#!/usr/bin/env python3
"""
Bokaro MMU Medical Officer Study Guide - PDF Generator
Uses reportlab for rich formatting
"""

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm, mm
from reportlab.lib.colors import (
    HexColor, white, black, Color
)
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    PageBreak, HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_RIGHT, TA_JUSTIFY
from reportlab.platypus import Flowable
from reportlab.lib import colors
import os

# ── Colour palette ──────────────────────────────────────────────────────────
DARK_BLUE   = HexColor("#1A3C6E")
MID_BLUE    = HexColor("#2E6DA4")
LIGHT_BLUE  = HexColor("#D6E8FA")
TEAL        = HexColor("#0D7377")
LIGHT_TEAL  = HexColor("#D0EFEF")
GREEN       = HexColor("#1E7A3E")
LIGHT_GREEN = HexColor("#D4EDDA")
ORANGE      = HexColor("#C75B00")
LIGHT_ORANGE= HexColor("#FDE8D0")
RED         = HexColor("#B22222")
LIGHT_RED   = HexColor("#FDDEDE")
YELLOW_BG   = HexColor("#FFFBE6")
YELLOW_BORDER= HexColor("#F0C040")
LIGHT_GRAY  = HexColor("#F4F6F9")
MID_GRAY    = HexColor("#8C9BAB")
DARK_GRAY   = HexColor("#2D3436")

OUTPUT_PATH = "/home/daytona/workspace/bokaro-mmu-guide/Bokaro_MMU_MO_Study_Guide.pdf"

# ── Custom Flowables ────────────────────────────────────────────────────────

class ColorBar(Flowable):
    """A full-width horizontal colour bar (used as section dividers)."""
    def __init__(self, color, height=6):
        super().__init__()
        self.bar_color = color
        self.height = height
        self.width = 0

    def wrap(self, availW, availH):
        self.width = availW
        return availW, self.height

    def draw(self):
        self.canv.setFillColor(self.bar_color)
        self.canv.rect(0, 0, self.width, self.height, fill=1, stroke=0)


class SectionHeader(Flowable):
    """Coloured section header banner."""
    def __init__(self, text, bg=DARK_BLUE, fg=white, font_size=13):
        super().__init__()
        self.text = text
        self.bg = bg
        self.fg = fg
        self.font_size = font_size
        self.width = 0
        self.height = 26

    def wrap(self, availW, availH):
        self.width = availW
        return availW, self.height

    def draw(self):
        c = self.canv
        c.setFillColor(self.bg)
        c.roundRect(0, 0, self.width, self.height, 4, fill=1, stroke=0)
        c.setFillColor(self.fg)
        c.setFont("Helvetica-Bold", self.font_size)
        c.drawString(8, 8, self.text)


def header_footer(canvas, doc):
    """Page header and footer on every page after the cover."""
    canvas.saveState()
    w, h = A4
    # Header bar
    canvas.setFillColor(DARK_BLUE)
    canvas.rect(0, h - 28, w, 28, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica-Bold", 9)
    canvas.drawString(18, h - 18, "BOKARO MMU - Medical Officer Study Guide")
    canvas.setFont("Helvetica", 8)
    canvas.drawRightString(w - 18, h - 18, "Piramal Swasthya | Confidential")
    # Footer
    canvas.setFillColor(DARK_BLUE)
    canvas.rect(0, 0, w, 20, fill=1, stroke=0)
    canvas.setFillColor(white)
    canvas.setFont("Helvetica", 8)
    canvas.drawString(18, 6, "For Internal Use Only - Piramal Swasthya MMU Programme, Bokaro, Jharkhand")
    canvas.drawRightString(w - 18, 6, f"Page {doc.page}")
    canvas.restoreState()


# ── Style factory ────────────────────────────────────────────────────────────

def make_styles():
    base = getSampleStyleSheet()

    def ps(name, **kw):
        return ParagraphStyle(name, **kw)

    s = {}
    s["cover_title"] = ps("cover_title",
        fontSize=28, fontName="Helvetica-Bold", textColor=white,
        alignment=TA_CENTER, spaceAfter=6, leading=34)
    s["cover_sub"] = ps("cover_sub",
        fontSize=14, fontName="Helvetica", textColor=HexColor("#D6E8FA"),
        alignment=TA_CENTER, spaceAfter=4, leading=18)
    s["cover_detail"] = ps("cover_detail",
        fontSize=10, fontName="Helvetica", textColor=HexColor("#A8C8E8"),
        alignment=TA_CENTER, spaceAfter=3, leading=14)

    s["toc_title"] = ps("toc_title",
        fontSize=15, fontName="Helvetica-Bold", textColor=DARK_BLUE,
        alignment=TA_CENTER, spaceAfter=10)
    s["toc_item"] = ps("toc_item",
        fontSize=10, fontName="Helvetica", textColor=DARK_GRAY,
        leftIndent=12, spaceAfter=3)

    s["section_title"] = ps("section_title",
        fontSize=14, fontName="Helvetica-Bold", textColor=DARK_BLUE,
        spaceBefore=10, spaceAfter=4)
    s["sub_title"] = ps("sub_title",
        fontSize=11, fontName="Helvetica-Bold", textColor=TEAL,
        spaceBefore=6, spaceAfter=3)
    s["body"] = ps("body",
        fontSize=9.5, fontName="Helvetica", textColor=DARK_GRAY,
        spaceAfter=4, leading=14, alignment=TA_JUSTIFY)
    s["bullet"] = ps("bullet",
        fontSize=9.5, fontName="Helvetica", textColor=DARK_GRAY,
        leftIndent=14, firstLineIndent=-10, spaceAfter=3,
        leading=13, bulletText="\u2022")
    s["bullet2"] = ps("bullet2",
        fontSize=9, fontName="Helvetica", textColor=DARK_GRAY,
        leftIndent=26, firstLineIndent=-10, spaceAfter=2,
        leading=12, bulletText="\u25e6")
    s["note"] = ps("note",
        fontSize=9, fontName="Helvetica-Oblique", textColor=ORANGE,
        spaceAfter=4, leftIndent=8, leading=13)
    s["warning"] = ps("warning",
        fontSize=9, fontName="Helvetica-Bold", textColor=RED,
        spaceAfter=4, leftIndent=8, leading=13)
    s["table_header"] = ps("table_header",
        fontSize=9, fontName="Helvetica-Bold", textColor=white,
        alignment=TA_CENTER)
    s["table_cell"] = ps("table_cell",
        fontSize=8.5, fontName="Helvetica", textColor=DARK_GRAY,
        alignment=TA_LEFT, leading=12)
    s["table_cell_c"] = ps("table_cell_c",
        fontSize=8.5, fontName="Helvetica", textColor=DARK_GRAY,
        alignment=TA_CENTER, leading=12)
    s["highlight"] = ps("highlight",
        fontSize=9.5, fontName="Helvetica-Bold", textColor=GREEN,
        spaceAfter=4, leading=14)
    s["page_title"] = ps("page_title",
        fontSize=18, fontName="Helvetica-Bold", textColor=DARK_BLUE,
        spaceAfter=6, spaceBefore=4, alignment=TA_LEFT)
    return s


def styled_table(data, col_widths, header_bg=DARK_BLUE, alt_bg=LIGHT_GRAY):
    """Build a styled table with alternating row colours."""
    row_count = len(data)
    style_cmds = [
        ("BACKGROUND",   (0, 0), (-1, 0), header_bg),
        ("TEXTCOLOR",    (0, 0), (-1, 0), white),
        ("FONTNAME",     (0, 0), (-1, 0), "Helvetica-Bold"),
        ("FONTSIZE",     (0, 0), (-1, 0), 9),
        ("ALIGN",        (0, 0), (-1, 0), "CENTER"),
        ("VALIGN",       (0, 0), (-1, -1), "MIDDLE"),
        ("ROWBACKGROUNDS",(0, 1), (-1, -1), [white, alt_bg]),
        ("GRID",         (0, 0), (-1, -1), 0.4, MID_GRAY),
        ("TOPPADDING",   (0, 0), (-1, -1), 4),
        ("BOTTOMPADDING",(0, 0), (-1, -1), 4),
        ("LEFTPADDING",  (0, 0), (-1, -1), 5),
        ("RIGHTPADDING", (0, 0), (-1, -1), 5),
        ("FONTNAME",     (0, 1), (-1, -1), "Helvetica"),
        ("FONTSIZE",     (0, 1), (-1, -1), 8.5),
    ]
    return Table(data, colWidths=col_widths, style=TableStyle(style_cmds), repeatRows=1)


def info_box(content_para, bg=LIGHT_BLUE, border=MID_BLUE):
    """Single-cell table acting as a coloured callout box."""
    t = Table([[content_para]], colWidths=[16.5*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",  (0,0), (-1,-1), bg),
        ("BOX",         (0,0), (-1,-1), 1.2, border),
        ("TOPPADDING",  (0,0), (-1,-1), 7),
        ("BOTTOMPADDING",(0,0),(-1,-1), 7),
        ("LEFTPADDING", (0,0), (-1,-1), 10),
        ("RIGHTPADDING",(0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t


# ════════════════════════════════════════════════════════════════════════════
# CONTENT BUILDER
# ════════════════════════════════════════════════════════════════════════════

def build_cover(story, s):
    """Full-page cover."""
    # Top colour block
    story.append(ColorBar(DARK_BLUE, height=220))
    story.append(Spacer(1, 0.3*cm))

    # Title block (using a table to overlay text on the blue bar is tricky
    # with platypus, so we just follow the bar with styled paragraphs)
    cover_data = [
        [Paragraph("BOKARO MMU", s["cover_title"])],
        [Paragraph("Medical Officer Study Guide", s["cover_sub"])],
        [Paragraph("Daily Protocols | Clinical Guidelines | Field Reference", s["cover_detail"])],
        [Spacer(1, 0.3*cm)],
        [Paragraph("Piramal Swasthya | Ispat Sanjeevani & Swasthya Kiran", s["cover_detail"])],
        [Paragraph("Bokaro Steel Plant Region, Jharkhand, India", s["cover_detail"])],
    ]
    cover_bg = Table(cover_data, colWidths=[16.5*cm])
    cover_bg.setStyle(TableStyle([
        ("BACKGROUND",   (0,0),(-1,-1), DARK_BLUE),
        ("TOPPADDING",   (0,0),(-1,-1), 6),
        ("BOTTOMPADDING",(0,0),(-1,-1), 6),
        ("LEFTPADDING",  (0,0),(-1,-1), 18),
        ("RIGHTPADDING", (0,0),(-1,-1), 18),
    ]))
    story.append(cover_bg)
    story.append(Spacer(1, 0.5*cm))
    story.append(ColorBar(TEAL, height=8))
    story.append(Spacer(1, 0.5*cm))

    # Summary cards
    cards = [
        ("PROGRAMME", "Ispat Sanjeevani (SAIL-BSP)\nSwasthya Kiran (BPSCL)"),
        ("LOCATION",  "Bokaro District, Jharkhand"),
        ("MANAGED BY","Piramal Swasthya\n(Piramal Foundation)"),
        ("PURPOSE",   "Preventive | Curative\nReferral | Health Education"),
    ]
    card_style_key = ParagraphStyle("ck", fontSize=8, fontName="Helvetica-Bold",
        textColor=MID_BLUE, alignment=TA_CENTER, leading=11)
    card_style_val = ParagraphStyle("cv", fontSize=9, fontName="Helvetica",
        textColor=DARK_GRAY, alignment=TA_CENTER, leading=12)

    card_data = [[
        Table([[Paragraph(k, card_style_key)],[Paragraph(v, card_style_val)]],
               colWidths=[3.8*cm],
               style=TableStyle([
                   ("BACKGROUND",(0,0),(-1,-1), LIGHT_BLUE),
                   ("BOX",(0,0),(-1,-1),1,MID_BLUE),
                   ("TOPPADDING",(0,0),(-1,-1),6),
                   ("BOTTOMPADDING",(0,0),(-1,-1),6),
               ]))
        for k, v in cards
    ]]
    story.append(Table(card_data, colWidths=[4*cm]*4,
        style=TableStyle([("LEFTPADDING",(0,0),(-1,-1),2),("RIGHTPADDING",(0,0),(-1,-1),2)])))

    story.append(Spacer(1, 0.8*cm))
    story.append(ColorBar(ORANGE, height=4))
    story.append(Spacer(1, 0.4*cm))

    # Disclaimer
    disc = ParagraphStyle("disc", fontSize=8, fontName="Helvetica-Oblique",
        textColor=MID_GRAY, alignment=TA_CENTER, leading=12)
    story.append(Paragraph(
        "This guide is intended for internal use by Piramal Swasthya Medical Officers. "
        "Clinical decisions must always be based on individual patient assessment, "
        "current NHM/MoHFW guidelines, and professional judgement.",
        disc))
    story.append(Spacer(1, 0.4*cm))
    ver = ParagraphStyle("ver", fontSize=8, fontName="Helvetica-Bold",
        textColor=DARK_BLUE, alignment=TA_CENTER)
    story.append(Paragraph("Version 1.0  |  July 2026  |  For Medical Officers - Bokaro MMU", ver))
    story.append(PageBreak())


def build_toc(story, s):
    story.append(Paragraph("TABLE OF CONTENTS", s["toc_title"]))
    story.append(ColorBar(TEAL, height=3))
    story.append(Spacer(1, 0.3*cm))

    toc_items = [
        ("1", "Piramal Swasthya & MMU Programme Overview"),
        ("2", "MMU Team Structure & Roles"),
        ("3", "Daily Pre-Camp Checklist"),
        ("4", "Service Point Workflow - Step by Step"),
        ("5", "Clinical Protocols - Triage & OPD"),
        ("6", "Maternal & Child Health (ANC / PNC / RCH)"),
        ("7", "Communicable Disease Protocols - Malaria, TB, Diarrhea, ARI"),
        ("8", "Non-Communicable Disease (NCD) Management"),
        ("9", "Emergency & Referral Protocols"),
        ("10", "Medicines Available in MMU (Essential Drug List)"),
        ("11", "Diagnostics & Equipment in MMU"),
        ("12", "AMRIT Digital System - Documentation Guide"),
        ("13", "Health Education & Literacy Sessions"),
        ("14", "End-of-Day Closing Protocol"),
        ("15", "Key Contacts & Escalation Matrix"),
        ("16", "Quick Drug Dose Reference"),
        ("17", "Research Evidence Summary"),
    ]
    for num, title in toc_items:
        story.append(Paragraph(
            f"<b>Section {num}</b> &nbsp;&nbsp; {title}",
            s["toc_item"]))
    story.append(PageBreak())


def build_section1(story, s):
    story.append(SectionHeader("SECTION 1 - PIRAMAL SWASTHYA & MMU PROGRAMME OVERVIEW"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("About Piramal Swasthya", s["sub_title"]))
    story.append(Paragraph(
        "Piramal Swasthya Management and Research Institute is a registered non-profit "
        "organisation under the Piramal Foundation, headquartered in Hyderabad. Founded "
        "in 2007 with a team of 1,400+ staff, its mission is to complement government "
        "efforts and advance Universal Health Coverage (UHC) by bringing healthcare "
        "to India's most underserved communities.", s["body"]))

    story.append(Paragraph("Core Values", s["sub_title"]))
    vals = [["Value", "Meaning"],
            ["Knowledge", "Evidence-based, continuously learning"],
            ["Action",    "Doing, not just planning"],
            ["Care",      "People first - patient and community centred"],
            ["Impact",    "Measurable change at scale"]]
    story.append(styled_table(vals, [4*cm, 12.5*cm], header_bg=TEAL))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("MMU Programmes in Bokaro", s["sub_title"]))
    progs = [
        ["Programme", "Partner", "Since", "Coverage", "Reach"],
        ["Ispat Sanjeevani", "Bokaro Steel Plant (SAIL)", "Feb 2016",
         "45 locations/month\n(41 villages + 4 schools)", "1.38 lakh+"],
        ["Swasthya Kiran",   "BPSCL", "Mar 2016",
         "40 villages/month\n(Chas & Jaridih blocks)", "1.34 lakh+"],
        ["Saranda Sanjeevani","SAIL - Kiriburu & Gua Mines","Nov 2023",
         "Communities near iron ore mines\n(West Singhbhum)", "Growing"],
    ]
    story.append(styled_table(progs,
        [3.8*cm, 3.8*cm, 2.2*cm, 4.5*cm, 2.2*cm]))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Programme Vision", s["sub_title"]))
    story.append(info_box(
        Paragraph(
            "<b>\"To transform India's health ecosystem through high-impact solutions, "
            "partnerships, and thought leadership - aligned to Universal Health Coverage.\"</b>",
            ParagraphStyle("qp", fontSize=10, fontName="Helvetica-BoldOblique",
                textColor=DARK_BLUE, alignment=TA_CENTER, leading=16)),
        bg=LIGHT_BLUE, border=MID_BLUE))
    story.append(PageBreak())


def build_section2(story, s):
    story.append(SectionHeader("SECTION 2 - MMU TEAM STRUCTURE & ROLES"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "A standard Piramal Swasthya MMU carries the following team members. "
        "As Medical Officer you are the clinical lead and are responsible for the "
        "quality of all health services delivered at the service point.", s["body"]))

