Rheumatic fever/rheumatic heart disease is a significant problem in children and young adults of our nation and hence needs attention on priority basis. This process documentation describes in brief how rheumatic activity (rheumatic fever and/or rheumatic heart disease) detection is being conducted via throat swab culture towards establishment of a RF/RHD registry in Tripura. Tripura is a state in North-East India which borders Bangladesh, Mizoram and Assam. This is a twinning project with PGIMER, Chandigarh. Agartala Govt. Medical College collects samples of throat swabs from school children (5-15 years) and also children coming to OPD/IPD. Agartala Govt. Medical College registers Rheumatic Fever and Rheumatic Heart Disease cases on basis of Jones’ criteria and ECHO cardiography respectively and provide secondary prophylaxis to all these cases at its paediatric OPD. There are three sub-registries functioning under AGMC in 3 districts, where cases are registered and secondary prophylaxis are provided. All the throat swab samples are cultured for the identification of Group A Beta haemolytic streptococcus at Dept. of Microbiology, AGMC. Beta haemolytic streptococcus strains are sent to PGIMER, Chandigarh for emm typing. This is supported by preparation and distribution of educational material; leaflets (Bengali) on RF/RHD were distributed to 33 schools. Doctor’s guideline modules, leaflets and posters to doctors of sub-registries were distributed. Various survey and study related forms include child record form, school survey form, consent form, registration form, patient card, requisition form, and monthly report form. Total 33 schools have been visited till now. Till date total number of throat swabs collected from schools was 1165.