Page History

S No

Name of Data Field

Field Type

Value/ Options

Validation/ Logic/ Condition

1

Separate Kitchen

Spinner

Is Mandatory
Choose:

·       Yes

·       No

2

Type of Fuel used for cooking

Spinner

Is Mandatory
Choose:
Firewood, Crop Residue, Cow Dung Cake, Coal, Kerosene, LPG, Other

3

Other type of fuel used for cooking

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

4

Primary Source of water

Spinner

Is Mandatory
Choose:
Tap Water, Handpump Inside House, Handpump Outside House, Well, Tank, River, Pond, Other

5

Other Source of Water

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

6

Availability of Electricity

Spinner

Is Mandatory
Choose:
Electricity Supply, Generator, Solar Power, Kerosene Lamp, Other

7

Other Availability of electricity

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

8

Availability of Toilet

Spinner

Is Mandatory
Choose:
Flush Toilet with Running Water, Flush Toilet without Water, Pit Toilet with Running Water Supply, Pit Toilet without Water Supply, Other, None

9

Other Availability of Toilet

Textbox

·       Enable if other is selected above

·       Is Mandatory if other is selected above

·       Allow Alphanumeric Character and special Characters

·       Character limit 100

After Household registration is completed, show below alert in pop:
"Do you want to proceed with registration of Head of the family"; "Yes" or "No"
If "Yes", navigate to the Beneficiary Registration
If "No", land back to Household list screen

Field Name

Input Type

Options / Values

Logic & Validations

Date of Registration

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

Beneficiary ID (AMRIT ID)

• Unique ID auto generated by the system

Photo

Camera

Optional

• Should have face detection/ Facial recognition
• Camera should identify & capture human face but not any objects
• Show an Do not show any 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

I want to add a person from*

Radio

·       Public Sector

• Private Sector

This field is not visible in the form/ screen. Will be handled in the backend.       

Mandatory

·       Single select

• Default: Public Sector selected. 

Type of Case Finding*

Radio

·       Passive (Routine programme)

• Active (Active Case Finding)

·This field is not visible in the form/ screen. Will be handled in the backend.          

Mandatory

·       Single select

• Default: Active selected.

First Name*

Text Input

·       Free text

·       Mandatory

·       Only English letters

• No numbers/special characters.

Middle & Last Name*

Text Input

• Free text

·       Mandatory

·       Only English letters

• No numbers/special characters.

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)

• Tuberculosis
• 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 Input

1–99

·       Required.

·       Numeric. Min 1 Max 99 in years

• Either Age or DOB required.

Date of Birth

Date Picker

• Populate automatically if entered

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

Gender*

Radio

·       Male

·       Female

·       Transgender

·       Mandatory

• Single select

Mobile number not available

Checkbox

• If this check box is selected, disable mobile number field.

Primary Phone*

Number

• Mandatory
• In case mobile number is not available, consider this number (9999999999) as mobile number (Will be handeled by default in the backend)

• Exactly 10 digits.

Whose mobile number

dropdown

·       Self

·       Husband

·       Mother

·       Father

·       Family Head

• Other

•  Default select "Self" option.

Address*

Text

• Free text

• Required. Max 2000 chars. Only English letters.
• Default value to be considered as "Village" name

Village*

Dropdown

• Required. 
• Cascaded from block
• Default value selected from location screen or selection to change the village is given from the dropdown list if a beneficiary is from another village. 

Caste*

Radio

·       SC

·       ST

·       Other

·       Mandatory

• Single select

Area*

Radio

·       Tribal-NPVTG

·       Tribal-PVTG

·       Rural

·       Urban

·       Urban Slum

·       Unknown

·       Mandatory

Default Unknown.

Marital Status*

Radio

·       Single

·       Married

·       Unknown

·       Mandatory·       Default Unknown

·       Should be made selectable (Blank) so that user can ask and fill this detail by asking beneficiary.

Are you Pregnant*

 radio button

• Yes
• No

• Enabled if "Marital status"= "Married", "Age">= "15 years" and “Gender”= “Female”
• Mandatory
• If ""Are you pregnant"= "Yes", then referral to NAAT and not digital chest x-ray.

Husband's/ Wife's Name

Textbox

·       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

·        

• Optional
• Accept alphabets only
• Character limit 50

• All letter should be in caps

Mother's Name

Textbox

·        

• Optional
• Accept alphabets only
• Character limit 50

• All letter should be in caps

Occupation*

Dropdown

·       Unknown

·       Student

·       Unemployed

·       Homemaker

·       Farmer

·       Laborer / Daily Wage Worker

·       Self-employed / Business

·       Government Employee

·       Private Employee

·       Health Care Worker

·       Retired / Pensioner

·       Other

·       Mandatory

·       Default Unknown.

Socioeconomic Status*

Radio

·       APL

·       BPL

·       Unknown

·       Mandatory

• Default Unknown.