    team = [
        ["Role", "Key Responsibilities", "Reports To"],
        ["Medical Officer (YOU)",
         "OPD consultation, diagnosis, prescription,\nANC/child health review, referral decisions,\nclinical supervision of team",
         "Area Manager"],
        ["Staff Nurse / ANM",
         "Vital signs, health screening, patient history,\nANC/PNC checks, immunisation record review,\nhealth education support",
         "Medical Officer"],
        ["Lab Technician",
         "POCT tests (Hb, sugar, malaria RDT, UPT,\nurine dipstick), worklist management,\nupload reports to AMRIT",
         "Medical Officer"],
        ["Pharmacist",
         "Drug dispensing (OTC + Schedule H),\nstock management, inventory indent,\nprescription photo capture coordination",
         "Medical Officer"],
        ["R&MO (Registration &\nMeasurement Officer)",
         "Beneficiary registration, ABHA generation,\nOP card / CD card filling, weight & height,\nphotograph capture of documents",
         "Medical Officer"],
        ["Driver / Pilot",
         "Vehicle operation (HMV licence required),\nlogistics, fuel management,\nvan maintenance reporting",
         "Area Manager"],
    ]
    story.append(styled_table(team, [3.8*cm, 8.5*cm, 4.2*cm]))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "NOTE: On camp days the MO is the senior-most clinical person present. "
        "All clinical decisions - including referral - are your responsibility. "
        "There is no specialist backup on site.", s["warning"]))
    story.append(PageBreak())


def build_section3(story, s):
    story.append(SectionHeader("SECTION 3 - DAILY PRE-CAMP CHECKLIST"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "Complete this checklist before the MMU departs the base point each morning. "
        "Tick off each item physically. Do not depart if critical items are missing.",
        s["body"]))
    story.append(Spacer(1, 0.15*cm))

    checks = [
        ("DOCUMENTS & ID",
         ["Valid NMC / JMC registration card (carry original)",
          "Piramal Swasthya ID card",
          "Today's service point schedule + route map (offline copy)",
          "Blank OP cards and CD cards stocked (alert at 30% threshold)",
          "Monthly visit register and critical case register",
          "Referral slips (pre-printed stock)"]),
        ("MEDICINES",
         ["Core drug kit loaded and secured in van storage",
          "Cold-chain items (if any vaccines/biologicals) in icebox with ice",
          "ORS sachets, Zinc tabs, IFA tablets, Albendazole checked",
          "Malaria ACT (Artemether-Lumefantrine) stock verified",
          "Controlled drugs (Schedule H) logged in controlled drug register",
          "Drug expiry dates spot-checked (remove any expired items)"]),
        ("EQUIPMENT & DIAGNOSTICS",
         ["Stethoscope, BP apparatus (manual + digital), pulse oximeter",
          "Thermometer (digital), weighing scales (adult + infant)",
          "Glucometer + strips, HemoCue / hemoglobinometer + cuvettes",
          "Malaria RDT kits, urine dipsticks, pregnancy test kits (UPT)",
          "Dressing tray, gloves, antiseptic, bandages",
          "Torch / penlight, measuring tape (for ANC)"]),
        ("DIGITAL SYSTEM",
         ["Tablet / laptop charged to 100% before departure",
          "AMRIT application open and functioning (offline sync verified)",
          "Webcam / camera working (for prescription photo capture)",
          "Mobile network dongle / SIM loaded with data",
          "Previous day's data synced to central server"]),
        ("TEAM READINESS",
         ["All team members present and in uniform",
          "Driver briefed on today's route (road conditions, alternate routes)",
          "Team WhatsApp group updated with today's schedule",
          "Emergency contact numbers saved: BSP Hospital, 108, Area Manager"]),
    ]

    for category, items in checks:
        story.append(Paragraph(category, s["sub_title"]))
        check_rows = [["#", "Item", "Done"]]
        for i, item in enumerate(items, 1):
            check_rows.append([str(i), item, "[ ]"])
        story.append(styled_table(check_rows, [0.8*cm, 13.5*cm, 1.5*cm],
            header_bg=MID_BLUE))
        story.append(Spacer(1, 0.2*cm))
    story.append(PageBreak())


def build_section4(story, s):
    story.append(SectionHeader("SECTION 4 - SERVICE POINT WORKFLOW (STEP BY STEP)"))
    story.append(Spacer(1, 0.3*cm))

    steps = [
        ("STEP 1 - ARRIVAL (15 min before camp time)",
         MID_BLUE, LIGHT_BLUE,
         ["Park MMU van in designated / shaded area",
          "Greet village head / Mukhiya and ASHA worker",
          "Set up counters: Registration | Nurse | Lab | Doctor | Pharmacy",
          "Display the service schedule board / banner if available",
          "Inform ASHA of any specific follow-up patients expected today"]),
        ("STEP 2 - REGISTRATION COUNTER",
         TEAL, LIGHT_TEAL,
         ["R&MO registers new beneficiaries - collects name, age, address, ABHA",
          "Returning patients: retrieve ABHA record from AMRIT (or OP card)",
          "Vital signs taken by Nurse: weight, height, temperature, SpO2, BP",
          "Triage flags added: Pregnant (P), Child under 5 (C), Emergency (E)",
          "Patients queue for Doctor counter in triage order"]),
        ("STEP 3 - DOCTOR CONSULTATION",
         GREEN, LIGHT_GREEN,
         ["Review nurse-recorded vitals and chief complaint before calling patient",
          "Full history and focused examination for each patient",
          "Order lab tests if required (Lab Tech processes immediately)",
          "Review lab results before finalising diagnosis and prescription",
          "Write prescription in AMRIT system + photo captured by R&MO",
          "Counsel patient on diagnosis, medicines, dose, duration, follow-up",
          "Mark high-risk patients for referral - complete referral slip"]),
        ("STEP 4 - PHARMACY COUNTER",
         ORANGE, LIGHT_ORANGE,
         ["Pharmacist dispenses medicines as per prescription",
          "OTC drugs dispensed without prescription; Schedule H only on Rx",
          "Patient educated on dose, timing, storage of medicines",
          "Drug issue entered in Beneficiary Drugs Issue Register",
          "Controlled drug dispensed: log in Controlled Drug Register"]),
        ("STEP 5 - HEALTH EDUCATION SESSION",
         HexColor("#6A1B8A"), HexColor("#EDE7F6"),
         ["Conduct 5-10 minute group session at end of camp (or start if time allows)",
          "Topics: malaria prevention, ANC importance, ORS for diarrhea, hand hygiene",
          "Use ASHA / ANM as language interpreter for tribal patients",
          "Distribute IEC (Information, Education, Communication) materials if available",
          "Record session in daily report: topic, audience size"]),
    ]

    for title, header_c, body_c, items in steps:
        step_content = [Paragraph(f"<b>{title}</b>",
            ParagraphStyle("sh", fontSize=10, fontName="Helvetica-Bold",
                textColor=header_c, spaceBefore=4, spaceAfter=3))]
        for item in items:
            step_content.append(Paragraph(
                f"\u2022  {item}",
                ParagraphStyle("si", fontSize=9, fontName="Helvetica",
                    textColor=DARK_GRAY, leftIndent=12, spaceAfter=2, leading=13)))
        box = Table([[step_content]], colWidths=[16.5*cm])
        box.setStyle(TableStyle([
            ("BACKGROUND", (0,0),(-1,-1), body_c),
            ("BOX",        (0,0),(-1,-1), 1, header_c),
            ("TOPPADDING", (0,0),(-1,-1), 6),
            ("BOTTOMPADDING",(0,0),(-1,-1),6),
            ("LEFTPADDING",(0,0),(-1,-1), 10),
            ("RIGHTPADDING",(0,0),(-1,-1),8),
        ]))
        story.append(box)
        story.append(Spacer(1, 0.2*cm))
    story.append(PageBreak())


def build_section5(story, s):
    story.append(SectionHeader("SECTION 5 - CLINICAL PROTOCOLS: TRIAGE & OPD"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Triage System", s["sub_title"]))
    triage = [
        ["Priority", "Flag", "Criteria", "Action"],
        ["IMMEDIATE", "RED",
         "Unconscious, severe respiratory distress,\nconvulsion, shock, eclampsia, PPH",
         "Stabilise. Call 108. Refer IMMEDIATELY.\nDo not delay for documentation."],
        ["URGENT", "ORANGE",
         "High fever (>39C), severe dehydration,\nSevere anaemia (Hb<7), Danger signs in child",
         "See within 10 minutes.\nTreat and refer if needed."],
        ["PRIORITY", "YELLOW",
         "Pregnant women (any stage),\nChildren under 5, Elderly (>60)",
         "See before general queue.\nAll ANC patients seen before others."],
        ["ROUTINE", "GREEN",
         "Stable adults with acute minor illness\nor chronic disease review",
         "See in registration order."],
    ]
    t = Table(triage, colWidths=[2.2*cm, 1.5*cm, 6.5*cm, 6.3*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND",   (0,0),(-1,0),  DARK_BLUE),
        ("TEXTCOLOR",    (0,0),(-1,0),  white),
        ("FONTNAME",     (0,0),(-1,0),  "Helvetica-Bold"),
        ("FONTSIZE",     (0,0),(-1,-1), 8.5),
        ("BACKGROUND",   (0,1),(-1,1),  HexColor("#FDDEDE")),
        ("BACKGROUND",   (0,2),(-1,2),  HexColor("#FDE8D0")),
        ("BACKGROUND",   (0,3),(-1,3),  YELLOW_BG),
        ("BACKGROUND",   (0,4),(-1,4),  LIGHT_GREEN),
        ("GRID",         (0,0),(-1,-1), 0.4, MID_GRAY),
        ("VALIGN",       (0,0),(-1,-1), "MIDDLE"),
        ("TOPPADDING",   (0,0),(-1,-1), 4),
        ("BOTTOMPADDING",(0,0),(-1,-1), 4),
        ("LEFTPADDING",  (0,0),(-1,-1), 5),
    ]))
    story.append(t)
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Standard OPD Consultation Flow", s["sub_title"]))
    flow_items = [
        "1. Review vitals recorded by Nurse before calling patient in",
        "2. Introduce yourself and establish rapport (use local language greetings)",
        "3. Chief complaint in patient's own words - listen without interrupting",
        "4. Relevant history: onset, duration, severity, associated symptoms, previous treatment",
        "5. Past history: known diabetes, hypertension, TB, previous hospitalisations",
        "6. Obstetric history (all women of reproductive age): LMP, pregnancies, deliveries",
        "7. Drug history and allergies - document clearly",
        "8. Focused physical examination as indicated",
        "9. Order point-of-care tests if needed - get results before prescribing",
        "10. Diagnosis entered in AMRIT - use ICD-10 code where possible",
        "11. Prescription: generic drug name, dose, frequency, duration, route",
        "12. Patient counselling: what the condition is, how to take medicines, red flags to watch",
        "13. Follow-up plan: next MMU visit date or referral instruction",
    ]
    for item in flow_items:
        story.append(Paragraph(item, s["bullet"]))
    story.append(PageBreak())


def build_section6(story, s):
    story.append(SectionHeader("SECTION 6 - MATERNAL & CHILD HEALTH (ANC / PNC / RCH)"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("ANC - 4 Visit Protocol (NHM Standard)", s["sub_title"]))
    anc = [
        ["Visit", "When", "Key Tasks for MO", "Investigations"],
        ["ANC-1", "< 12 weeks",
         "Confirm pregnancy (UPT)\nRegister in JSSY / MCP card\nBlood group, Hb, BP, weight\nIFA + Calcium started\nTetanus toxoid (TT-1)",
         "Hb, blood group, urine\nRBS / blood sugar\nHIV & VDRL if available"],
        ["ANC-2", "14-26 weeks",
         "BP, weight, fundal height\nFoetal heart sounds\nIFA + Calcium continued\nTT-2 (if not given)",
         "Hb (repeat if anaemia)\nUrine albumin + sugar"],
        ["ANC-3", "28-34 weeks",
         "BP, weight, fundal height\nPresentation check\nRefer to CHC/PHC if high risk\nBirth preparedness counselling",
         "Hb repeat\nUrine albumin + sugar"],
        ["ANC-4", "36 weeks+",
         "Finalise birth plan\nCounselling: institutional delivery\nJSSY registration confirmed\nNewborn care counselling",
         "Hb, urine\nRefer to facility"],
    ]
    story.append(styled_table(anc, [1.5*cm, 2.2*cm, 7*cm, 5.8*cm], header_bg=TEAL))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph("ANC Danger Signs - REFER IMMEDIATELY", s["sub_title"]))
    dangers = ["Severe headache + blurred vision + swelling (eclampsia warning)",
               "BP > 140/90 mmHg on two readings",
               "Severe anaemia: Hb < 7 g/dL + pallor + breathlessness",
               "Vaginal bleeding at any stage of pregnancy",
               "Absent foetal movements after 28 weeks",
               "Fever with altered consciousness (cerebral malaria risk)",
               "Premature labour signs before 37 weeks"]
    warn_content = [Paragraph(f"\u26a0  {d}",
        ParagraphStyle("dg", fontSize=9, fontName="Helvetica-Bold",
            textColor=RED, leftIndent=10, spaceAfter=3, leading=13))
        for d in dangers]
    box = Table([[warn_content]], colWidths=[16.5*cm])
    box.setStyle(TableStyle([
        ("BACKGROUND",(0,0),(-1,-1), LIGHT_RED),
        ("BOX",(0,0),(-1,-1),1.5,RED),
        ("TOPPADDING",(0,0),(-1,-1),8), ("BOTTOMPADDING",(0,0),(-1,-1),8),
        ("LEFTPADDING",(0,0),(-1,-1),10),
    ]))
    story.append(box)
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Child Health - IMNCI Assessment Points", s["sub_title"]))
    child = [
        ["Age Group", "Priority Checks", "Action"],
        ["Neonate\n0-28 days",
         "Weight, temperature, jaundice, cord care\nBreastfeeding assessment, danger signs",
         "Refer if: weight < 2kg, jaundice,\npoor feeding, respiratory distress"],
        ["Infant\n1-12 months",
         "Weight-for-age (growth chart)\nImmunisation status, anaemia, ARI signs\nDiarrhoea, malnutrition screen (MUAC)",
         "SAM (MUAC < 11.5 cm): refer NRC\nMAM: therapeutic feeding counselling"],
        ["Child\n1-5 years",
         "Fever assessment (malaria in Jharkhand)\nCough > 2 weeks (TB screening)\nWorm infestation signs, nutritional status",
         "Albendazole 6-monthly\nDeworming + Vit A biannually"],
    ]
    story.append(styled_table(child, [2.5*cm, 8*cm, 6*cm], header_bg=GREEN))
    story.append(PageBreak())


def build_section7(story, s):
    story.append(SectionHeader("SECTION 7 - COMMUNICABLE DISEASE PROTOCOLS"))
    story.append(Spacer(1, 0.3*cm))

    # Malaria
    story.append(Paragraph("7A. MALARIA (HIGH PRIORITY in Jharkhand)", s["sub_title"]))
    story.append(Paragraph(
        "Jharkhand is a high malaria-endemic state. P. falciparum predominates and can be "
        "fatal if not treated promptly. Test EVERY febrile patient with malaria RDT.", s["body"]))

    mal = [
        ["Parameter", "P. vivax", "P. falciparum"],
        ["First-line treatment",
         "Chloroquine 25mg/kg over 3 days\n+ Primaquine 0.25mg/kg x 14 days",
         "ACT: Artemether-Lumefantrine\nAdult: 4 tabs twice daily x 3 days\n+ Primaquine single dose"],
        ["Severe / cerebral malaria",
         "REFER IMMEDIATELY to hospital",
         "REFER IMMEDIATELY - do NOT treat in MMU"],
        ["Pregnancy",
         "Chloroquine safe (avoid Primaquine)",
         "Quinine + Clindamycin (refer to PHC/CHC)"],
        ["Children",
         "Dose by weight - use NVBDCP chart",
         "ACT by weight - use NVBDCP chart"],
        ["Danger signs - REFER",
         "Altered consciousness, convulsions, severe anaemia,\nrespiratory distress, jaundice, haemoglobinuria",
         "Same - any one sign = immediate referral"],
    ]
    story.append(styled_table(mal, [3.5*cm, 6.5*cm, 6.5*cm], header_bg=RED))
    story.append(Spacer(1, 0.2*cm))

    # TB
    story.append(Paragraph("7B. TUBERCULOSIS (TB) - Identify & Refer", s["sub_title"]))
    story.append(Paragraph(
        "DO NOT start anti-TB treatment in the MMU. Your role is to identify "
        "presumptive TB and refer to the nearest DOTS centre.", s["warning"]))
    tb_signs = ["Cough > 2 weeks (most important symptom)",
                "Unexplained weight loss",
                "Evening fever / night sweats > 2 weeks",
                "Haemoptysis (blood in sputum)",
                "Contact with confirmed TB patient (household)"]
    for item in tb_signs:
        story.append(Paragraph(item, s["bullet"]))
    story.append(Paragraph(
        "ACTION: Issue a presumptive TB referral slip to the nearest DOTS centre / PHC. "
        "Enter in AMRIT. Follow up on next visit to confirm patient reached facility.",
        s["note"]))
    story.append(Spacer(1, 0.2*cm))

    # Diarrhea
    story.append(Paragraph("7C. DIARRHEA & DEHYDRATION", s["sub_title"]))
    diarr = [
        ["Dehydration Plan", "Criteria", "Treatment in MMU"],
        ["Plan A - No dehydration",
         "Alert, drinking well, no sunken eyes",
         "ORS at home: 200ml after each loose stool\nZinc 20mg/day x 14 days (children)\nContinue feeding"],
        ["Plan B - Some dehydration",
         "Restless/irritable, sunken eyes,\ndrinks eagerly",
         "ORS 75ml/kg over 4 hours in MMU\nReassess after 4 hours\nZinc 20mg/day x 14 days"],
        ["Plan C - Severe dehydration",
         "Lethargic/unconscious, very sunken eyes,\nunable to drink",
         "REFER IMMEDIATELY with IV fluids\nStart IV/IO access if possible\nCall 108"],
    ]
    story.append(styled_table(diarr, [3.2*cm, 6*cm, 7.3*cm], header_bg=MID_BLUE))
    story.append(Spacer(1, 0.2*cm))

