Section A. Family Planning Services For Women of Reproductive Age
Section A. Family Planning Services For Women of Reproductive Age
Section A. Family Planning Services For Women of Reproductive Age
g.1 IUD-I
g.2 IUD-PP
h. NFP-LAM 1 11 12 1 1 2 2 1 10 11
i. NFP-BBT
j. NFP-CMM 11 11 11 11
k. NFP-STM
l. NFP-SDM 5 5 5 5
m. Total Current Users 1 112 113 1 1 2 2 1 111 112
Section B. Maternal Care and Services
By Age Group By Age Group
Maternal Care Indicators Maternal Care Indicators
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
Section B.1 Prenatal Care
1. No. of pregnant women with at least 4 prenatal visits 1 1 8. No. of pregnant women given one dose of deworming tablet
2. No. of pregnant women assessed of their nutritional status during the 1st 9. No. of pregnant women screened for syphilis
trimester
a. No. of pregnant women seen in the first trimester who have normal BMI 10. No. of pregnant women tested positive for syphilis
b. No. of pregnant women seen in the first trimester who have low BMI 11. No. of pregnant women screened for Hepatitis B
c. No. of pregnant women seen in the first trimester who have high BMI 12. No. of pregnant women tested positive for Hepatitis B
3. No. of pregnant women for the first time given at least 2 doses of Td 13. No. of pregnant women screened for HIV
4. No. of pregnant women for the 2nd or more times given at least 3 doses of Td 14. No. of pregnant women tested for CBC or Hgb & Hct count
(Td2 Plus)
No. of pregnant women who completed dose of iron with folic acid No. of pregnant women tested for CBC or Hgb & Hct count diagnosed with
5. supplementation 15. anemia
No. of pregnant women who completed doses of calcium carbonate
6. supplementation 16. No. of pregnant women screened for gestational diabetes
7. No. of pregnant women given iodine capsule 17. No. of pregnant women tested positive for gestational diabetes
26. No. of postpartum women who completed iron with folic acid supplementation 1 1
Infants 6 months old initiated to Infant 6-11 months old who completed
24. Preterm/LBW infants given iron supplementation 27. complementary feeding but no longer or 30.
never been breastfed MNP supplementation
25. Infants exclusively breastfed until 6th month 2 2 28. Infants 6-11 months given 1 dose of 31. Children 12-23 months who completed
Vitamin A 100,000 I.U MNP supplementation
C3. Deworming Services for Infants, Children and Adolescents
32. 1-19 years old given 2 doses of deworming drug b. SAC, 5-9 years old dewormed (2 doses)
a. PSAC, 1-4 years old dewormed (2 doses) c. Adolescents, 10-19 years old dewormed (2 doses)
C4. Management of Sick Infants and Children
Sick children 12-59 months old received Diarrhea cases 0-59 months old received
33. Sick infants 6-11 months old seen 36. 39.
Vitamin A ORS with zinc
34. Sick infants 6-11 months old received Vitamin A 37. Diarrhea cases 0-59 months old seen 40. Pneumonia cases 0-59 months old
35. Sick children 12-59 months old seen 38. Diarrhea cases 0-59 months old received 41. Pneumonia cases 0-59 months completed
ORS treatment
Page 1 of 27
Section E. Infectious Disease Prevention & Control Services
E3. Soil Transmitted Helminthiasis Prevention and Control Male Female Total E5. Tuberculosis Prevention and Control Male Female Total
1. No. of WRA 20-49 years old who completed 2 doses of deworming tablet 1. No. of notified TB cases, all forms
E8. Rabies Prevention and Control Male Female Total 2. No. of registered bacteriologicaly confirmed drug resistant TB (RR/MDR-TB Cases)
1. No. of animal bites 3. No. of TB, all forms that are cured and completely treated
2. No. of deaths due to Rabies 4. No. of registered bacteriology confirmed drug resistant TB Cases (RR/MDR-TB) cured and completed treatment
Page 2 of 27
FHSIS REPORT for the MONTH: JANUARY YEAR: 2021
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
Cholera A00.0-A00.9 0 0 0
A09.0
Acute Watery Diarrhea 0 0 0
(watery)
A09.0