Weight (Kgs)

Number input

Numeric

Numeric; 1 decimal place allowed.

Height (cms)

Number input

Numeric

Numeric; 1 decimal place allowed.

BMI = Weight / (Height/100)²

Auto-calculated (read-only)

Calculated value

Auto-calculated when both Height and Weight are entered. Formula: Weight ÷ (Height ÷ 100)². Display to 1 decimal place. Non-editable.

Temperature (Degree Fahrenheit)

Radio + free textbox

Free textbox also provided for manual entry.

Normal range shown: 97–99°F.

• Temperature convert into a single variable to directly enter figure. 
• Apply validation for entry in the range minimum 95 and maximum 107 Degree Fahrenheit.
•  Allow one decimal 
• Display labels of -<97 – hypothermia, 97-99 – Normal, >99 – Fever.
• If >99 degree Fahrenheit then show alert for Referral to HWC

Submit

Button

—

Beneficiary moves to Nurse module queue.

Counselling Date

Date picker

Date

Mandatory. Default: Today. Not > Today. Must be >= Registration date.

Counselling Officer Name

Auto-filled (read-only)

Logged-in user

Auto-filled from logged-in Counselling Officer account. Read only.

— PATIENT HEADER (AUTO-FILLED, READ-ONLY) —

Beneficiary Name

Textbox (read-only)

Auto-filled

First Name + Last Name from beneficiary record.

Beneficiary ID (AMRIT ID)

Textbox (read-only)

Auto-filled

From beneficiary record.

Nikshay ID

Textbox (read-only)

Auto-filled

From Diagnostics screen. Read only.

Age / Gender

Textbox (read-only)

Auto-filled

Age (years) and Gender from beneficiary record.

Diagnosis

Textbox (read-only)

Auto-filled

X-ray Result  |  NAAT Result  |  Liquid Culture Result — populated from diagnostic records. Read only.

SECTION A: DISEASE AWARENESS

TB disease explained to patient

Radio button

Yes/ No

Mandatory.

Must be checked before proceeding.

Confirms counsellor has explained TB to the patient.

Transmission route explained

Radio button

Yes/ No

Mandatory.

Symptoms explained

Radio button

Yes/ No

Mandatory.

Treatment duration explained

Radio button

Yes/ No

Mandatory.

Disease awareness notes

Free text

—

Optional. Max 500 chars.

SECTION B: DO'S AND DON'TS

Cover mouth while coughing — advised

Radio button

Yes/ No

Mandatory.

Complete full treatment course — advised

Radio button

Yes/ No

Mandatory.

Regular follow-up attendance — advised

Radio button

Yes/ No

Mandatory.

Nutritional guidance provided

Radio button

Yes/ No

Mandatory.

No smoking / alcohol — advised

Radio button

Yes/ No

Mandatory.

Isolation precautions explained

Radio button

Yes/ No

Mandatory.

Do's & Don'ts notes

Free text

—

Optional. Max 500 chars.

SECTION C: GOVERNMENT SCHEMES

Nikshay Poshan Yojana (NPY) eligibility explained

Radio button

Yes/ No

NPY: DBT of Rs. 1000/month for duration of treatment.

DOTS free treatment explained

Radio button

Yes/ No

 Confirm patient understands treatment is free under NTEP.

Schemes notes

Free text

—

Optional. Max 300 chars.

SECTION D: TREATMENT REGIMEN

Regimen explained to patient

Radio button

Yes/ No

Mandatory.

Medication names explained

Radio button

Yes/ No

Mandatory.

Side effects explained

Radio button

Yes/ No

Mandatory.

Importance of adherence explained

Radio button

Yes/ No

Mandatory.

Treatment regimen notes

Free text

—

Optional. Max 300 chars.

SECTION E: COUNSELLING COMPLETION

Counselling completion status

Radio button

Complete  |  Refused

Mandatory.

Make all the above sections obsolete if “Counselling completion status” = “Refused”

If Refused → enable 'Reason for refusal' field.

Reason for refusal

Free text

—

Mandatory if Counselling status = Refused. Max 300 chars.

Counsellor remarks

Free text

—

Optional. Max 500 chars.

Submit

Option to submit to be given here, so that counsellor can submit and move to another patient. Next Section can be opened at a later date 

SECTION EF: Follow Up to TU

To be done within 15 days

Editable

Has the patient started the prescribed TB treatment regimen?

Radio button

Yes/ No

If No is selected, then enable “Reason for not starting the prescribed TB treatment regimen”

Reason for not starting the prescribed TB treatment regimen

Free text

To be enabled if “Has the patient started the prescribed TB treatment regimen” = “No”

Up to 500 characteristics

Has the patient visited the DOTS centre / referred health facility for treatment collection?

Radio button

Yes/ No

Has the patient reported side effects to the treating doctor or DOTS centre?

Radio button

Yes/ No

Submit

Button

—

Save counselling record. If status = Complete → Nikshay record updated; case marked 'Counselled'.