    # ARI
    story.append(Paragraph("7D. ACUTE RESPIRATORY INFECTION (ARI) - Children", s["sub_title"]))
    ari = [
        ["Classification", "Signs", "Treatment"],
        ["PNEUMONIA",
         "Fast breathing (>50 in infants, >40 in 1-5yr)\nLower chest indrawing",
         "Amoxicillin 40mg/kg/day x 5 days\nParacetamol for fever\nReview in 2 days"],
        ["SEVERE PNEUMONIA",
         "Chest indrawing + any danger sign:\nCyanosis, unable to feed, convulsion,\nstridor, lethargy",
         "REFER IMMEDIATELY\nFirst dose Amoxicillin before referral"],
        ["NO PNEUMONIA (Cough/Cold)",
         "No fast breathing, no chest indrawing",
         "No antibiotics needed\nSaline nasal drops, honey (>1yr)\nReturn if worsens"],
    ]
    story.append(styled_table(ari, [3.5*cm, 6*cm, 7*cm], header_bg=MID_BLUE))
    story.append(PageBreak())


def build_section8(story, s):
    story.append(SectionHeader("SECTION 8 - NON-COMMUNICABLE DISEASE (NCD) MANAGEMENT"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "NCDs are rising rapidly in Jharkhand's tribal and rural population. "
        "Evidence shows that even with 80%+ screening coverage, disease control rates "
        "remain below 35% (Tamil Nadu doorstep health study, BMC Primary Care 2025). "
        "Adherence counselling at every MMU visit is essential.", s["body"]))
    story.append(Spacer(1, 0.15*cm))

    story.append(Paragraph("Hypertension Protocol", s["sub_title"]))
    htn = [
        ["Stage", "BP Reading", "MMU Action", "Target"],
        ["Normal",         "< 120/80",   "Educate, rescreen in 1 year", "Maintain"],
        ["Elevated",       "120-129 / <80", "Lifestyle counselling, rescreen in 3 months", "< 120/80"],
        ["Stage 1 HTN",    "130-139 / 80-89",
         "Start Amlodipine 5mg OD if lifestyle fails x 3 months\nCounselling: salt, alcohol, tobacco",
         "< 130/80"],
        ["Stage 2 HTN",    "> 140/90",
         "Start Amlodipine 5mg + Enalapril 5mg\nCD card, monthly follow-up\nRefer if uncontrolled at 3 months",
         "< 130/80"],
        ["Hypertensive\nUrgency","> 180/120 (asymptomatic)",
         "Amlodipine 10mg stat, rest, repeat BP in 30 min\nRefer to PHC/CHC for monitoring",
         "Gradual reduction"],
        ["Hypertensive\nEmergency","> 180/120 + symptoms\n(headache, vision change, chest pain)",
         "REFER IMMEDIATELY - call 108\nDo not delay",
         "Hospital"],
    ]
    story.append(styled_table(htn, [2.3*cm, 3*cm, 7*cm, 4.2*cm], header_bg=DARK_BLUE))
    story.append(Spacer(1, 0.25*cm))

    story.append(Paragraph("Diabetes Protocol", s["sub_title"]))
    dm = [
        ["RBS / FBS Level", "Classification", "MMU Action"],
        ["RBS < 140 / FBS < 100", "Normal", "Annual rescreen, lifestyle advice"],
        ["RBS 140-199 / FBS 100-125", "Prediabetes",
         "Lifestyle counselling: diet + exercise\nRepeat in 3 months"],
        ["RBS > 200 with symptoms\nor FBS > 126 on two occasions", "Diabetes Mellitus",
         "Start Metformin 500mg BD (with food)\nCD card, dietary counselling\nMonthly follow-up\nRefer if HbA1c-equivalent poor control"],
        ["RBS < 70 (Hypoglycaemia)",
         "EMERGENCY",
         "Conscious: 15-20g fast sugar (glucose tablets, sugar water)\nUnconscious: REFER with IV Dextrose en route"],
    ]
    story.append(styled_table(dm, [4.5*cm, 3.5*cm, 8.5*cm], header_bg=ORANGE))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph(
        "KEY REMINDER: Always ask existing HTN/DM patients at every visit: "
        "Are you taking your medicines daily? Any missed doses? This single question "
        "is the most impactful NCD intervention you can do in an MMU setting.", s["note"]))
    story.append(PageBreak())


def build_section9(story, s):
    story.append(SectionHeader("SECTION 9 - EMERGENCY & REFERRAL PROTOCOLS"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "The MMU has no in-patient beds or IV therapy capability. Your job in an "
        "emergency is to STABILISE, COMMUNICATE, and TRANSPORT quickly.", s["warning"]))
    story.append(Spacer(1, 0.2*cm))

    ref = [
        ["Condition", "First Aid in MMU", "Refer To", "Call"],
        ["Eclampsia / Pre-eclampsia",
         "Left lateral position\nMgSO4 if available\nSecure airway",
         "BSP Hospital / District Hospital", "108"],
        ["Severe Malaria\n(cerebral / severe anaemia)",
         "Artesunate IM if available\nIV access\nSupplemental O2",
         "BSP Hospital / Sadar Hospital", "108"],
        ["Acute MI / Chest Pain",
         "Aspirin 325mg stat (chew)\nRest, O2 if available\nNitrates if BP > 90",
         "BSP Hospital Emergency", "108 + BSP ER"],
        ["Severe Dehydration\n(Plan C Diarrhea)",
         "IV access + Ringer's Lactate\nORS via NG tube\nMonitor vitals",
         "Nearest CHC / PHC", "108"],
        ["Anaphylaxis",
         "Adrenaline 0.5mg IM (thigh)\nLay flat, legs raised\nIV access",
         "BSP Hospital", "108"],
        ["Snake Bite",
         "Immobilise, keep calm\nNO tourniquet, NO incision\nMark swelling edge + time",
         "BSP Hospital (anti-venom)", "108 + 100"],
        ["Neonatal Danger Signs\n(poor feeding, hypothermia, jaundice)",
         "Warm, breastfeed support\nKangaroo Mother Care position",
         "BSP Hospital / NRC", "108"],
        ["Road Accident / Trauma",
         "ABC: Airway-Breathing-Circulation\nControl bleeding with pressure\nSpinal precautions",
         "BSP Hospital Emergency", "108 + 100"],
    ]
    story.append(styled_table(ref, [3.5*cm, 5.5*cm, 4*cm, 3.5*cm], header_bg=RED))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Referral Documentation (MANDATORY)", s["sub_title"]))
    ref_items = ["Patient name, age, ABHA ID",
                 "Diagnosis / provisional diagnosis",
                 "Reason for referral (specific - not just 'further management')",
                 "Vitals at time of referral",
                 "Treatment given before referral",
                 "Receiving facility name and contact",
                 "Accompanying person's name and contact",
                 "Your name, signature, MMU name, date and time"]
    for item in ref_items:
        story.append(Paragraph(item, s["bullet"]))
    story.append(Paragraph(
        "FOLLOW-UP: On the next visit to the same village, ask ASHA whether the "
        "referred patient reached the hospital. Update AMRIT referral status.",
        s["note"]))
    story.append(PageBreak())


def build_section10(story, s):
    story.append(SectionHeader("SECTION 10 - MEDICINES IN MMU (ESSENTIAL DRUG LIST)"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "The MMU drug kit follows the NHM Essential Medicines List (NLEM 2022) for "
        "primary health care. The exact list is maintained by the Pharmacist. "
        "Below is the standard therapeutic category breakdown.", s["body"]))
    story.append(Spacer(1, 0.15*cm))

    drugs = [
        ("ANALGESICS / ANTIPYRETICS / ANTI-INFLAMMATORY", GREEN, [
            ["Drug", "Dose (Adult)", "Indication"],
            ["Paracetamol 500mg", "500-1000mg 6-8 hourly", "Fever, mild pain"],
            ["Ibuprofen 400mg", "400mg 8 hourly (with food)", "Pain, inflammation"],
            ["Diclofenac 50mg", "50mg 8-12 hourly", "Musculoskeletal pain"],
        ]),
        ("ANTI-INFECTIVES", RED, [
            ["Drug", "Dose (Adult)", "Indication"],
            ["Amoxicillin 500mg", "500mg 8 hourly x 5-7 days", "ARI, skin, UTI"],
            ["Cotrimoxazole (480mg)", "2 tabs BD x 5 days", "UTI, ARI"],
            ["Doxycycline 100mg", "100mg BD x 7 days", "Respiratory, skin"],
            ["Metronidazole 400mg", "400mg TDS x 5-7 days", "Anaerobic, GI"],
            ["Albendazole 400mg", "400mg single dose", "Worm infestations"],
            ["Artemether-Lumefantrine", "4 tabs BD x 3 days (adult)", "P. falciparum malaria"],
            ["Chloroquine 250mg", "25mg/kg over 3 days", "P. vivax malaria"],
            ["Primaquine 7.5mg", "Per NVBDCP protocol", "Malaria radical cure"],
            ["Fluconazole 150mg", "150mg single dose", "Vaginal candidiasis"],
            ["Clotrimazole cream", "Apply BD x 2 weeks", "Tinea, fungal skin"],
        ]),
        ("GASTROINTESTINAL", MID_BLUE, [
            ["Drug", "Dose (Adult)", "Indication"],
            ["ORS Sachets", "200ml after each loose stool", "Diarrhea, dehydration"],
            ["Zinc 20mg (paediatric)", "20mg/day x 14 days", "Diarrhea (child < 5)"],
            ["Pantoprazole 40mg", "40mg OD (before food)", "Peptic ulcer, GERD"],
            ["Metoclopramide 10mg", "10mg 8 hourly", "Nausea, vomiting"],
            ["Antacid suspension", "10-20ml TDS (after food)", "Gastritis, hyperacidity"],
            ["Hyoscine butylbromide 10mg", "10mg 8 hourly", "Abdominal spasm"],
        ]),
        ("CARDIOVASCULAR / NCD", DARK_BLUE, [
            ["Drug", "Dose (Adult)", "Indication"],
            ["Amlodipine 5mg", "5-10mg OD", "Hypertension"],
            ["Enalapril 5mg", "5-10mg OD-BD", "Hypertension, heart failure"],
            ["Atenolol 50mg", "25-100mg OD", "Hypertension, angina"],
            ["Aspirin 75mg", "75mg OD (after food)", "CVD prevention"],
            ["Metformin 500mg", "500mg BD (with food)", "Type 2 diabetes"],
            ["Glibenclamide 5mg", "2.5-5mg OD (before breakfast)", "Type 2 diabetes"],
        ]),
        ("MATERNAL & CHILD HEALTH", TEAL, [
            ["Drug", "Dose", "Indication"],
            ["IFA tablets (adult)", "1 tab OD x 100 days (ANC)", "Anaemia prevention in pregnancy"],
            ["IFA tablets (paediatric)", "1 tab/syrup daily x 3 months", "Childhood anaemia"],
            ["Folic acid 5mg", "5mg OD in first trimester", "Neural tube defect prevention"],
            ["Calcium 500mg", "2 tabs OD (ANC)", "Preeclampsia prevention"],
            ["Vitamin A 200,000 IU", "Single dose 6-monthly", "Children 1-5 years"],
            ["Oxytocin injection", "10 IU IM after delivery", "PPH prevention (if present at delivery)"],
        ]),
        ("TOPICAL / FIRST AID", ORANGE, [
            ["Item", "Use", "Notes"],
            ["Povidone Iodine (Betadine)", "Wound cleaning, antisepsis", "Dilute to 10% for irrigation"],
            ["Gentamicin eye drops", "1-2 drops 4 hourly", "Bacterial conjunctivitis"],
            ["Hydrocortisone cream 1%", "Apply BD x 5 days", "Allergic skin reactions"],
            ["Bandages (crepe + gauge)", "Wound dressing", "Various sizes"],
            ["Examination gloves", "All procedures", "Non-sterile + sterile packs"],
        ]),
    ]

    for category, color, rows in drugs:
        story.append(Paragraph(category, ParagraphStyle("cat",
            fontSize=9.5, fontName="Helvetica-Bold", textColor=color,
            spaceBefore=6, spaceAfter=3)))
        story.append(styled_table(rows, [4.5*cm, 5.5*cm, 6.5*cm], header_bg=color))
        story.append(Spacer(1, 0.15*cm))
    story.append(PageBreak())


def build_section11(story, s):
    story.append(SectionHeader("SECTION 11 - DIAGNOSTICS & EQUIPMENT IN MMU"))
    story.append(Spacer(1, 0.3*cm))

    equip = [
        ["Equipment / Device", "Purpose", "When to Use", "MO Action if Abnormal"],
        ["BP Apparatus\n(Manual + Digital)", "Blood pressure measurement",
         "All adults, every visit\nAll pregnant women",
         "HTN protocol (Section 8)\nDocument in CD card"],
        ["Pulse Oximeter", "SpO2 + pulse rate",
         "Respiratory complaints\nPneumonia assessment\nMalaria + anaemia",
         "SpO2 < 94%: oxygen + refer\nSpO2 < 90%: URGENT referral"],
        ["Digital Thermometer", "Core body temperature",
         "All patients with fever history",
         "> 39C: malaria RDT mandatory\n> 40C + child: URGENT treatment"],
        ["Weighing Scale\n(Adult + Infant)", "Weight monitoring",
         "All ANC patients (every visit)\nAll children (growth monitoring)",
         "ANC: plot on graph, counsel on gestational gain\nChild: MUAC if low weight"],
        ["Glucometer", "Random / fasting blood sugar",
         "All known diabetics (every visit)\nSymptoms of diabetes in adults\nGDM screening in ANC",
         "RBS > 200: DM protocol\nRBS < 70: hypoglycaemia protocol\nLog in CD card"],
        ["HemoCue /\nHemoglobinometer", "Haemoglobin level",
         "All ANC patients (every visit)\nAnaemia symptoms\nChildren with pallor",
         "Hb < 7: severe - refer\nHb 7-10: treat + supplement\nHb < 11 pregnant: intensify IFA"],
        ["Malaria RDT Kit", "P. vivax / P. falciparum antigen",
         "EVERY febrile patient in MMU\n(do not skip - endemic area)",
         "Positive: treat per species protocol\nNegative + high suspicion: refer for slide test"],
        ["Urine Dipstick", "Protein, glucose, nitrites, blood",
         "All ANC patients\nUTI symptoms\nDiabetes screening",
         "Protein 2+ in ANC: pre-eclampsia - refer\nNitrites positive: treat UTI"],
        ["Pregnancy Test Kit (UPT)", "hCG detection",
         "Women with amenorrhoea\nConfirm / rule out pregnancy",
         "Positive: register for ANC immediately\nNote LMP, EDD, JSSY eligibility"],
        ["Measuring Tape", "Fundal height (symphysis-fundus)",
         "Every ANC visit after 20 weeks",
         "SF height < dates by > 3cm: IUGR - refer\n> dates: macrosomia / polyhydramnios - refer"],
    ]
    story.append(styled_table(equip,
        [3.2*cm, 3*cm, 4.3*cm, 6*cm], header_bg=DARK_BLUE))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "MAINTENANCE RULE: Report any equipment malfunction to your Area Manager "
        "via Asset Damage Report (ADR) within 12 hours of discovery. "
        "Never operate a clinic session without a functional BP apparatus and thermometer.",
        s["warning"]))
    story.append(PageBreak())


def build_section12(story, s):
    story.append(SectionHeader("SECTION 12 - AMRIT DIGITAL SYSTEM: DOCUMENTATION GUIDE"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("What is AMRIT?", s["sub_title"]))
    story.append(Paragraph(
        "AMRIT (Accessible Medical Records via Integrated Technologies) is Piramal Swasthya's "
        "open-source electronic health record (EHR) platform. It is ABHA-linked, "
        "works offline, and syncs to central servers when internet is available. "
        "Every patient you see must be registered in AMRIT.", s["body"]))

    story.append(Paragraph("Doctor Module - What to Enter", s["sub_title"]))
    amrit_fields = [
        ["Field", "What to Enter", "Why It Matters"],
        ["Chief Complaint", "Patient's words, not medical jargon initially",
         "Drives triage and diagnosis consistency"],
        ["Diagnosis", "Provisional or confirmed - use ICD-10 code if known",
         "Enables disease burden analytics"],
        ["Prescription", "Generic drug name, dose, frequency, duration, route",
         "Pharmacist dispenses from this; legal record"],
        ["Lab Results", "Enter values from POCT (Hb, RBS, malaria result etc.)",
         "Historical trends tracked across visits"],
        ["Referral", "Facility name, reason, date, urgency",
         "Follow-up audit by Area Manager"],
        ["Visit Type", "OPD / ANC / PNC / Child Health / School Health",
         "Programme reporting to funders (SAIL/BPSCL)"],
        ["Follow-up Date", "Next expected MMU visit to this village",
         "Patient reminded via automated SMS"],
    ]
    story.append(styled_table(amrit_fields, [3*cm, 7*cm, 6.5*cm], header_bg=TEAL))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph("CD (Chronic Disease) Card System", s["sub_title"]))
    cd_items = ["Every HTN / DM / anaemia / thyroid patient must have a CD card",
                "CD card captures: diagnosis, all medication changes, test results, visit dates",
                "Patient keeps the physical CD card - bring it every visit",
                "MO updates AMRIT CD record at every visit - cross-reference with physical card",
                "If patient misses a visit: inform ASHA worker to do home follow-up",
                "Non-adherent patient: document reason; counsel without judgment"]
    for item in cd_items:
        story.append(Paragraph(item, s["bullet"]))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph("End-of-Day Sync Protocol", s["sub_title"]))
    sync = ["Before leaving service point: sync AMRIT if mobile data available",
            "If no signal at service point: sync at first signal point on return route",
            "NEVER leave data unsynced for more than 24 hours",
            "Check sync confirmation message before closing application",
            "Report sync failures to IT support via Area Manager same day"]
    for item in sync:
        story.append(Paragraph(item, s["bullet"]))
    story.append(PageBreak())


