|
String
|
Linea di divisione
|
1
|
|
0
|
|
|
|
|
Screening (positive if only one of the following symptoms is positive)
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
2
|
vb1
|
|
|
|
1
|
|
Cough
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
3
|
vb2
|
|
|
|
1
|
|
Fever
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
4
|
vb3
|
|
|
|
1
|
|
Night sweats
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
5
|
vb4
|
|
|
|
1
|
|
Weight loss
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
6
|
vb5
|
|
|
|
1
|
|
Lethargy/ Reduced Playfulness? (only for <15)
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
7
|
vb13
|
|
|
|
1
|
|
Failure to Thrive? (only for <15)
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
8
|
vb14
|
|
|
|
1
|
|
Chest Pain
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
9
|
vb15
|
|
|
|
1
|
|
History of Contact with a person with TB
|
|
|
|
|
|
| | | |
|
String
|
Score Result
|
10
|
vt2
|
0
|
|
|
|
=vb1+vb2+vb3+vb4+vb5+vb13+vb14+vb15
|
TB Screening Score
|
|
|
|
|
|
| | | |
|
String
|
Score Detail
|
11
|
vt1
|
0
|
|
|
|
=vb1+vb2+vb3+vb4+vb5+vb13+vb14+vb15
|
TB Screening Result
|
|
|
|
|
|
| | | |
|
String
|
Linea di divisione
|
12
|
|
0
|
|
|
|
|
Indicate Action Taken
|
|
|
|
|
|
| | | |
|
Boolean (0/1)
|
Check box
|
13
|
vb10
|
|
|
|
|
|
Sputum Smear Ordered
|
|
|
|
|
|
| | | |
|
Positive/Negative/Indet.
|
Select
|
14
|
vt2
|
|
|
|
|
|
Sputum Smear Result
|
vb10
|
|
|
|
|
| | | |
|
Boolean (0/1)
|
Check box
|
15
|
vb11
|
|
|
|
|
|
Chest Xray Ordered
|
|
|
|
|
|
| | | |
|
String
|
Select
|
16
|
vt3
|
|
|
|
|
|
Chest Xray Result
|
vb11
|
|
|
|
|
| | | |
|
Boolean (0/1)
|
Check box
|
17
|
vb12
|
|
|
|
|
|
GeneXpert Ordered
|
|
|
|
|
|
| | | |
|
String
|
Select
|
18
|
vt4
|
|
|
|
|
|
GeneXpert Result
|
vb12
|
|
|
|
|
| | | |
|
Positive/Negative/Indet.
|
Select
|
19
|
vt5
|
|
|
|
|
|
Clinical diagnosis
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
20
|
vt6
|
|
|
|
|
|
Invitation of contacts
|
|
|
|
|
|
| | | |
|
String
|
Select
|
21
|
vt7
|
|
|
|
|
|
Resulting TB Status
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
22
|
vt8
|
|
|
|
|
|
Evaluated for TPT
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
23
|
vt9
|
|
|
|
|
|
Start Anti-TBs
|
|
|
|
|
|
| | | |
|
Datetime
|
Date Picker
|
24
|
vd2
|
|
|
|
|
|
Anti-TBs Start Date
|
|
|
|
|
|
| | | |
|
String
|
Text box
|
25
|
vt10
|
|
|
|
|
|
Facility where patient started on TB treatment
|
|
|
|
|
|
| | | |
|
String
|
Linea di divisione
|
26
|
|
0
|
|
|
|
|
TPT FollowUp
|
|
|
|
|
|
| | | |
|
Datetime
|
Date Picker
|
27
|
vd1
|
|
|
|
|
|
TPT Due Date
|
|
|
|
|
|
| | | |
|
Numeric
|
Text box
|
28
|
vn1
|
|
|
|
|
|
Weight
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
29
|
vb6
|
|
|
|
|
|
Hepatotoxicity?
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
30
|
vb7
|
|
|
|
|
|
Peripheral Neuropathy?
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
31
|
vb8
|
|
|
|
|
|
Does the patient have Rash?
|
|
|
|
|
|
| | | |
|
Boolean (Yes/No)
|
Select
|
32
|
vb9
|
|
|
|
|
|
Others? (e.g. gastrointestinal disturbances)
|
|
|
|
|
|
| | | |
|
String
|
Select
|
33
|
vt1
|
|
|
|
|
|
Adherence Measurement
|
|
|
|
|
|
| | | |
|
Large text
|
Text area
|
34
|
vm1
|
|
|
|
|
|
Action Taken Notes
|
|
|
|
|
|
| | | |
