radio button

• General
• SC
• ST
• OBC
• OC
• Not Given

• should be editable
• optional

Religion

radio button

• Hindu
• Muslim
• Christian
• Sikhism
• Buddhism
• Jainism
• Parsi
• Other
• Not disclosed

• should be editable
• optional

Economic Status

radio button

• APL
• BPL
• Don't know

• optional

Type of Residential area

radio button

• Rural
• Urban
• Tribal
• Tea Garden
• Other

• optional

Other Type of Residential area

Textbox

• Enable if other is selected above
• Allow Alphanumeric Character and special Characters
• Character limit 100

Occupation

free text

• Default value is unknown

• Optional

Village/ Hamlet

dropdown

• Single selection allowed
• This must auto fetch the dropdown values (Villages) with which the user is aligned.

Sub Centre

dropdown

•  Single selection

Capture Geolocation

• Capture current location details (latitude, longitude, address)

Cancel

Button

• Yes
• No

• 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 volunteer as sometime by mistake cancel button is clicked.

Submit

• 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.

•  Continue next to "TB Screening" Screen

* If "Yes" is selected for any one of the questions below with "*" ; "Refer for "digital chest x-ray" or "Collecting the sputum sample".

** If "Yes" is selected for any one of the questions below with "**" ; "Advise tracing and screening of all family members".

TB Screening

Date 

Calendar 
Date Picker 

Is Mandatory 

• Default value Today's Date 

• Not greater than Today's Date 

• Accept date greater or equal to Date of beneficiary registration 

• should not allow to update in edit or once submitted 

Coughing More than 2 weeks * 

radio button 

•  Yes 
• No 

•  Mandatory

Blood in Sputum * 

radio button 

•  Yes 
• No 

•  Mandatory

Fever > 2 weeks * 

radio button 

•  Yes 
• No 

•  Mandatory

Rise of fever in evening*

radio button 

•  Yes 
• No 

•  Mandatory

Loss of Appetite*

radio button 

•  Yes 
• No 

•  Mandatory

Loss of Weight * 

radio button 

•  Yes 
• No 

•  Mandatory

Night Sweats * 

radio button 

•  Yes 
• No 

•  Mandatory

History of TB *

radio button 

•  Yes 
• No 

•  Mandatory

Are you currently taking Anti TB drugs  **

radio button 

• Yes 
• No 

•  Mandatory

Anyone in Family Currently Suffering from TB **

radio button 

• Yes 
• No 

•  Mandatory

Submit 

Button 

 Continue next to "General Examination"

Fields

Validation

Anthropometric (Optional)

Weight (Kgs) 

- 

Height (cms) 

- 

BMI=Weight/(Height/100) ²  

Should be auto calculated if height and weight details are entered

Vitals (Optional)

Temperature (Degree Fahrenheit) 

• Also give free textbox for manual entry.
• Give predefined options (Normal range= 97-99 F)

a) 97.5

b) 98.5

c) 99.5

d)>= 100

If option d)>= 100 is chosen, show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

Pulse Rate (beats per minute) 

• Also give free textbox for manual entry.

Give predefined options (Normal range= 60-90 BPM)

a) less than 60

b) 60-70

c) 70-80

d) More than 90

If "less than 60" or "more than 90" option is chosen, show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

Systolic Blood Pressure (mmHg)

•  Give space to write measurement

• If >=140 mmHg (High BP) or <90 mmHg (low BP) show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

 Diastolic Blood Pressure (mmHg)

• Give space to write measurement

• If >=90 mmHg (High BP) or <60 mmHg (low BP) show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

Random Blood sugar (mg/dl)

• Give space to write measurement

• If >=100 mm/dl show alert "Refer to Health and Wellness Centre" and show such beneficiaries in "Referral" card in Home

Skip Button

Submit Button

 Continue next to "Diagnostics" Screen

Diagnostics 

Is Digital chest x-ray conducted

• Yes
• No

• To be enabled for everyone except "Are you pregnant" = "Yes"

Digital Chest X-Ray Test Result 

• Positive

• Negative

• Enable only if "Is Digital Chest X-ray conducted"=“Yes”
• If "Positive" is selected, move this case to Confirmed TB cases module and also enable sputum test fields for further testing.