def build_section13(story, s):
    story.append(SectionHeader("SECTION 13 - HEALTH EDUCATION & LITERACY SESSIONS"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph(
        "Health literacy is a core output of the MMU programme. Research shows that "
        "mobile health vans empower communities through health education and improve "
        "health-seeking behaviour (Seth R et al., BMJ Paed Open 2025). "
        "Conduct a group health talk at every service point.", s["body"]))

    story.append(Paragraph("Monthly Health Education Topic Calendar", s["sub_title"]))
    topics = [
        ["Month", "Primary Topic", "Key Messages", "Target Audience"],
        ["January",  "TB Awareness",
         "Cough > 2 weeks = test for TB\nComplete full course of DOTS\nTB is curable",
         "All adults"],
        ["February", "Malaria Prevention",
         "Sleep under bednet\nDrain stagnant water\nSeek care for any fever within 24 hrs",
         "All community"],
        ["March",    "Women's Health / ANC",
         "4 ANC visits importance\nInstitutional delivery = JSSY benefit\nIFA tablet daily",
         "Women 15-49 yrs"],
        ["April",    "Summer Diarrhea / ORS",
         "ORS preparation demonstration\nHand washing with soap\nBoil or filter drinking water",
         "Mothers + children"],
        ["May",      "Heat Stroke Prevention",
         "Stay hydrated\nAvoid midday sun\nSigns of heat exhaustion",
         "All community"],
        ["June",     "Monsoon Diseases",
         "Malaria, dengue, leptospirosis prevention\nClean water storage\nMosquito control",
         "All community"],
        ["July",     "Child Nutrition",
         "Breastfeeding for first 6 months\nComplementary feeding from 6 months\nGrowth monitoring",
         "Mothers with children < 5"],
        ["August",   "Hypertension",
         "Reduce salt intake\nMedication adherence\nRegular BP check",
         "Adults > 30 yrs"],
        ["September","Diabetes Awareness",
         "Signs of diabetes\nLifestyle: diet + exercise\nMedication adherence",
         "Adults > 30 yrs"],
        ["October",  "Eye & Ear Health",
         "School vision screening results\nMicronutrient deficiency signs\nReferral pathways",
         "Children + elderly"],
        ["November", "Tobacco / Alcohol Harm",
         "Cancer risk\nQuit lines available\nEffect on family health",
         "Men + adolescents"],
        ["December", "Immunisation Review",
         "Check immunisation cards\nMissed vaccines: go to nearest PHC\nCold chain importance",
         "Children 0-5 yrs"],
    ]
    story.append(styled_table(topics,
        [1.8*cm, 3*cm, 6.5*cm, 5.2*cm], header_bg=MID_BLUE))
    story.append(Spacer(1, 0.2*cm))

    story.append(Paragraph("Conducting the Session (5-10 minutes)", s["sub_title"]))
    session = ["Ask ASHA to gather attendees while patients wait (use waiting time productively)",
               "Use simple, visual demonstrations - show, don't just tell (ORS preparation, handwashing)",
               "Speak in Khortha/Sadri - use ANM or ASHA as interpreter for tribal languages",
               "Allow 2-3 minutes for questions - this reveals local misconceptions to address",
               "Close with one key take-home message repeated three times",
               "Record in AMRIT daily report: topic, number of attendees (male/female)"]
    for item in session:
        story.append(Paragraph(item, s["bullet"]))
    story.append(PageBreak())


def build_section14(story, s):
    story.append(SectionHeader("SECTION 14 - END-OF-DAY CLOSING PROTOCOL"))
    story.append(Spacer(1, 0.3*cm))

    closing = [
        ["#", "Task", "Responsible", "Done"],
        ["1", "Count remaining patients - ensure no one left unseen", "MO", "[ ]"],
        ["2", "Verify all prescriptions entered in AMRIT", "MO", "[ ]"],
        ["3", "Referral slips issued and documented in register", "MO", "[ ]"],
        ["4", "All lab results entered and filed", "Lab Tech", "[ ]"],
        ["5", "Drug issue register completed for the day", "Pharmacist", "[ ]"],
        ["6", "Remaining drug stock counted; indent flagged if < 30%", "Pharmacist", "[ ]"],
        ["7", "Cold-chain items secured in icebox for transit", "Pharmacist", "[ ]"],
        ["8", "Equipment cleaned and stored; ADR filed if any damage", "Nurse / R&MO", "[ ]"],
        ["9", "AMRIT data synced (or scheduled for sync at base)", "MO / R&MO", "[ ]"],
        ["10","Daily report submitted to Area Manager (WhatsApp / email)", "MO", "[ ]"],
        ["11","Next service point schedule confirmed with Driver", "MO", "[ ]"],
        ["12","MO signs off daily camp report (hard copy + digital)", "MO", "[ ]"],
    ]
    story.append(styled_table(closing, [0.8*cm, 8*cm, 3.5*cm, 1.5*cm],
        header_bg=DARK_BLUE))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Daily Report - Minimum Data to Submit", s["sub_title"]))
    dr = [["Data Point", "Format"],
          ["Date and Service Point name", "DD/MM/YYYY - Village Name, Block"],
          ["Total OPD count (M/F/Child)", "Numbers"],
          ["ANC patients seen", "Number"],
          ["Malaria RDTs done / positive", "X done / Y positive (P.v / P.f)"],
          ["Referrals made", "Number + brief reason"],
          ["Health education session", "Topic + attendee count"],
          ["Stock alerts", "Drug name + current stock level"],
          ["Equipment issues", "Description + ADR number if raised"],
          ["Unusual events / observations", "Free text"]]
    story.append(styled_table(dr, [7*cm, 9.5*cm], header_bg=TEAL))
    story.append(PageBreak())


def build_section15(story, s):
    story.append(SectionHeader("SECTION 15 - KEY CONTACTS & ESCALATION MATRIX"))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Emergency Numbers - Save These NOW", s["sub_title"]))
    contacts = [
        ["Service", "Number", "When to Call"],
        ["Ambulance (National)", "108", "All medical emergencies needing transport"],
        ["Police Emergency", "100", "Security / accident / snake bite in remote area"],
        ["Fire / Disaster", "101", "Fire, flood, natural disaster at camp"],
        ["Child Helpline", "1098", "Child abuse, abandoned child"],
        ["Women's Helpline", "181", "Domestic violence, GBV"],
        ["BSP Hospital Emergency", "Contact Area Manager for number", "Medical referral from Bokaro villages"],
        ["Bokaro Sadar Hospital", "Contact Area Manager for number", "Government referral facility"],
        ["Nearest PHC / CHC", "Obtain from Area Manager on Day 1", "Referral, DOTS, immunisation linkage"],
    ]
    story.append(styled_table(contacts, [4*cm, 5*cm, 7.5*cm], header_bg=RED))
    story.append(Spacer(1, 0.3*cm))

    story.append(Paragraph("Escalation Matrix", s["sub_title"]))
    matrix = [
        ["Issue", "Escalate To", "Timeline"],
        ["Clinical doubt / complex case", "Area Manager (who contacts Medical Director)", "Same day"],
        ["Medicine stock critically low", "Area Manager / Pharmacist at HQ", "When reaching 30% stock"],
        ["Equipment breakdown", "Area Manager + ADR form", "Within 12 hours"],
        ["Team conflict / HR issue", "Area Manager then Zonal Manager", "Within 24 hours"],
        ["Patient complaint", "Area Manager", "Same day"],
        ["Unusual disease cluster / outbreak suspicion",
         "Area Manager + District CMO", "IMMEDIATELY"],
        ["Road / vehicle breakdown", "Driver + Area Manager", "Immediately"],
        ["Data sync failure > 24 hours", "IT Support via Area Manager", "Within 24 hours"],
    ]
    story.append(styled_table(matrix, [5*cm, 5.5*cm, 6*cm], header_bg=DARK_BLUE))
    story.append(PageBreak())


def build_section16(story, s):
    story.append(SectionHeader("SECTION 16 - QUICK DRUG DOSE REFERENCE"))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Paediatric doses: always calculate by weight. Adult doses below "
        "assume average adult weight 50-70 kg. Verify with NLEM 2022 for full details.",
        s["note"]))
    story.append(Spacer(1, 0.1*cm))

    doses = [
        ["Drug", "Adult Dose", "Paediatric Dose", "Key Caution"],
        ["Paracetamol", "500-1000mg 6-8h", "15mg/kg/dose 6h (max 4 doses/day)",
         "Max 4g/day adult\nAvoid in liver disease"],
        ["Amoxicillin", "500mg 8h x 5-7d", "40mg/kg/day in 3 divided doses",
         "Check penicillin allergy"],
        ["ORS", "200-400ml/loose stool", "Per WHO Plan A/B/C protocol",
         "Never restrict fluids"],
        ["Zinc (paeds diarrhea)", "N/A", "< 6 months: 10mg/day x 14d\n> 6 months: 20mg/day x 14d",
         "Not for adults"],
        ["Artemether-\nLumefantrine (adult)", "4 tabs BD x 3 days (80/480mg)",
         "Use weight-based paed tabs\n(NVBDCP chart mandatory)", "Fatty food improves absorption"],
        ["Chloroquine\n(P. vivax)", "600mg Day1, 300mg Day2+3",
         "10mg/kg Day1, 7.5mg/kg Day2+3",
         "Check G6PD before Primaquine"],
        ["Metformin", "500mg BD with food\nMax 2g/day", "Not used in children",
         "Hold if eGFR < 30\nCaution: contrast procedures"],
        ["Amlodipine", "5-10mg OD", "Not routinely in MMU",
         "Ankle oedema common S/E"],
        ["IFA (adult)", "1 tab OD (100mg Fe + 0.5mg FA)", "Paed syrup: 3mg/kg/day Fe",
         "Take with Vit C, not with tea"],
        ["Albendazole", "400mg single dose", "< 2yr: 200mg; > 2yr: 400mg",
         "Avoid in pregnancy Trimester 1"],
        ["Metronidazole", "400mg TDS x 5-7d", "35-50mg/kg/day in 3 doses",
         "Avoid alcohol\nMetallic taste common"],
        ["Aspirin (CVD)", "75mg OD after food", "Not used in children < 16yr",
         "Stop 7 days before surgery\nPeptic ulcer caution"],
    ]
    story.append(styled_table(doses,
        [3.5*cm, 3.5*cm, 4.5*cm, 5*cm], header_bg=DARK_BLUE))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "This table is a quick field reference only. Always verify full prescribing "
        "information in the NHM Drug Formulary or NLEM 2022 before prescribing "
        "unfamiliar medications or complex cases.",
        s["warning"]))
    story.append(PageBreak())


def build_section17(story, s):
    story.append(SectionHeader("SECTION 17 - RESEARCH EVIDENCE SUMMARY"))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph(
        "Key peer-reviewed evidence supporting the MMU model and relevant to "
        "clinical practice in Bokaro.", s["body"]))

    papers = [
        ["#", "Study", "Journal / Year", "Key Finding"],
        ["1",
         "Kumar A et al.\nMMU Functioning in Jharkhand\nPMID: 20108880",
         "Indian J Public Health\n2009",
         ">90% medicine availability in MMUs\n>90% patients had no prior info on MMU schedule\nMMUs successful in reaching under-served areas"],
        ["2",
         "Akhtar MH et al.\nMobile PHC Review\nPMC9870199",
         "PMC / 2023\nCited by 27",
         "MMUs effective in India for primary + specialist outreach\nViable for rural and urban underserved populations"],
        ["3",
         "Seth R et al.\nMobile Health Van - Delhi\nPMID: 39773979",
         "BMJ Paed Open\n2025",
         "41,062 clinic visits over 6 years\n96% patient satisfaction\nMHV improves health literacy\nPathways to tertiary care established"],
        ["4",
         "Subramaniam S et al.\nDoorstep NCD - Tamil Nadu\nPMID: 41398228",
         "BMC Primary Care\n2025",
         "79-82% NCD screening coverage\nBut only 9-35% disease control\nAdherence counselling is critical"],
        ["5",
         "Boone P et al.\nCHAMPION RCT - Telangana\nPMID: 28678849",
         "PLoS Medicine\n2017 (RCT)",
         "Mobile outreach + health education:\nReduced neonatal mortality by 24% (RR 0.76)\n92 fewer deaths per 14,000 women enrolled"],
        ["6",
         "Bhattacharya S et al.\nHTN in Jharkhand Tribals\nPMID: 40630337",
         "Cureus / 2025",
         "HTN rising in Jharkhand tribal populations\nDelayed diagnosis, poor access, low health awareness\nOutreach strategies (including MMU) are key solution"],
    ]
    story.append(styled_table(papers,
        [0.7*cm, 5.3*cm, 3*cm, 7.5*cm], header_bg=DARK_BLUE))
    story.append(Spacer(1, 0.3*cm))
    story.append(Paragraph("Research Gap & Opportunity for You", s["sub_title"]))
    story.append(Paragraph(
        "There is no published peer-reviewed research specifically on Piramal Swasthya's "
        "Ispat Sanjeevani or Swasthya Kiran MMU outcomes in Bokaro. As an MO with access "
        "to AMRIT longitudinal data covering 1.38 lakh+ beneficiaries, you have an "
        "outstanding opportunity to conduct original research. "
        "Potential study designs include: morbidity pattern analysis, "
        "ANC completion rate assessment, referral completion audit, "
        "and NCD control rate evaluation. "
        "Contact IIPHG, RIMS Ranchi, or PHFI for academic collaboration and ethics approval.",
        s["body"]))
    story.append(PageBreak())


def build_final_page(story, s):
    story.append(Spacer(1, 1*cm))
    story.append(ColorBar(DARK_BLUE, height=6))
    story.append(Spacer(1, 0.5*cm))
    end_title = ParagraphStyle("et", fontSize=20, fontName="Helvetica-Bold",
        textColor=DARK_BLUE, alignment=TA_CENTER, spaceAfter=10)
    story.append(Paragraph("You Are Ready", end_title))
    story.append(ColorBar(TEAL, height=4))
    story.append(Spacer(1, 0.5*cm))

    mantra_items = [
        ("REGISTER", "Every patient in AMRIT - if it's not documented, it didn't happen"),
        ("TRIAGE",   "See pregnant women and children first, always"),
        ("REFER EARLY", "When in doubt, refer. Never delay a sick patient"),
        ("STOCK CHECK","Generate medicine indent at 30% stock - never run out on camp day"),
        ("HEALTH TALK","5 minutes of education at every camp changes behaviour over time"),
        ("SYNC DATA", "End every day with AMRIT synced to server"),
        ("FOLLOW UP", "Check that your referred patients reached the hospital"),
        ("STAY SAFE", "Never take unsafe roads. Full sleeves, repellent in the evening"),
    ]

    for key, value in mantra_items:
        row_content = [
            Paragraph(f"<b>{key}</b>",
                ParagraphStyle("mk", fontSize=10, fontName="Helvetica-Bold",
                    textColor=white, alignment=TA_CENTER)),
            Paragraph(value,
                ParagraphStyle("mv", fontSize=9.5, fontName="Helvetica",
                    textColor=DARK_GRAY))
        ]
        t = Table([row_content], colWidths=[3.5*cm, 13*cm])
        t.setStyle(TableStyle([
            ("BACKGROUND", (0,0),(0,0), TEAL),
            ("BACKGROUND", (1,0),(1,0), LIGHT_TEAL),
            ("BOX",        (0,0),(-1,-1), 0.5, TEAL),
            ("VALIGN",     (0,0),(-1,-1), "MIDDLE"),
            ("TOPPADDING", (0,0),(-1,-1), 7),
            ("BOTTOMPADDING",(0,0),(-1,-1),7),
            ("LEFTPADDING",(0,0),(-1,-1), 8),
        ]))
        story.append(t)
        story.append(Spacer(1, 0.15*cm))

    story.append(Spacer(1, 0.5*cm))
    story.append(ColorBar(ORANGE, height=4))
    story.append(Spacer(1, 0.3*cm))
    final_note = ParagraphStyle("fn", fontSize=9, fontName="Helvetica-Oblique",
        textColor=MID_GRAY, alignment=TA_CENTER, leading=14)
    story.append(Paragraph(
        "This guide was prepared to support Medical Officers joining Piramal Swasthya's "
        "MMU Programme in Bokaro, Jharkhand.\n"
        "Clinical protocols are based on NHM / MoHFW / NVBDCP / WHO guidelines "
        "as of 2025-2026. Always verify with the latest government guidelines.\n"
        "Compiled July 2026 | Version 1.0 | For Internal Use Only",
        final_note))


