Common to all diseases

Patient details

https://www.uthsc.edu/gim/documents/ward-H&P.pdf

Demographic

1. Husbands / Fathers name in full
2. Caste
3. Category
4. Village (Drop Down list)
5. Cluster (Drop Down list)

Socioeconomic

1. Occupation
2. Land Holding
3. Debts
4. BPL Card Holder
5. Income
6. Some measure of rural economic status e.g Kuppuswamy scale - derive from:Education
7. Occupation of the head of the household
8. Income of family

Clinical

1. Duration of illness before diagnosis
2. Treatment at the time of diagnosis
3. Weight at diagnosis
4. Height at diagnosis
5. Waist circumference
6. Hip circumference
7. Current treatment of disease
8. Status of treatment (On treatment, cured, not cured, Not taking treatment etc)
9. Complication
10. Current status of the patient (death, cured) (should be handled via Treatment outcome concept)
11. Associated disease (also a diagnosis?, if so there it can be removed from here)
12. Who has followed up the patient?