Is Sputum sample collected

• Yes
• No

• To be enabled in the following conditions-

1. If "History of TB" = "Yes"
2. If "Are you pregnant= yes"
3. If "Are you currently taking Anti TB drugs" = "yes"

Recommended for Truenat test

• Yes
• No

• To be enabled if "Are you pregnant= yes" 

Truenat test result

 radio button 

• Positive
• Negative

• Enable only if "Is Truenat conducted"=“Yes”
• Option to edit/ select after submission of the form
• If "Positive" is selected, move this case to Confirmed TB cases module.

Recommended for liquid culture test

• Yes
• No

• To be enabled only if "History of TB" = "Yes", "Currently on Anti-TB drugs" = "Yes"

Liquid Culture test result

 radio button 

• Positive
• Negative

• If "Positive" is selected, move this case to Confirmed TB cases module.
• Option to edit/ select after submission of the form
  

Name of data Field 

Field Type 

Value/ Options 

Validation/ Logic/ Condition Date 

Date 

Calendar Calendar 
Date Picker Picker Mandatory 

Mandatory 

• Default value Today's
Date 
• Date 

• Not greater than Today's
Date 
• Date 

• Accept date greater or equal to Date of beneficiary
registration 
• registration 

• should not allow to update in edit or once
submitted 
• submitted 

Name Name Textbox 

Textbox 

Auto fill from Beneficiary details details 
Show: First Name + Last Name Name 
Read only only 

Age Age Textbox 

Textbox 

Auto fill from Beneficiary details details 
Read only only 

Gender

Textbox Textbox 

Auto fill from Beneficiary details details 
Read only only 

Nikshay ID 

Textbox 

Symptomatic TB 

• Enable if "Yes" is selected

Is Sputum sample collected? 

radio button 

• Yes 
• No 

•  Mandatory

Sputum sample submitted at 

radio button 

• MC 
• DH
• CHC
• PHC
• HWC 

• Enable if "Yes" is selected for 'Is Sputum sample collected?
• HWC= Health and Wellness Centre, PHC= Primary Health Centre, CHC= Community Health Centre, DH= District hospital, MC= Medical College

• for 'Is Sputum sample collected.
• Enable if "Yes" is selected for "Digital Chest X-ray conducted"
• Enable if "Yes" is selected for "NAT conducted"

Is Digital Chest X-ray conducted

• Yes
• No 

• To be auto selected "Yes" if "Is Digital chest x-ray conducted = yes"

Digital Chest X-Ray Test Result 

• Positive

• Negative

• Enable only if "Digital Chest X-ray conducted"=“Yes”
• Auto select the result if "Digital Chest X-Ray Test Result" is already captured in the diagnostics screen.
• Also give option to do manual selection
• If "Positive" is selected, move

Sputum Test result 

radio button 

• Positive 
• Negative 

• Enable if "Yes" is selected for 'Is Sputum sample collected?' 
If positive, move
• this case to Confirmed TB cases module and also enable sputum test fields for further testing.

Asymptomatic TBSputum Test

• To be enabled in the following conditions-

a) If "Digital if "Yes" is selected in any "Asymptomatic Screening fields"TB Chest X-Ray Test done

• Yes
• No 

• Enable only for Asymptomatic TB case 

• If “Yes” is selected enable ‘Nikshay Id’ 

Chest X-Ray Test Result 

• Clinically Diagnosed TB 

• TB Not suspected 

• Enable only “Yes” is selected for X-Ray test 

• Enable only for Asymptomatic TB case 
• If "Clinically diagnosed TB" is selected, move this case to Confirmed TB cases module.

Nikshay ID 

Textbox 

• Enable if "Yes" is selected for 'Is Sputum sample collected.
• Enable if "Yes" is selected for "TB Chest X-ray test done"

Type of suspected TB case 
 

Radio button 

• New case of TB 

• Previously treated TB case 

• DR-TB case 

• Mandatory 

Reason for suspected TB case 

Dropdown 

• Treatment failure 

• TB Relapse/ Recurring symptoms 

• Contact with DR-TB case 

• Treatment after LFU (Lost to Follow-up) 

• Other 

• Enable this field only if “Type of TB case” is “Previously treated TB case” or “DR-TB case” 

Other 

textbox 

• Mandatory if enabled 

• To be enabled if “Reason for suspected TB case” = “Other” 