# ════════════════════════════════════════════════════════════════════════════
# MAIN
# ════════════════════════════════════════════════════════════════════════════

def main():
    doc = SimpleDocTemplate(
        OUTPUT_PATH,
        pagesize=A4,
        rightMargin=1.8*cm,
        leftMargin=1.8*cm,
        topMargin=1.5*cm,
        bottomMargin=1.5*cm,
        title="Bokaro MMU Medical Officer Study Guide",
        author="Piramal Swasthya",
        subject="MMU Guidelines and Daily Protocols",
    )

    s = make_styles()
    story = []

    build_cover(story, s)
    build_toc(story, s)
    build_section1(story, s)
    build_section2(story, s)
    build_section3(story, s)
    build_section4(story, s)
    build_section5(story, s)
    build_section6(story, s)
    build_section7(story, s)
    build_section8(story, s)
    build_section9(story, s)
    build_section10(story, s)
    build_section11(story, s)
    build_section12(story, s)
    build_section13(story, s)
    build_section14(story, s)
    build_section15(story, s)
    build_section16(story, s)
    build_section17(story, s)
    build_final_page(story, s)

    doc.build(story, onFirstPage=lambda c, d: None, onLaterPages=header_footer)
    print(f"PDF generated: {OUTPUT_PATH}")
    import os
    size_kb = os.path.getsize(OUTPUT_PATH) // 1024
    print(f"File size: {size_kb} KB")


if __name__ == "__main__":
    main()

<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Bokaro MMU Medical Officer Study Guide</title>
<style>
  @page {
    size: A4;
    margin: 2cm 1.8cm 2cm 1.8cm;
    @top-center {
      content: "Bokaro MMU - Medical Officer Study Guide | Piramal Swasthya";
      font-size: 8pt;
      color: #555;
    }
    @bottom-center {
      content: counter(page);
      font-size: 8pt;
      color: #555;
    }
  }
  * { box-sizing: border-box; margin: 0; padding: 0; }
  body { font-family: Arial, sans-serif; font-size: 9.5pt; color: #2D3436; line-height: 1.45; }

  /* COVER PAGE */
  .cover { page-break-after: always; background: #1A3C6E; color: white; min-height: 270mm; padding: 40px 40px 30px 40px; display: flex; flex-direction: column; justify-content: space-between; }
  .cover-top { text-align: center; padding: 30px 0 20px 0; }
  .cover-top h1 { font-size: 36pt; font-weight: bold; color: white; margin-bottom: 8px; letter-spacing: 2px; }
  .cover-top h2 { font-size: 18pt; color: #D6E8FA; margin-bottom: 6px; font-weight: normal; }
  .cover-top h3 { font-size: 11pt; color: #A8C8E8; margin-bottom: 4px; font-weight: normal; }
  .cover-teal-bar { background: #0D7377; height: 8px; margin: 20px 0; border-radius: 3px; }
  .cover-cards { display: flex; gap: 10px; justify-content: center; flex-wrap: wrap; }
  .cover-card { background: rgba(255,255,255,0.12); border: 1px solid rgba(255,255,255,0.3); border-radius: 6px; padding: 12px 16px; text-align: center; flex: 1; min-width: 120px; }
  .cover-card .card-key { font-size: 7.5pt; font-weight: bold; color: #D6E8FA; letter-spacing: 1px; margin-bottom: 5px; }
  .cover-card .card-val { font-size: 9pt; color: white; }
  .cover-orange-bar { background: #C75B00; height: 5px; margin: 20px 0; border-radius: 3px; }
  .cover-footer { text-align: center; color: #A8C8E8; font-size: 8pt; line-height: 1.6; }

  /* TOC */
  .toc-page { page-break-after: always; padding: 10px 0; }
  .toc-page h2 { text-align: center; color: #1A3C6E; font-size: 16pt; margin-bottom: 10px; }
  .toc-bar { background: #0D7377; height: 4px; margin-bottom: 16px; border-radius: 2px; }
  .toc-item { padding: 5px 10px; border-bottom: 1px dotted #ccc; font-size: 9.5pt; color: #2D3436; }
  .toc-item span { color: #1A3C6E; font-weight: bold; }

  /* SECTION HEADERS */
  .section-header { background: #1A3C6E; color: white; padding: 9px 14px; font-size: 12pt; font-weight: bold; border-radius: 4px; margin: 0 0 12px 0; page-break-after: avoid; }
  .section-header.teal { background: #0D7377; }
  .section-header.green { background: #1E7A3E; }
  .section-header.orange { background: #C75B00; }
  .section-header.red { background: #B22222; }
  .section-header.mid-blue { background: #2E6DA4; }

  /* CONTENT */
  .section { page-break-before: always; }
  .section:first-of-type { page-break-before: avoid; }
  h3.sub { color: #0D7377; font-size: 10.5pt; margin: 10px 0 5px 0; page-break-after: avoid; }
  p { margin-bottom: 6px; font-size: 9.5pt; text-align: justify; }
  ul { margin-left: 18px; margin-bottom: 6px; }
  ul li { margin-bottom: 3px; font-size: 9.5pt; }
  ul.check li::marker { content: "☐ "; }

  /* TABLES */
  table { width: 100%; border-collapse: collapse; margin-bottom: 10px; font-size: 8.5pt; page-break-inside: avoid; }
  table th { background: #1A3C6E; color: white; padding: 5px 7px; text-align: center; font-weight: bold; font-size: 9pt; }
  table td { padding: 4px 7px; border: 0.5px solid #AAA; vertical-align: top; }
  table tr:nth-child(even) td { background: #F4F6F9; }
  table tr:nth-child(odd) td { background: white; }
  table.teal th { background: #0D7377; }
  table.green th { background: #1E7A3E; }
  table.orange th { background: #C75B00; }
  table.red th { background: #B22222; }
  table.mid-blue th { background: #2E6DA4; }

  /* CALLOUT BOXES */
  .box-blue { background: #D6E8FA; border: 1.5px solid #2E6DA4; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }
  .box-green { background: #D4EDDA; border: 1.5px solid #1E7A3E; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }
  .box-red { background: #FDDEDE; border: 1.5px solid #B22222; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }
  .box-orange { background: #FDE8D0; border: 1.5px solid #C75B00; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }
  .box-yellow { background: #FFFBE6; border: 1.5px solid #F0C040; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }
  .box-teal { background: #D0EFEF; border: 1.5px solid #0D7377; border-radius: 5px; padding: 10px 14px; margin-bottom: 8px; }

  .note { color: #C75B00; font-style: italic; font-size: 9pt; margin: 4px 0 6px 8px; }
  .warning { color: #B22222; font-weight: bold; font-size: 9pt; margin: 4px 0 6px 8px; }
  .highlight { color: #1E7A3E; font-weight: bold; font-size: 9.5pt; }

  /* STEP BOXES */
  .step-box { border-radius: 5px; padding: 10px 14px; margin-bottom: 10px; page-break-inside: avoid; }
  .step-box .step-title { font-weight: bold; font-size: 10pt; margin-bottom: 6px; }
  .step-box ul { margin-left: 16px; }
  .step-blue { background: #D6E8FA; border-left: 5px solid #2E6DA4; }
  .step-teal { background: #D0EFEF; border-left: 5px solid #0D7377; }
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</head>
<body>

<!-- ═══════════════════════════ COVER ═══════════════════════════ -->
<div class="cover">
  <div class="cover-top">
    <h1>BOKARO MMU</h1>
    <h2>Medical Officer Study Guide</h2>
    <h3>Daily Protocols &nbsp;|&nbsp; Clinical Guidelines &nbsp;|&nbsp; Field Reference</h3>
    <div class="cover-teal-bar"></div>
    <h3>Piramal Swasthya &nbsp;|&nbsp; Ispat Sanjeevani &amp; Swasthya Kiran</h3>
    <h3>Bokaro Steel Plant Region, Jharkhand, India</h3>
  </div>
  <div class="cover-teal-bar"></div>
  <div class="cover-cards">
    <div class="cover-card">
      <div class="card-key">PROGRAMME</div>
      <div class="card-val">Ispat Sanjeevani (SAIL-BSP)<br>Swasthya Kiran (BPSCL)</div>
    </div>
    <div class="cover-card">
      <div class="card-key">LOCATION</div>
      <div class="card-val">Bokaro District<br>Jharkhand, India</div>
    </div>
    <div class="cover-card">
      <div class="card-key">MANAGED BY</div>
      <div class="card-val">Piramal Swasthya<br>(Piramal Foundation)</div>
    </div>
    <div class="cover-card">
      <div class="card-key">PURPOSE</div>
      <div class="card-val">Preventive | Curative<br>Referral | Health Education</div>
    </div>
  </div>
  <div class="cover-orange-bar"></div>
  <div class="cover-footer">
    This guide is intended for internal use by Piramal Swasthya Medical Officers.<br>
    Clinical decisions must always be based on individual patient assessment, current NHM/MoHFW guidelines, and professional judgement.<br><br>
    <strong>Version 1.0 &nbsp;|&nbsp; July 2026 &nbsp;|&nbsp; For Medical Officers - Bokaro MMU</strong>
  </div>
</div>

<!-- ═══════════════════════════ TABLE OF CONTENTS ═══════════════════════════ -->
<div class="toc-page">
  <h2>TABLE OF CONTENTS</h2>
  <div class="toc-bar"></div>
  <div class="toc-item"><span>Section 1</span> &nbsp;&nbsp; Piramal Swasthya &amp; MMU Programme Overview</div>
  <div class="toc-item"><span>Section 2</span> &nbsp;&nbsp; MMU Team Structure &amp; Roles</div>
  <div class="toc-item"><span>Section 3</span> &nbsp;&nbsp; Daily Pre-Camp Checklist</div>
  <div class="toc-item"><span>Section 4</span> &nbsp;&nbsp; Service Point Workflow - Step by Step</div>
  <div class="toc-item"><span>Section 5</span> &nbsp;&nbsp; Clinical Protocols - Triage &amp; OPD</div>
  <div class="toc-item"><span>Section 6</span> &nbsp;&nbsp; Maternal &amp; Child Health (ANC / PNC / RCH)</div>
  <div class="toc-item"><span>Section 7</span> &nbsp;&nbsp; Communicable Disease Protocols - Malaria, TB, Diarrhea, ARI</div>
  <div class="toc-item"><span>Section 8</span> &nbsp;&nbsp; Non-Communicable Disease (NCD) Management</div>
  <div class="toc-item"><span>Section 9</span> &nbsp;&nbsp; Emergency &amp; Referral Protocols</div>
  <div class="toc-item"><span>Section 10</span> &nbsp;&nbsp; Medicines Available in MMU (Essential Drug List)</div>
  <div class="toc-item"><span>Section 11</span> &nbsp;&nbsp; Diagnostics &amp; Equipment in MMU</div>
  <div class="toc-item"><span>Section 12</span> &nbsp;&nbsp; AMRIT Digital System - Documentation Guide</div>
  <div class="toc-item"><span>Section 13</span> &nbsp;&nbsp; Health Education &amp; Literacy Sessions</div>
  <div class="toc-item"><span>Section 14</span> &nbsp;&nbsp; End-of-Day Closing Protocol</div>
  <div class="toc-item"><span>Section 15</span> &nbsp;&nbsp; Key Contacts &amp; Escalation Matrix</div>
  <div class="toc-item"><span>Section 16</span> &nbsp;&nbsp; Quick Drug Dose Reference</div>
  <div class="toc-item"><span>Section 17</span> &nbsp;&nbsp; Research Evidence Summary</div>
  <div class="toc-item"><span>Final Page</span> &nbsp;&nbsp; MO Field Mantra - You Are Ready</div>
</div>

<!-- ═══════════════════════════ SECTION 1 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 1 - PIRAMAL SWASTHYA &amp; MMU PROGRAMME OVERVIEW</div>
  <h3 class="sub">About Piramal Swasthya</h3>
  <p>Piramal Swasthya Management and Research Institute is a registered non-profit organisation under the Piramal Foundation, headquartered in Hyderabad. Founded in 2007 with a team of 1,400+ staff, its mission is to complement government efforts and advance Universal Health Coverage (UHC) by bringing healthcare to India's most underserved communities.</p>
  <h3 class="sub">Core Values</h3>
  <table class="teal">
    <tr><th>Value</th><th>Meaning</th></tr>
    <tr><td><strong>Knowledge</strong></td><td>Evidence-based, continuously learning organisation</td></tr>
    <tr><td><strong>Action</strong></td><td>Doing, not just planning - field-first approach</td></tr>
    <tr><td><strong>Care</strong></td><td>People first - patient and community centred at all times</td></tr>
    <tr><td><strong>Impact</strong></td><td>Measurable change at scale - data-driven accountability</td></tr>
  </table>
  <h3 class="sub">Vision Statement</h3>
  <div class="box-blue" style="text-align:center;">
    <strong>"To transform India's health ecosystem through high-impact solutions, partnerships, and thought leadership - aligned to Universal Health Coverage."</strong>
  </div>
  <h3 class="sub">MMU Programmes in Bokaro</h3>
  <table>
    <tr><th>Programme Name</th><th>Partner / Funder</th><th>Since</th><th>Coverage</th><th>Beneficiaries Reached</th></tr>
    <tr><td><strong>Ispat Sanjeevani</strong></td><td>Bokaro Steel Plant (SAIL)</td><td>Feb 2016</td><td>45 locations/month (41 villages + 4 schools)</td><td>1.38 lakh+</td></tr>
    <tr><td><strong>Swasthya Kiran</strong></td><td>Bokaro Power Supply Co. Ltd. (BPSCL)</td><td>Mar 2016</td><td>40 villages/month - Chas &amp; Jaridih blocks</td><td>1.34 lakh+</td></tr>
    <tr><td><strong>Saranda Sanjeevani</strong></td><td>SAIL - Kiriburu &amp; Gua Iron Ore Mines</td><td>Nov 2023</td><td>Tribal communities near West Singhbhum mines</td><td>Growing</td></tr>
  </table>
  <p>Daily footfall per MMU: <strong>50-60 beneficiaries per camp day.</strong> All services are provided <strong>free of charge</strong> to all beneficiaries.</p>
</div>

<!-- ═══════════════════════════ SECTION 2 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 2 - MMU TEAM STRUCTURE &amp; ROLES</div>
  <p>A standard Piramal Swasthya MMU carries the following team. As Medical Officer you are the clinical lead and are responsible for the quality of all health services at the service point.</p>
  <table>
    <tr><th>Role</th><th>Key Responsibilities</th><th>Reports To</th></tr>
    <tr><td><strong>Medical Officer (YOU)</strong></td><td>OPD consultation, diagnosis, prescription; ANC/child health review; referral decisions; clinical supervision of entire team</td><td>Area Manager</td></tr>
    <tr><td><strong>Staff Nurse / ANM</strong></td><td>Vital signs, health screening, patient history; ANC/PNC checks; immunisation record review; health education support</td><td>Medical Officer</td></tr>
    <tr><td><strong>Lab Technician</strong></td><td>POCT tests (Hb, blood sugar, malaria RDT, UPT, urine dipstick); worklist management; upload results to AMRIT</td><td>Medical Officer</td></tr>
    <tr><td><strong>Pharmacist</strong></td><td>Drug dispensing (OTC + Schedule H on prescription); stock management; inventory indent at 30% stock; prescription photo coordination</td><td>Medical Officer</td></tr>
    <tr><td><strong>R&amp;MO (Registration &amp; Measurement Officer)</strong></td><td>Beneficiary registration; ABHA generation; OP card / CD card filling; weight &amp; height; document photo capture</td><td>Medical Officer</td></tr>
    <tr><td><strong>Driver / Pilot</strong></td><td>Vehicle operation (HMV licence required); logistics; fuel management; van maintenance reporting</td><td>Area Manager</td></tr>
  </table>
  <div class="box-red">
    <p class="warning">NOTE: On camp days the MO is the senior-most clinical person present. All clinical decisions - including referrals - are your sole responsibility. There is NO specialist backup on site.</p>
  </div>
</div>

<!-- ═══════════════════════════ SECTION 3 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 3 - DAILY PRE-CAMP CHECKLIST</div>
  <p>Complete this checklist before the MMU departs the base point each morning. Do not depart if any critical item is missing.</p>

  <h3 class="sub">A. Documents &amp; ID</h3>
  <table class="mid-blue">
    <tr><th>#</th><th>Item</th><th>Done</th></tr>
    <tr><td>1</td><td>Valid NMC / JMC registration card (carry original)</td><td>[ ]</td></tr>
    <tr><td>2</td><td>Piramal Swasthya ID card</td><td>[ ]</td></tr>
    <tr><td>3</td><td>Today's service point schedule + route map (offline copy)</td><td>[ ]</td></tr>
    <tr><td>4</td><td>Blank OP cards and CD cards stocked (alert at 30% threshold)</td><td>[ ]</td></tr>
    <tr><td>5</td><td>Monthly visit register and critical case register</td><td>[ ]</td></tr>
    <tr><td>6</td><td>Pre-printed referral slips in stock</td><td>[ ]</td></tr>
  </table>

  <h3 class="sub">B. Medicines</h3>
  <table class="mid-blue">
    <tr><th>#</th><th>Item</th><th>Done</th></tr>
    <tr><td>1</td><td>Core drug kit loaded and secured in van storage</td><td>[ ]</td></tr>
    <tr><td>2</td><td>Cold-chain items (vaccines/biologicals if any) in icebox with ice</td><td>[ ]</td></tr>
    <tr><td>3</td><td>ORS sachets, Zinc tablets, IFA tablets, Albendazole checked</td><td>[ ]</td></tr>
    <tr><td>4</td><td>Malaria ACT (Artemether-Lumefantrine) stock verified</td><td>[ ]</td></tr>
    <tr><td>5</td><td>Schedule H (controlled) drugs logged in controlled drug register</td><td>[ ]</td></tr>
    <tr><td>6</td><td>Drug expiry dates spot-checked - all expired items removed</td><td>[ ]</td></tr>
  </table>

  <h3 class="sub">C. Equipment &amp; Diagnostics</h3>
  <table class="mid-blue">
    <tr><th>#</th><th>Item</th><th>Done</th></tr>
    <tr><td>1</td><td>Stethoscope, BP apparatus (manual + digital), pulse oximeter</td><td>[ ]</td></tr>
    <tr><td>2</td><td>Digital thermometer, weighing scales (adult + infant)</td><td>[ ]</td></tr>
    <tr><td>3</td><td>Glucometer + strips, HemoCue / hemoglobinometer + cuvettes</td><td>[ ]</td></tr>
    <tr><td>4</td><td>Malaria RDT kits, urine dipsticks, pregnancy test kits (UPT)</td><td>[ ]</td></tr>
    <tr><td>5</td><td>Dressing tray, gloves (sterile + non-sterile), antiseptic, bandages</td><td>[ ]</td></tr>
    <tr><td>6</td><td>Torch / penlight, measuring tape (for ANC fundal height)</td><td>[ ]</td></tr>
  </table>

  <h3 class="sub">D. Digital System &amp; Team</h3>
  <table class="mid-blue">
    <tr><th>#</th><th>Item</th><th>Done</th></tr>
    <tr><td>1</td><td>Tablet / laptop charged to 100% before departure</td><td>[ ]</td></tr>
    <tr><td>2</td><td>AMRIT application open and functioning - offline sync verified</td><td>[ ]</td></tr>
    <tr><td>3</td><td>Webcam / camera working for prescription photo capture</td><td>[ ]</td></tr>
    <tr><td>4</td><td>Previous day's data synced to central server</td><td>[ ]</td></tr>
    <tr><td>5</td><td>All team members present and in uniform</td><td>[ ]</td></tr>
    <tr><td>6</td><td>Driver briefed on route - emergency numbers saved: BSP Hospital, 108, Area Manager</td><td>[ ]</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 4 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 4 - SERVICE POINT WORKFLOW (STEP BY STEP)</div>

  <div class="step-box step-blue">
    <div class="step-title" style="color:#2E6DA4;">STEP 1 - ARRIVAL (15 minutes before camp time)</div>
    <ul>
      <li>Park MMU van in designated / shaded area near the village</li>
      <li>Greet village head (Mukhiya/Pradhan) and ASHA worker</li>
      <li>Set up counters: Registration | Nurse | Lab | Doctor | Pharmacy</li>
      <li>Display the service schedule board or banner if available</li>
      <li>Inform ASHA of specific follow-up patients expected today</li>
    </ul>
  </div>

  <div class="step-box step-teal">
    <div class="step-title" style="color:#0D7377;">STEP 2 - REGISTRATION COUNTER</div>
    <ul>
      <li>R&amp;MO registers new beneficiaries - name, age, address, ABHA ID</li>
      <li>Returning patients: retrieve ABHA record from AMRIT (or OP card)</li>
      <li>Vital signs taken by Nurse: weight, height, temperature, SpO2, BP</li>
      <li>Triage flags added: Pregnant (P), Child under 5 (C), Emergency (E)</li>
      <li>Patients queue for Doctor counter in triage order</li>
    </ul>
  </div>

  <div class="step-box step-green">
    <div class="step-title" style="color:#1E7A3E;">STEP 3 - DOCTOR CONSULTATION</div>
    <ul>
      <li>Review nurse-recorded vitals and chief complaint before calling patient</li>
      <li>Full history and focused physical examination for each patient</li>
      <li>Order point-of-care lab tests if required - Lab Tech processes immediately</li>
      <li>Review lab results before finalising diagnosis and prescription</li>
      <li>Write prescription in AMRIT system + photo captured by R&amp;MO</li>
      <li>Counsel patient: diagnosis, medicine name, dose, duration, what to watch for</li>
      <li>Mark high-risk patients for referral - complete referral slip before leaving</li>
    </ul>
  </div>

  <div class="step-box step-orange">
    <div class="step-title" style="color:#C75B00;">STEP 4 - PHARMACY COUNTER</div>
    <ul>
      <li>Pharmacist dispenses medicines as per MO prescription</li>
      <li>OTC drugs dispensed without prescription; Schedule H only on Rx</li>
      <li>Patient educated on dose, timing, storage of each medicine</li>
      <li>Drug issue entered in Beneficiary Drugs Issue Register</li>
      <li>Controlled drug dispensed: logged in Controlled Drug Register with signature</li>
    </ul>
  </div>

  <div class="step-box step-purple">
    <div class="step-title" style="color:#6A1B8A;">STEP 5 - HEALTH EDUCATION SESSION (5-10 min)</div>
    <ul>
      <li>Conduct group health talk while patients wait (use waiting time productively)</li>
      <li>Use ASHA / ANM as language interpreter for Khortha/Sadri/tribal languages</li>
      <li>Visual demonstrations: ORS preparation, handwashing technique</li>
      <li>Allow 2-3 minutes for questions - reveals local misconceptions</li>
      <li>Record in AMRIT daily report: topic + attendee count (male/female)</li>
    </ul>
  </div>
</div>

<!-- ═══════════════════════════ SECTION 5 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 5 - CLINICAL PROTOCOLS: TRIAGE &amp; OPD</div>
  <h3 class="sub">Triage System</h3>
  <table>
    <tr><th>Priority</th><th>Flag</th><th>Criteria</th><th>Action</th></tr>
    <tr class="triage-red"><td><strong>IMMEDIATE</strong></td><td><strong style="color:#B22222;">RED</strong></td><td>Unconscious, severe respiratory distress, convulsion, shock, eclampsia, PPH</td><td>Stabilise. Call 108. Refer IMMEDIATELY. Do not delay for documentation.</td></tr>
    <tr class="triage-orange"><td><strong>URGENT</strong></td><td><strong style="color:#C75B00;">ORANGE</strong></td><td>High fever (&gt;39°C), severe dehydration, severe anaemia (Hb &lt;7), danger signs in child</td><td>See within 10 minutes. Treat and refer if needed.</td></tr>
    <tr class="triage-yellow"><td><strong>PRIORITY</strong></td><td><strong style="color:#8B7000;">YELLOW</strong></td><td>Pregnant women (any stage), children under 5, elderly (&gt;60 years)</td><td>See before general queue. All ANC patients seen before others.</td></tr>
    <tr class="triage-green"><td><strong>ROUTINE</strong></td><td><strong style="color:#1E7A3E;">GREEN</strong></td><td>Stable adults with acute minor illness or chronic disease review</td><td>See in registration order.</td></tr>
  </table>

  <h3 class="sub">Standard OPD Consultation Flow</h3>
  <ol style="margin-left:18px; font-size:9.5pt;">
    <li style="margin-bottom:4px;">Review vitals recorded by Nurse before calling patient in</li>
    <li style="margin-bottom:4px;">Introduce yourself - greet in local language (Khortha/Sadri/Hindi)</li>
    <li style="margin-bottom:4px;">Chief complaint in patient's own words - listen without interrupting</li>
    <li style="margin-bottom:4px;">History: onset, duration, severity, associated symptoms, previous treatment</li>
    <li style="margin-bottom:4px;">Past history: known diabetes, hypertension, TB, previous hospitalisations</li>
    <li style="margin-bottom:4px;">Obstetric history (all women of reproductive age): LMP, pregnancies, deliveries</li>
    <li style="margin-bottom:4px;">Drug history and documented allergies</li>
    <li style="margin-bottom:4px;">Focused physical examination as indicated by history</li>
    <li style="margin-bottom:4px;">Order POCT tests if needed - get results before prescribing</li>
    <li style="margin-bottom:4px;">Diagnosis entered in AMRIT system</li>
    <li style="margin-bottom:4px;">Prescription: generic drug name, dose, frequency, duration, route</li>
    <li style="margin-bottom:4px;">Patient counselling: what the condition is, how to take medicines, red flags to return</li>
    <li style="margin-bottom:4px;">Follow-up plan: next MMU visit date or referral instruction</li>
  </ol>
</div>

<!-- ═══════════════════════════ SECTION 6 ═══════════════════════════ -->
<div class="section">
  <div class="section-header teal">SECTION 6 - MATERNAL &amp; CHILD HEALTH (ANC / PNC / RCH)</div>
  <h3 class="sub">ANC - 4 Visit Protocol (NHM Standard)</h3>
  <table class="teal">
    <tr><th>Visit</th><th>Timing</th><th>Key MO Tasks</th><th>Investigations</th></tr>
    <tr><td><strong>ANC-1</strong></td><td>Before 12 weeks</td><td>Confirm pregnancy (UPT); register in JSSY/MCP card; blood group, Hb, BP, weight; start IFA + Calcium; TT-1</td><td>Hb, blood group, urine; RBS; HIV &amp; VDRL if available</td></tr>
    <tr><td><strong>ANC-2</strong></td><td>14-26 weeks</td><td>BP, weight, fundal height; foetal heart sounds; IFA + Calcium continued; TT-2 if not given</td><td>Hb (repeat if anaemia); urine albumin + sugar</td></tr>
    <tr><td><strong>ANC-3</strong></td><td>28-34 weeks</td><td>BP, weight, fundal height; presentation check; birth preparedness counselling; refer CHC/PHC if high-risk</td><td>Hb repeat; urine albumin + sugar</td></tr>
    <tr><td><strong>ANC-4</strong></td><td>36 weeks+</td><td>Finalise birth plan; institutional delivery counselling; JSSY registration confirmed; newborn care counselling</td><td>Hb, urine; refer to delivery facility</td></tr>
  </table>

  <h3 class="sub">ANC Danger Signs - REFER IMMEDIATELY if any present</h3>
  <div class="box-red">
    <ul>
      <li>Severe headache + blurred vision + facial/hand swelling (eclampsia warning)</li>
      <li>Blood pressure &gt; 140/90 mmHg on two readings 4 hours apart</li>
      <li>Severe anaemia: Hb &lt; 7 g/dL + pallor + breathlessness or palpitations</li>
      <li>Any vaginal bleeding at any stage of pregnancy</li>
      <li>Absent foetal movements after 28 weeks</li>
      <li>Fever with altered consciousness (cerebral malaria risk - endemic in Jharkhand)</li>
      <li>Premature labour signs before 37 weeks (uterine contractions, watery discharge)</li>
    </ul>
  </div>

  <h3 class="sub">Child Health - IMNCI Assessment Points</h3>
  <table class="green">
    <tr><th>Age Group</th><th>Priority Checks</th><th>Action</th></tr>
    <tr><td><strong>Neonate (0-28 days)</strong></td><td>Weight, temperature, jaundice, cord care; breastfeeding assessment; danger signs (poor feeding, convulsion, fast breathing)</td><td>Refer if: weight &lt;2 kg, jaundice, poor feeding, respiratory distress, hypothermia</td></tr>
    <tr><td><strong>Infant (1-12 months)</strong></td><td>Weight-for-age on growth chart; immunisation status; anaemia; ARI signs; diarrhoea; malnutrition screen (MUAC)</td><td>SAM (MUAC &lt; 11.5 cm): refer NRC. MAM: therapeutic feeding + counselling</td></tr>
    <tr><td><strong>Child (1-5 years)</strong></td><td>Fever (malaria RDT mandatory in Jharkhand); cough &gt;2 weeks (TB screen); worm signs; nutritional status</td><td>Albendazole 6-monthly; Vitamin A biannually; refer malnourished</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 7 ═══════════════════════════ -->
<div class="section">
  <div class="section-header red">SECTION 7 - COMMUNICABLE DISEASE PROTOCOLS</div>

  <h3 class="sub">7A. MALARIA (HIGH PRIORITY - Jharkhand is endemic)</h3>
  <p>Test EVERY febrile patient with malaria RDT. P. falciparum predominates in Jharkhand and can be fatal if not treated within 24 hours.</p>
  <table class="red">
    <tr><th>Parameter</th><th>P. vivax</th><th>P. falciparum</th></tr>
    <tr><td><strong>First-line treatment</strong></td><td>Chloroquine 25mg/kg over 3 days + Primaquine 0.25mg/kg x 14 days</td><td>ACT: Artemether-Lumefantrine (adult: 4 tabs BD x 3 days) + Primaquine single dose</td></tr>
    <tr><td><strong>Severe / cerebral malaria</strong></td><td colspan="2" style="text-align:center; font-weight:bold; background:#FDDEDE !important;">REFER IMMEDIATELY to hospital - do NOT attempt to treat severe malaria in MMU</td></tr>
    <tr><td><strong>In pregnancy</strong></td><td>Chloroquine is safe (avoid Primaquine)</td><td>Quinine + Clindamycin - refer to PHC/CHC for initiation</td></tr>
    <tr><td><strong>Children</strong></td><td colspan="2">Dose strictly by weight using NVBDCP national drug policy chart (2023)</td></tr>
    <tr><td><strong>Danger signs - REFER</strong></td><td colspan="2">Altered consciousness, convulsions, severe anaemia (Hb&lt;5), respiratory distress, jaundice, haemoglobinuria, repeated vomiting</td></tr>
  </table>

  <h3 class="sub">7B. TUBERCULOSIS (TB) - Identify and Refer Only</h3>
  <div class="box-red"><p class="warning">DO NOT start anti-TB treatment in the MMU. Your role is identify presumptive TB and refer to the nearest DOTS centre. Never prescribe anti-TB drugs at MMU level.</p></div>
  <p><strong>Presumptive TB - refer if ANY of:</strong></p>
  <ul>
    <li>Cough lasting more than 2 weeks (most important symptom)</li>
    <li>Unexplained weight loss in last 1-2 months</li>
    <li>Evening fever or night sweats for more than 2 weeks</li>
    <li>Haemoptysis (blood in sputum - any amount)</li>
    <li>Household contact with a confirmed TB patient</li>
  </ul>
  <p class="note">ACTION: Issue presumptive TB referral slip to nearest DOTS centre / PHC. Enter in AMRIT. Follow up on next village visit to confirm patient reached the facility.</p>

  <h3 class="sub">7C. DIARRHEA &amp; DEHYDRATION</h3>
  <table class="mid-blue">
    <tr><th>WHO Plan</th><th>Assessment Criteria</th><th>Treatment in MMU</th></tr>
    <tr><td><strong>Plan A</strong><br>(No dehydration)</td><td>Alert, drinking well, no sunken eyes, skin pinch returns quickly</td><td>ORS at home: 200ml after each loose stool; Zinc 20mg/day x 14 days (children); continue feeding</td></tr>
    <tr><td><strong>Plan B</strong><br>(Some dehydration)</td><td>Restless/irritable, sunken eyes, drinks eagerly, skin pinch slow return</td><td>ORS 75ml/kg over 4 hours at MMU; reassess after 4 hours; Zinc 20mg x 14 days</td></tr>
    <tr><td><strong>Plan C</strong><br>(Severe dehydration)</td><td>Lethargic or unconscious, very sunken eyes, unable to drink, skin pinch very slow</td><td>REFER IMMEDIATELY with IV fluids initiated; call 108; Ringer's Lactate 100ml/kg</td></tr>
  </table>

  <h3 class="sub">7D. ARI - Acute Respiratory Infection (Children)</h3>
  <table class="mid-blue">
    <tr><th>Classification</th><th>Signs</th><th>MMU Treatment</th></tr>
    <tr><td><strong>NO PNEUMONIA</strong></td><td>No fast breathing, no chest indrawing</td><td>No antibiotics; saline nasal drops; honey (over 1 year); return if worsens</td></tr>
    <tr><td><strong>PNEUMONIA</strong></td><td>Fast breathing (over 50/min in infants; over 40/min in 1-5yr) OR lower chest indrawing</td><td>Amoxicillin 40mg/kg/day in 3 doses x 5 days; Paracetamol for fever; review in 2 days</td></tr>
    <tr><td><strong>SEVERE PNEUMONIA</strong></td><td>Any danger sign: cyanosis, unable to feed, convulsion, stridor, lethargy + fast breathing</td><td>REFER IMMEDIATELY; give first dose Amoxicillin before referral; call 108</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 8 ═══════════════════════════ -->
<div class="section">
  <div class="section-header orange">SECTION 8 - NON-COMMUNICABLE DISEASE (NCD) MANAGEMENT</div>
  <p>NCDs are rising rapidly in Jharkhand's tribal and rural population. Evidence shows that even with 80%+ screening coverage, disease control rates remain below 35% (Tamil Nadu doorstep health study, BMC Primary Care 2025). Adherence counselling at every MMU visit is the most impactful intervention.</p>