Result"= "Positive"

b) If "History of TB" = "Yes"

c) If "Are you pregnant= yes"

d) If "Are you currently taking Anti TB drugs" = "yes"

Is Sputum sample collected? 

radio button 

• Yes 
• No 

• To be auto selected "Yes" if "Is Sputum sample collected= yes"

Sputum Sample submitted at

dropdown

• DMC
• DH
• CHC
• PHC
• SC

•  Optional

Is Truenat conducted

radio button 

• Yes
• No 

• To be auto selected "Yes" if "Is Truenat conducted = yes" and "Sputum Sample Collected" = "Yes" or if "Digital Chest X-Ray Test Result" = "Positive"

Truenat test result

 radio button 

• Positive
• Negative

• Enable only if "Is Truenat conducted"=“Yes”
• Option to edit/ select after submission of the form
• Auto select the result if "Truenat test result" is already captured in the diagnostics screen.
• Also give option to do manual selection
• If "Positive" is selected, move this case to Confirmed TB cases module.

Is Liquid culture conducted

radio button 

• Yes
• No 

• To be auto selected "Yes" if "Is liquid culture conducted = yes" and "Sputum Sample Collected" = "Yes"
• To be enabled only if "History of TB" = "Yes", "Currently on Anti-TB drugs" = "Yes"

Liquid Culture test result

 radio button 

• Positive
• Negative

• Auto select the result if "Liquid Culture test result" is already captured in the diagnostics screen.
• Also give option to do manual selection
• If "Positive" is selected,

Has the diagnosis of DR-TB been confirmed? 

Radio button 

• Yes  

• Enable this field only if “type of  suspected TB case”= “Previously treated TB case” or “DR-TB case” 
• Default value is “No”

If “Yes” is selected then
• move this case to Confirmed TB cases module.
• Option to edit/ select after submission of the form
  

Capture Geolocation

• Capture current location details (latitude, longitude, address)

Submit Submit Button 

Button 

Field Name

Field Type

Options

Validation

Filter/ Selection option

Dropdown

The Dropdown Values are

• Today
• January
• February
• March
• April
• May
• June
• July
• August
• September
• October
• November
• December

If this filter is selected, then show all the values of the dashboard indicators pertaining to the time period selected.

Filter/ Selection option

Dropdown

Village/ Hamlet names to be put here

If this filter is selected, then show all the values of the dashboard indicators pertaining to the particular village selected.

Total TB screenings

Total Positives/ Negatives 

Male- Positives/ Negatives 
Female- Positives/ Negatives 
Children (<15 yrs)- Positives/ Negatives 
Others

Card must be yellow in colour

It must auto populate based on the filter selected.

Total number should be shown in bold with sex aggregated data- male, female, Children, others

Total TB suspected cases

Total Positives/ Negatives 

Male- Positives/ Negatives 
Female- Positives/ Negatives 
Children (<15 yrs)- Positives/ Negatives 
Others

Card must be yellow in colour

It must auto populate based on the filter selected.

Total number should be shown in bold with sex aggregated data- male, female, Children, others

Total TB confirmed cases

Total Positives/ Negatives 

Male- Positives/ Negatives 
Female- Positives/ Negatives 
Children (<15 yrs)- Positives/ Negatives 
Others

Card must be yellow in colour

It must auto populate based on the filter selected.

Total number should be shown in bold with sex aggregated data- male, female, Children, others

Total Digital Chest X-Rays conducted

Total Positives/ Negatives

Male- Positive/ Negative
Female- Positive/ Negative
Children (5-15 years)- Positives/ Negatives
Others

Age>= 60 years- Positives/ Negatives

 It must auto populate based on the filter selected.

Total number should be shown in bold with sex aggregated data- male, female, Children, others

Total Sputum collection conducted

Total- Positives/ Negatives

Male- Positives/ Negatives
Female- Positives/ Negatives
Children (<15 yrs)- Positives/ Negatives
Others

Age>= 60 years- Positives/ Negatives

 It must auto populate based on the filter selected.

Total number should be shown in bold with sex aggregated data- male, female, Children, others

Total Truenat tests conducted

Male- Positives/ Negatives
Female- Positives/ Negatives
Children (<15 yrs)- Positives/ Negatives
Others

Age>= 60 years- Positives/ Negatives