  <h3 class="sub">Hypertension Protocol</h3>
  <table class="orange">
    <tr><th>Stage</th><th>BP Reading</th><th>MMU Action</th><th>Target</th></tr>
    <tr><td>Normal</td><td>&lt; 120/80</td><td>Educate; rescreen in 1 year</td><td>Maintain</td></tr>
    <tr><td>Elevated</td><td>120-129 / &lt;80</td><td>Lifestyle counselling; rescreen in 3 months</td><td>&lt; 120/80</td></tr>
    <tr><td>Stage 1 HTN</td><td>130-139 / 80-89</td><td>Start Amlodipine 5mg OD after 3 months lifestyle failure; CD card; counsel on salt, alcohol, tobacco</td><td>&lt; 130/80</td></tr>
    <tr><td>Stage 2 HTN</td><td>&gt; 140/90</td><td>Start Amlodipine 5mg + Enalapril 5mg; CD card; monthly follow-up; refer if uncontrolled at 3 months</td><td>&lt; 130/80</td></tr>
    <tr><td><strong>Hypertensive Emergency</strong></td><td>&gt; 180/120 + symptoms (headache, vision change, chest pain, confusion)</td><td style="color:#B22222;"><strong>REFER IMMEDIATELY - call 108 - do not delay</strong></td><td>Hospital</td></tr>
  </table>

  <h3 class="sub">Diabetes Protocol</h3>
  <table class="orange">
    <tr><th>RBS / FBS Level</th><th>Classification</th><th>MMU Action</th></tr>
    <tr><td>RBS &lt; 140 / FBS &lt; 100</td><td>Normal</td><td>Annual rescreen; diet and exercise counselling</td></tr>
    <tr><td>RBS 140-199 / FBS 100-125</td><td>Prediabetes</td><td>Lifestyle counselling: diet modification + 30 min exercise daily; repeat in 3 months</td></tr>
    <tr><td>RBS &gt; 200 with symptoms OR FBS &gt; 126 on two occasions</td><td>Diabetes Mellitus</td><td>Start Metformin 500mg BD with food; open CD card; dietary counselling; monthly follow-up</td></tr>
    <tr><td>RBS &lt; 70 (Hypoglycaemia)</td><td><strong>EMERGENCY</strong></td><td>Conscious: 15-20g fast sugar (glucose tablets, sugar water). Unconscious: REFER with IV Dextrose 25% en route</td></tr>
  </table>

  <div class="box-orange">
    <p class="note"><strong>KEY REMINDER:</strong> Ask every HTN/DM patient at every visit: "Are you taking your medicines daily? Any missed doses?" This single question is the most impactful NCD intervention you can make in an MMU setting.</p>
  </div>
</div>

<!-- ═══════════════════════════ SECTION 9 ═══════════════════════════ -->
<div class="section">
  <div class="section-header red">SECTION 9 - EMERGENCY &amp; REFERRAL PROTOCOLS</div>
  <div class="box-red"><p class="warning">The MMU has no in-patient beds or IV therapy capability beyond initial stabilisation. Your role in an emergency is: STABILISE - COMMUNICATE - TRANSPORT.</p></div>

  <table class="red">
    <tr><th>Emergency</th><th>First Aid in MMU</th><th>Refer To</th><th>Call</th></tr>
    <tr><td><strong>Eclampsia</strong></td><td>Left lateral position; MgSO4 if available; secure airway; dim lights</td><td>BSP Hospital / District Hospital</td><td>108</td></tr>
    <tr><td><strong>Severe Malaria</strong></td><td>Artesunate IM if available; IV access; supplemental O2; keep flat</td><td>BSP Hospital / Sadar Hospital</td><td>108</td></tr>
    <tr><td><strong>Suspected MI / Chest Pain</strong></td><td>Aspirin 325mg stat (chew); rest; O2 if available; Nitrates if BP &gt; 90</td><td>BSP Hospital Emergency</td><td>108 + BSP ER</td></tr>
    <tr><td><strong>Severe Dehydration (Plan C)</strong></td><td>IV access + Ringer's Lactate 100ml/kg; ORS via NG if possible; monitor vitals</td><td>Nearest CHC / PHC</td><td>108</td></tr>
    <tr><td><strong>Anaphylaxis</strong></td><td>Adrenaline 0.5mg IM outer thigh; lay flat with legs raised; IV access</td><td>BSP Hospital</td><td>108</td></tr>
    <tr><td><strong>Snake Bite</strong></td><td>Immobilise limb; keep calm and still; NO tourniquet, NO incision; mark swelling edge + time</td><td>BSP Hospital (anti-venom available)</td><td>108 + 100</td></tr>
    <tr><td><strong>Neonatal Danger Signs</strong></td><td>Warm baby (Kangaroo Mother Care); support breastfeeding; keep with mother</td><td>BSP Hospital / NRC</td><td>108</td></tr>
    <tr><td><strong>Road Trauma</strong></td><td>ABC - Airway-Breathing-Circulation; control bleeding with direct pressure; spinal precautions</td><td>BSP Hospital Emergency</td><td>108 + 100</td></tr>
  </table>

  <h3 class="sub">Mandatory Referral Documentation (every referral must include)</h3>
  <ul>
    <li>Patient name, age, sex, ABHA ID</li>
    <li>Diagnosis / provisional diagnosis (be specific)</li>
    <li>Reason for referral - clinical justification in clear language</li>
    <li>Vital signs at time of referral</li>
    <li>Treatment given before referral (medicines, doses, times)</li>
    <li>Receiving facility name and contact number</li>
    <li>Accompanying person's name and contact number</li>
    <li>MO name, signature, MMU name, date and time</li>
  </ul>
  <p class="note">FOLLOW-UP: On the next visit to the same village, ask the ASHA whether the referred patient reached the hospital. Update AMRIT referral status accordingly.</p>
</div>

<!-- ═══════════════════════════ SECTION 10 ═══════════════════════════ -->
<div class="section">
  <div class="section-header green">SECTION 10 - MEDICINES IN MMU (ESSENTIAL DRUG LIST)</div>
  <p>The MMU drug kit follows the NHM Essential Medicines List (NLEM 2022) for primary health care. Below is the standard therapeutic breakdown.</p>

  <h3 class="sub">Analgesics / Antipyretics</h3>
  <table class="green">
    <tr><th>Drug</th><th>Dose (Adult)</th><th>Indication</th></tr>
    <tr><td>Paracetamol 500mg</td><td>500-1000mg every 6-8 hours (max 4g/day)</td><td>Fever, mild to moderate pain</td></tr>
    <tr><td>Ibuprofen 400mg</td><td>400mg every 8 hours with food</td><td>Pain, inflammation, dysmenorrhea</td></tr>
    <tr><td>Diclofenac 50mg</td><td>50mg every 8-12 hours</td><td>Musculoskeletal pain, joint pain</td></tr>
  </table>

  <h3 class="sub">Anti-Infectives</h3>
  <table class="red">
    <tr><th>Drug</th><th>Dose (Adult)</th><th>Indication</th></tr>
    <tr><td>Amoxicillin 500mg</td><td>500mg every 8 hours x 5-7 days</td><td>ARI, skin infections, UTI</td></tr>
    <tr><td>Cotrimoxazole 480mg</td><td>2 tablets BD x 5 days</td><td>UTI, ARI, diarrhea</td></tr>
    <tr><td>Doxycycline 100mg</td><td>100mg BD x 7 days</td><td>Respiratory, skin, tick fever</td></tr>
    <tr><td>Metronidazole 400mg</td><td>400mg TDS x 5-7 days</td><td>Anaerobic infections, amoebiasis, Giardia</td></tr>
    <tr><td>Albendazole 400mg</td><td>400mg single dose</td><td>Worm infestations (6-monthly deworming)</td></tr>
    <tr><td>Artemether-Lumefantrine</td><td>4 tablets BD x 3 days (adult over 35kg)</td><td>P. falciparum malaria (first-line)</td></tr>
    <tr><td>Chloroquine 250mg</td><td>25mg/kg over 3 days (600/300/300mg)</td><td>P. vivax malaria</td></tr>
    <tr><td>Primaquine 7.5mg</td><td>Per NVBDCP 2023 protocol by species</td><td>Malaria radical cure (check G6PD)</td></tr>
    <tr><td>Fluconazole 150mg</td><td>150mg single dose</td><td>Vaginal candidiasis</td></tr>
    <tr><td>Clotrimazole cream 1%</td><td>Apply BD x 2-4 weeks</td><td>Tinea, dermatophyte skin infections</td></tr>
  </table>

  <h3 class="sub">Gastrointestinal</h3>
  <table class="mid-blue">
    <tr><th>Drug</th><th>Dose (Adult)</th><th>Indication</th></tr>
    <tr><td>ORS sachets</td><td>200ml after each loose stool</td><td>Diarrhea, dehydration (all ages)</td></tr>
    <tr><td>Zinc 20mg (paediatric)</td><td>10mg/day under 6 months; 20mg/day over 6 months x 14 days</td><td>Diarrhea in children under 5</td></tr>
    <tr><td>Pantoprazole 40mg</td><td>40mg OD before food</td><td>Peptic ulcer disease, GERD</td></tr>
    <tr><td>Metoclopramide 10mg</td><td>10mg every 8 hours</td><td>Nausea, vomiting</td></tr>
    <tr><td>Antacid suspension</td><td>10-20ml TDS after food</td><td>Gastritis, hyperacidity, dyspepsia</td></tr>
    <tr><td>Hyoscine butylbromide 10mg</td><td>10mg every 8 hours</td><td>Abdominal spasm, colic</td></tr>
  </table>

  <h3 class="sub">Cardiovascular / NCD</h3>
  <table>
    <tr><th>Drug</th><th>Dose (Adult)</th><th>Indication</th></tr>
    <tr><td>Amlodipine 5mg</td><td>5-10mg OD</td><td>Hypertension (first-line)</td></tr>
    <tr><td>Enalapril 5mg</td><td>5-20mg OD-BD</td><td>Hypertension, diabetic nephropathy</td></tr>
    <tr><td>Atenolol 50mg</td><td>25-100mg OD</td><td>Hypertension, angina</td></tr>
    <tr><td>Aspirin 75mg</td><td>75mg OD after food</td><td>CVD secondary prevention</td></tr>
    <tr><td>Metformin 500mg</td><td>500mg BD with food (max 2g/day)</td><td>Type 2 Diabetes Mellitus</td></tr>
    <tr><td>Glibenclamide 5mg</td><td>2.5-5mg OD before breakfast</td><td>Type 2 DM (if Metformin not tolerated)</td></tr>
  </table>

  <h3 class="sub">Maternal &amp; Child Health</h3>
  <table class="teal">
    <tr><th>Drug</th><th>Dose</th><th>Indication</th></tr>
    <tr><td>IFA tablets (adult)</td><td>1 tablet OD x 100 days during ANC</td><td>Iron deficiency anaemia prevention in pregnancy</td></tr>
    <tr><td>IFA tablets (paediatric)</td><td>1 tablet or syrup daily x 3 months</td><td>Childhood anaemia prevention</td></tr>
    <tr><td>Folic acid 5mg</td><td>5mg OD in first trimester</td><td>Neural tube defect prevention</td></tr>
    <tr><td>Calcium 500mg</td><td>2 tablets OD throughout ANC</td><td>Pre-eclampsia prevention</td></tr>
    <tr><td>Vitamin A 200,000 IU</td><td>Single dose every 6 months</td><td>Children 1-5 years (deficiency prevention)</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 11 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 11 - DIAGNOSTICS &amp; EQUIPMENT IN MMU</div>
  <table>
    <tr><th>Equipment</th><th>Purpose</th><th>When to Use</th><th>MO Action if Abnormal</th></tr>
    <tr><td><strong>BP Apparatus</strong></td><td>Blood pressure measurement</td><td>All adults every visit; all pregnant women</td><td>HTN protocol (Section 8); document in CD card</td></tr>
    <tr><td><strong>Pulse Oximeter</strong></td><td>SpO2 + pulse rate</td><td>All respiratory complaints; malaria + anaemia</td><td>SpO2 &lt;94%: give oxygen + refer urgently. SpO2 &lt;90%: immediate referral</td></tr>
    <tr><td><strong>Digital Thermometer</strong></td><td>Body temperature</td><td>All patients with fever history</td><td>&gt;39°C: malaria RDT mandatory. &gt;40°C in child: urgent treatment</td></tr>
    <tr><td><strong>Weighing Scale (Adult + Infant)</strong></td><td>Weight monitoring</td><td>All ANC patients (every visit); all children</td><td>ANC: plot on graph. Child: MUAC if low weight for age</td></tr>
    <tr><td><strong>Glucometer</strong></td><td>Random / fasting blood sugar</td><td>Known diabetics; diabetes symptoms; GDM screening in ANC</td><td>RBS &gt;200: DM protocol. RBS &lt;70: hypoglycaemia protocol. Log in CD card</td></tr>
    <tr><td><strong>HemoCue / Hemoglobinometer</strong></td><td>Haemoglobin level (g/dL)</td><td>All ANC patients; anaemia symptoms; children with pallor</td><td>Hb &lt;7: severe - refer. Hb 7-10: treat + supplement. Hb &lt;11 in pregnancy: intensify IFA</td></tr>
    <tr><td><strong>Malaria RDT Kit</strong></td><td>P. vivax / P. falciparum antigen</td><td>EVERY febrile patient - do not skip in endemic Jharkhand</td><td>Positive: treat per species (Section 7A). Negative + high suspicion: refer for thick film</td></tr>
    <tr><td><strong>Urine Dipstick</strong></td><td>Protein, glucose, nitrites, blood</td><td>All ANC patients; UTI symptoms; diabetes screening</td><td>Protein 2+ in ANC: pre-eclampsia - refer. Nitrites positive: treat UTI</td></tr>
    <tr><td><strong>Pregnancy Test Kit (UPT)</strong></td><td>hCG detection</td><td>Women with missed period; confirm/rule out pregnancy</td><td>Positive: register for ANC immediately; note LMP, EDD, JSSY eligibility</td></tr>
    <tr><td><strong>Measuring Tape</strong></td><td>Symphysis-fundus (SF) height</td><td>Every ANC visit after 20 weeks</td><td>SF &lt; dates by &gt;3cm: IUGR - refer. SF &gt; dates: macrosomia/polyhydramnios - refer</td></tr>
  </table>
  <p class="warning">MAINTENANCE RULE: Report any equipment malfunction within 12 hours via Asset Damage Report (ADR) to Area Manager. Never conduct a camp without a working BP apparatus and thermometer.</p>
</div>

<!-- ═══════════════════════════ SECTION 12 ═══════════════════════════ -->
<div class="section">
  <div class="section-header teal">SECTION 12 - AMRIT DIGITAL SYSTEM: DOCUMENTATION GUIDE</div>
  <p><strong>AMRIT</strong> (Accessible Medical Records via Integrated Technologies) is Piramal Swasthya's open-source EHR platform. It is ABHA-linked, works offline, and syncs to central servers when internet is available. Every patient must be registered in AMRIT.</p>

  <h3 class="sub">Doctor Module - What to Enter</h3>
  <table class="teal">
    <tr><th>Field</th><th>What to Enter</th><th>Why It Matters</th></tr>
    <tr><td>Chief Complaint</td><td>Patient's words initially, then clinical description</td><td>Drives triage and diagnosis consistency in audits</td></tr>
    <tr><td>Diagnosis</td><td>Provisional or confirmed - ICD-10 code where known</td><td>Enables disease burden analytics for programme reports</td></tr>
    <tr><td>Prescription</td><td>Generic drug name, dose, frequency, duration, route</td><td>Pharmacist dispenses from this; serves as legal record</td></tr>
    <tr><td>Lab Results</td><td>Values from POCT (Hb, RBS, malaria result, urine)</td><td>Historical trends tracked across visits for follow-up</td></tr>
    <tr><td>Referral</td><td>Facility name, clinical reason, date, urgency level</td><td>Referral completion audit by Area Manager</td></tr>
    <tr><td>Visit Type</td><td>OPD / ANC / PNC / Child Health / School Health</td><td>Programme reporting to CSR funders (SAIL / BPSCL)</td></tr>
    <tr><td>Follow-up Date</td><td>Next expected MMU visit date to this village</td><td>Patient receives automated SMS reminder</td></tr>
  </table>

  <h3 class="sub">CD (Chronic Disease) Card System</h3>
  <ul>
    <li>Every patient with HTN, DM, anaemia, or chronic illness must have a CD card</li>
    <li>CD card captures: diagnosis, all medication changes, test results, visit dates</li>
    <li>Patient keeps the physical CD card and brings it to every visit</li>
    <li>MO updates AMRIT CD record at every visit - cross-reference with physical card</li>
    <li>If patient misses a visit: inform ASHA worker to do home follow-up visit</li>
    <li>Non-adherent patient: document reason; counsel respectfully without judgment</li>
  </ul>

  <h3 class="sub">End-of-Day Sync Protocol</h3>
  <ul>
    <li>Before leaving service point: sync AMRIT if mobile data is available</li>
    <li>If no signal at service point: sync at first connectivity point on return route</li>
    <li>Never leave data unsynced for more than 24 hours</li>
    <li>Confirm sync success message before closing the application</li>
    <li>Report sync failures to IT support via Area Manager on the same day</li>
  </ul>
</div>

<!-- ═══════════════════════════ SECTION 13 ═══════════════════════════ -->
<div class="section">
  <div class="section-header mid-blue">SECTION 13 - HEALTH EDUCATION &amp; LITERACY SESSIONS</div>
  <p>Health literacy is a core output of the MMU programme. Research shows that mobile health vans empower communities through health education and improve health-seeking behaviour (Seth R et al., BMJ Paediatrics Open 2025 - 70,000+ children received education sessions). Conduct a group health talk at every service point.</p>

  <h3 class="sub">Monthly Health Education Topic Calendar</h3>
  <table class="mid-blue">
    <tr><th>Month</th><th>Primary Topic</th><th>Key Messages</th><th>Target Audience</th></tr>
    <tr><td>January</td><td>TB Awareness</td><td>Cough over 2 weeks = test for TB; complete full DOTS course; TB is fully curable</td><td>All adults</td></tr>
    <tr><td>February</td><td>Malaria Prevention</td><td>Sleep under bednet; drain stagnant water; seek care for any fever within 24 hours</td><td>All community</td></tr>
    <tr><td>March</td><td>Women's Health / ANC</td><td>4 ANC visits importance; institutional delivery = JSSY benefit; take IFA tablet daily</td><td>Women 15-49 years</td></tr>
    <tr><td>April</td><td>Summer Diarrhea / ORS</td><td>Demonstrate ORS preparation; handwashing with soap; boil or filter drinking water</td><td>Mothers + children</td></tr>
    <tr><td>May</td><td>Heat Stroke Prevention</td><td>Stay hydrated; avoid midday sun; signs of heat exhaustion and first aid</td><td>All community</td></tr>
    <tr><td>June</td><td>Monsoon Diseases</td><td>Malaria, dengue, leptospirosis prevention; clean water storage; mosquito control at home</td><td>All community</td></tr>
    <tr><td>July</td><td>Child Nutrition</td><td>Breastfeed exclusively for first 6 months; complementary feeding from 6 months; growth monitoring</td><td>Mothers with children under 5</td></tr>
    <tr><td>August</td><td>Hypertension</td><td>Reduce salt intake; take medicines daily; check BP regularly at MMU</td><td>Adults over 30</td></tr>
    <tr><td>September</td><td>Diabetes Awareness</td><td>Signs of diabetes; lifestyle: diet and exercise; medicine adherence is essential</td><td>Adults over 30</td></tr>
    <tr><td>October</td><td>Eye &amp; Ear Health</td><td>School vision screening; micronutrient deficiency signs; referral pathways available</td><td>Children + elderly</td></tr>
    <tr><td>November</td><td>Tobacco / Alcohol Harm</td><td>Cancer risk; quit lines available; effect on family health and income</td><td>Men + adolescents</td></tr>
    <tr><td>December</td><td>Immunisation Review</td><td>Check immunisation cards; missed vaccines: go to nearest PHC; cold chain importance</td><td>Children 0-5 years</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 14 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 14 - END-OF-DAY CLOSING PROTOCOL</div>
  <table>
    <tr><th>#</th><th>Task</th><th>Who</th><th>Done</th></tr>
    <tr><td>1</td><td>Count remaining patients - ensure no one left unseen at service point</td><td>MO</td><td>[ ]</td></tr>
    <tr><td>2</td><td>Verify all prescriptions entered in AMRIT system</td><td>MO</td><td>[ ]</td></tr>
    <tr><td>3</td><td>All referral slips issued and documented in critical case register</td><td>MO</td><td>[ ]</td></tr>
    <tr><td>4</td><td>All lab results entered and physically filed</td><td>Lab Tech</td><td>[ ]</td></tr>
    <tr><td>5</td><td>Drug issue register completed for the day with totals</td><td>Pharmacist</td><td>[ ]</td></tr>
    <tr><td>6</td><td>Remaining drug stock counted; indent flagged if below 30%</td><td>Pharmacist</td><td>[ ]</td></tr>
    <tr><td>7</td><td>Cold-chain items secured in icebox for transit back to base</td><td>Pharmacist</td><td>[ ]</td></tr>
    <tr><td>8</td><td>Equipment cleaned and stored; ADR form filed if any damage found</td><td>Nurse / R&amp;MO</td><td>[ ]</td></tr>
    <tr><td>9</td><td>AMRIT data synced to server (or scheduled for sync at base)</td><td>MO / R&amp;MO</td><td>[ ]</td></tr>
    <tr><td>10</td><td>Daily report submitted to Area Manager (WhatsApp + email)</td><td>MO</td><td>[ ]</td></tr>
    <tr><td>11</td><td>Next service point schedule confirmed with Driver</td><td>MO + Driver</td><td>[ ]</td></tr>
    <tr><td>12</td><td>MO signs off daily camp report (hard copy + digital)</td><td>MO</td><td>[ ]</td></tr>
  </table>

  <h3 class="sub">Daily Report Minimum Data to Submit</h3>
  <table class="teal">
    <tr><th>Data Point</th><th>Format</th></tr>
    <tr><td>Date and Service Point name</td><td>DD/MM/YYYY - Village Name, Block</td></tr>
    <tr><td>Total OPD count</td><td>Males / Females / Children (separate counts)</td></tr>
    <tr><td>ANC patients seen today</td><td>Number + ANC visit number (1st/2nd/3rd/4th)</td></tr>
    <tr><td>Malaria RDTs conducted / positive</td><td>X done / Y positive (P.v / P.f separately)</td></tr>
    <tr><td>Referrals made</td><td>Number + brief clinical reason for each</td></tr>
    <tr><td>Health education session</td><td>Topic + attendee count (male/female)</td></tr>
    <tr><td>Stock alerts</td><td>Drug name + current stock level + indent raised Y/N</td></tr>
    <tr><td>Equipment issues</td><td>Description + ADR number if raised</td></tr>
    <tr><td>Unusual events / observations</td><td>Free text - disease clusters, road issues, community feedback</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 15 ═══════════════════════════ -->
<div class="section">
  <div class="section-header red">SECTION 15 - KEY CONTACTS &amp; ESCALATION MATRIX</div>
  <h3 class="sub">Emergency Numbers - Save These on Day 1</h3>
  <table class="red">
    <tr><th>Service</th><th>Number</th><th>When to Call</th></tr>
    <tr><td><strong>Ambulance (National Emergency)</strong></td><td><strong style="font-size:12pt;">108</strong></td><td>All medical emergencies requiring transport from camp</td></tr>
    <tr><td>Police Emergency</td><td>100</td><td>Security, accident, snake bite requiring police in remote area</td></tr>
    <tr><td>Fire / Disaster</td><td>101</td><td>Fire, flood, natural disaster at camp site</td></tr>
    <tr><td>Child Helpline</td><td>1098</td><td>Child abuse, abandoned child found at camp</td></tr>
    <tr><td>Women's Helpline</td><td>181</td><td>Domestic violence, gender-based violence disclosure</td></tr>
    <tr><td>BSP Hospital Emergency</td><td>Obtain from Area Manager on Day 1</td><td>Medical referral for all Bokaro village patients</td></tr>
    <tr><td>Bokaro Sadar Hospital</td><td>Obtain from Area Manager on Day 1</td><td>Government referral facility for non-BSP catchment</td></tr>
    <tr><td>Nearest PHC / CHC</td><td>Obtain from Area Manager on Day 1</td><td>Referral, DOTS, immunisation, delivery linkage</td></tr>
  </table>

  <h3 class="sub">Escalation Matrix</h3>
  <table>
    <tr><th>Issue Type</th><th>Escalate To</th><th>Timeline</th></tr>
    <tr><td>Clinical doubt / complex case</td><td>Area Manager (who connects Medical Director)</td><td>Same day</td></tr>
    <tr><td>Medicine stock critically low</td><td>Area Manager + Pharmacist at HQ</td><td>When reaching 30% stock level</td></tr>
    <tr><td>Equipment breakdown</td><td>Area Manager + ADR form submission</td><td>Within 12 hours</td></tr>
    <tr><td>Team conflict / HR issue</td><td>Area Manager then Zonal Manager</td><td>Within 24 hours</td></tr>
    <tr><td>Patient complaint about services</td><td>Area Manager directly</td><td>Same day</td></tr>
    <tr><td>Unusual disease cluster / outbreak suspicion</td><td>Area Manager + District CMO simultaneously</td><td>IMMEDIATELY</td></tr>
    <tr><td>Road / vehicle breakdown in field</td><td>Driver + Area Manager</td><td>Immediately upon occurrence</td></tr>
    <tr><td>AMRIT data sync failure over 24 hours</td><td>IT Support via Area Manager</td><td>Within 24 hours</td></tr>
  </table>
</div>

<!-- ═══════════════════════════ SECTION 16 ═══════════════════════════ -->
<div class="section">
  <div class="section-header">SECTION 16 - QUICK DRUG DOSE REFERENCE</div>
  <p class="note">Paediatric doses: always calculate by weight. Adult doses below assume average adult weight 50-70 kg. Verify with NLEM 2022 for full prescribing information.</p>
  <table>
    <tr><th>Drug</th><th>Adult Dose</th><th>Paediatric Dose</th><th>Key Caution</th></tr>
    <tr><td><strong>Paracetamol</strong></td><td>500-1000mg every 6-8h (max 4g/day)</td><td>15mg/kg/dose every 6h (max 4 doses/day)</td><td>Max 4g/day adult; avoid in liver disease</td></tr>
    <tr><td><strong>Amoxicillin</strong></td><td>500mg every 8h x 5-7 days</td><td>40mg/kg/day in 3 divided doses</td><td>Check for penicillin allergy before prescribing</td></tr>
    <tr><td><strong>ORS</strong></td><td>200-400ml after each loose stool</td><td>Per WHO Plan A/B/C dehydration protocol</td><td>Never restrict fluid; encourage maximum intake</td></tr>
    <tr><td><strong>Zinc (paediatric)</strong></td><td>Not used in adults</td><td>Under 6 months: 10mg/day x 14 days; over 6 months: 20mg/day x 14 days</td><td>Only for children under 5 with diarrhea</td></tr>
    <tr><td><strong>Artemether-Lumefantrine</strong></td><td>4 tablets BD x 3 days (80/480mg tablet)</td><td>Weight-based paediatric tablets per NVBDCP chart (mandatory)</td><td>Take with fatty food to improve absorption</td></tr>
    <tr><td><strong>Chloroquine (P. vivax)</strong></td><td>600mg Day 1; 300mg Day 2 and 3</td><td>10mg/kg Day 1; 7.5mg/kg Day 2 and 3</td><td>Check G6PD status before prescribing Primaquine</td></tr>
    <tr><td><strong>Metformin</strong></td><td>500mg BD with food (max 2g/day)</td><td>Not used in children in MMU setting</td><td>Hold if eGFR below 30; caution before contrast</td></tr>
    <tr><td><strong>Amlodipine</strong></td><td>5-10mg OD (any time of day)</td><td>Not routinely used at MMU level</td><td>Ankle oedema is common side effect - counsel patient</td></tr>
    <tr><td><strong>IFA (adult)</strong></td><td>1 tablet OD (100mg Fe + 0.5mg Folic acid)</td><td>Syrup: 3mg/kg/day elemental iron</td><td>Take with Vitamin C; avoid with tea or milk</td></tr>
    <tr><td><strong>Albendazole</strong></td><td>400mg single dose</td><td>Under 2 years: 200mg; over 2 years: 400mg single dose</td><td>Avoid in first trimester of pregnancy</td></tr>
    <tr><td><strong>Metronidazole</strong></td><td>400mg TDS x 5-7 days</td><td>35-50mg/kg/day in 3 divided doses</td><td>Strict alcohol avoidance during treatment; metallic taste common</td></tr>
    <tr><td><strong>Aspirin (CVD prevention)</strong></td><td>75mg OD after food</td><td>Not used in children under 16 years</td><td>Stop 7 days before surgery; caution in peptic ulcer</td></tr>
    <tr><td><strong>Adrenaline (anaphylaxis)</strong></td><td>0.5mg (0.5ml of 1:1000) IM outer thigh</td><td>0.01mg/kg IM (max 0.5mg)</td><td>IM only - not IV unless cardiac arrest; can repeat at 5 min</td></tr>
  </table>
  <p class="warning">This is a quick field reference only. Always verify full prescribing information in NLEM 2022 or NHM Drug Formulary before prescribing unfamiliar drugs or complex cases.</p>
</div>

<!-- ═══════════════════════════ SECTION 17 ═══════════════════════════ -->
<div class="section">
  <div class="section-header mid-blue">SECTION 17 - RESEARCH EVIDENCE SUMMARY</div>
  <p>Key peer-reviewed evidence supporting the MMU model and relevant to clinical practice in Bokaro. Use these citations in any programme reports, proposals, or research you write.</p>
  <table>
    <tr><th>#</th><th>Study &amp; PMID</th><th>Journal / Year</th><th>Key Finding</th></tr>
    <tr><td>1</td><td><strong>Kumar A et al.</strong><br>MMU Functioning in Jharkhand<br>PMID: 20108880</td><td>Indian Journal of Public Health, 2009</td><td>Over 90% medicine availability in MMUs. Over 90% patients had NO prior information about MMU schedule. Overall conclusion: MMUs successful in reaching under-served areas of Jharkhand.</td></tr>
    <tr><td>2</td><td><strong>Akhtar MH et al.</strong><br>Mobile PHC State-of-Art Review<br>PMC: 9870199</td><td>PMC Open Access, 2023. Cited by 27.</td><td>MMUs effective in India for both primary and specialist outreach. Viable model for rural and urban underserved populations in developing countries.</td></tr>
    <tr><td>3</td><td><strong>Seth R et al.</strong><br>Mobile Health Van Delhi<br>PMID: 39773979</td><td>BMJ Paediatrics Open, 2025</td><td>41,062 clinic visits over 6 years; visits peaked at 8,864 in 2023. Health education to 70,000+ children. MHV empowers communities with health literacy and creates referral pathways to tertiary care.</td></tr>
    <tr><td>4</td><td><strong>Subramaniam S et al.</strong><br>Doorstep NCD Tamil Nadu<br>PMID: 41398228</td><td>BMC Primary Care, 2025</td><td>79-82% NCD screening coverage achieved. But only 9.8% diabetes control and 35.4% hypertension control. Critical lesson: screening alone is not enough - adherence counselling is essential.</td></tr>
    <tr><td>5</td><td><strong>Boone P et al.</strong><br>CHAMPION Cluster RCT<br>PMID: 28678849</td><td>PLoS Medicine, 2017 (Highest evidence - RCT)</td><td>Mobile outreach + health education package reduced neonatal mortality by 24% (Risk Ratio 0.76, p=0.0018). 92 fewer deaths per 14,000 women. Cost: approximately USD 11,795 per death averted - highly cost-effective.</td></tr>
    <tr><td>6</td><td><strong>Bhattacharya S et al.</strong><br>Hypertension in Jharkhand Tribals<br>PMID: 40630337</td><td>Cureus, 2025</td><td>HTN rising rapidly in Jharkhand's tribal population (previously considered low-risk). Key barriers: delayed diagnosis, restricted access, low health literacy. Outreach strategies including MMU are the primary recommended solution.</td></tr>
  </table>

  <h3 class="sub">Research Opportunity for You as MO in Bokaro</h3>
  <div class="box-blue">
    <p>There is no published peer-reviewed research specifically on Piramal Swasthya's Ispat Sanjeevani or Swasthya Kiran MMU outcomes in Bokaro. As an MO with access to AMRIT longitudinal data on over 1.38 lakh beneficiaries, you have a unique opportunity for original research. Potential study designs include: morbidity pattern analysis, ANC completion rate audit, referral completion tracking, and NCD disease control evaluation. Contact IIPHG Gandhinagar, RIMS Ranchi, or PHFI Delhi for academic collaboration and ethics approval.</p>
  </div>
</div>

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    <div class="color-bar bar-blue"></div>
    <h2 style="color:#1A3C6E; font-size:22pt; margin:16px 0;">You Are Ready</h2>
    <div class="color-bar bar-teal"></div>
  </div>

  <div class="mantra-row"><div class="mantra-key">REGISTER</div><div class="mantra-val">Every patient in AMRIT - if it is not documented, it did not happen</div></div>
  <div class="mantra-row"><div class="mantra-key">TRIAGE</div><div class="mantra-val">See pregnant women and children under 5 first, without exception, every camp</div></div>
  <div class="mantra-row"><div class="mantra-key">REFER EARLY</div><div class="mantra-val">When in doubt, refer. The nearest hospital is always better than a missed diagnosis in the field</div></div>
  <div class="mantra-row"><div class="mantra-key">STOCK CHECK</div><div class="mantra-val">Generate medicine indent at 30% stock - never run out on a camp day</div></div>
  <div class="mantra-row"><div class="mantra-key">HEALTH TALK</div><div class="mantra-val">5 minutes of education at every camp changes behaviour and builds trust over months</div></div>
  <div class="mantra-row"><div class="mantra-key">SYNC DATA</div><div class="mantra-val">End every day with AMRIT synced to the central server without exception</div></div>
  <div class="mantra-row"><div class="mantra-key">FOLLOW UP</div><div class="mantra-val">Check on your next visit that referred patients actually reached the hospital</div></div>
  <div class="mantra-row"><div class="mantra-key">STAY SAFE</div><div class="mantra-val">Never take unsafe roads. Wear full sleeves and use repellent every evening in the field</div></div>
  <div class="mantra-row"><div class="mantra-key">TAKE CARE</div><div class="mantra-val">Eat regularly, drink water, sleep enough. A healthy doctor gives better care</div></div>

  <div class="color-bar bar-orange" style="margin-top:20px;"></div>
  <p style="text-align:center; color:#8C9BAB; font-style:italic; font-size:8.5pt; margin-top:12px; line-height:1.7;">
    This guide was prepared to support Medical Officers joining Piramal Swasthya's MMU Programme in Bokaro, Jharkhand.<br>
    Clinical protocols are based on NHM / MoHFW / NVBDCP / WHO guidelines as of 2025-2026.<br>
    Always verify with the latest government guidelines before clinical application.<br><br>
    <strong>Compiled July 2026 &nbsp;|&nbsp; Version 1.0 &nbsp;|&nbsp; For Internal Use Only &nbsp;|&nbsp; Piramal Swasthya MMU Programme</strong>
  </p>
</div>

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