Acute Bloody Diarrhea 0 0 0
(bloody)
Typhoid and Paratyphoid Fever A01.1-A01.4 0 0 0
Leptospirosis A27.0-A27.9 0 0 0
Leprosy A30.0-A30.9 0 0 0
Diphtheria A36.0-A36.9 0 0 0
Meningococcemia A39.2-A39.4 0 0 0
Syphilis A50-A53 0 0 0
Gonorrhea A54.0-A54.9 0 0 0
Malaria B50-B54 0 0 0
Schistosomiasis B65.0-B65.9 0 0 0
Filariasis B74.0-B74.9 0 0 0
Influenza J11.1 0 0 0
Pneumonia J18.90-J18.99 0 0 0
Acute Lower Respiratory Tract
J22 2 1 0 3 3
Infection
Other Diseases
Chickenpox B01.89 0 0 0
Chronic Obstructive Pulmonary
J44.0-J44.9 0 0 0
Disease (COPD)
Hypertension I10.0-I10.9 0 2 2
2
Skin Diseases 0 0 0
Tuberculosis, Respiratory 0 0 0
Vertigo 1 0 1 1
Infected Wound 2 0 2
1 1
Tonsilitis 0 1 1
1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
4. Bronchitis, Acute 2
5. Hypertension 2
7. Infected Wound 2
8. TY Suspect 1
9. Amoebiasis 1
10. Vertigo 1
Section A.2.b Ten Leading Causes of Morbidity in Males
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. Bronchitis, Acute 2
2. Infected Wound 2
3. ARI in below 5 1
4. 1
5.
6.
7.
8.
9.
10.
Section A.2.c Ten Leading Causes of Morbidity in Females
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. Acute Lower Respiratory Tract Infection 3
2. ARI in below 5 2
4. Hypertension 2
6. TY Suspect 1
7. Amoebiasis 1
8. Vertigo 1
9. Tonsilitis 1
10.
Section A.2.d Ten Leading Causes of Morbidity in Under-Five Children
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. ARI in below 5 3
3. Bronchitis, Acute 2
4. TY Suspect 1
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
5. Amoebiasis 1
6.
7.
8.
9.
10.
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
Section A.2.e Ten Leading Causes of Morbidity in Adolescents 10-19 Years Old
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. ARI for 5 and above 2
2. TY Suspect 1
3. Tonsilitis 1
4.
5.
6.
7.
8.
9.
10.
Section A.2.f Ten Leading Causes of Morbidity in Senior Citizens ≥ 60 years old
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. Hypertension 2
2. Infected Wound 1
3.
4.
5.
6.
7.
8.
9.
10.
Section A.2.g Ten Leading Causes of Morbidity in Pregnant Women
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
g.1 IUD-I
g.2 IUD-PP
h. NFP-LAM 1 10 11 2 2 1 8 9
i. NFP-BBT
j. NFP-CMM 11 11 11 11
k. NFP-STM
l. NFP-SDM 5 5 5 5
m. Total Current Users 1 111 112 2 2 1 111 112
Section B. Maternal Care and Services
By Age Group By Age Group
Maternal Care Indicators Maternal Care Indicators
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
Section B.1 Prenatal Care
1. No. of pregnant women with at least 4 prenatal visits 8. No. of pregnant women given one dose of deworming tablet
2. No. of pregnant women assessed of their nutritional status during the 1st 9. No. of pregnant women screened for syphilis
trimester
a. No. of pregnant women seen in the first trimester who have normal BMI 10. No. of pregnant women tested positive for syphilis
b. No. of pregnant women seen in the first trimester who have low BMI 11. No. of pregnant women screened for Hepatitis B
c. No. of pregnant women seen in the first trimester who have high BMI 12. No. of pregnant women tested positive for Hepatitis B
3. No. of pregnant women for the first time given at least 2 doses of Td 13. No. of pregnant women screened for HIV
No. of pregnant women for the 2nd or more times given at least 3 doses of Td
4. 14. No. of pregnant women tested for CBC or Hgb & Hct count
(Td2 Plus)
5. No. of pregnant women who completed dose of iron with folic acid 15. No. of pregnant women tested for CBC or Hgb & Hct count diagnosed with
supplementation anemia
6. No. of pregnant women who completed doses of calcium carbonate 16. No. of pregnant women screened for gestational diabetes
supplementation
7. No. of pregnant women given iodine capsule 17. No. of pregnant women tested positive for gestational diabetes
25. No. postpartum women together with their newborn who completed at least 2 27. No. of postpartum women with Vitamin A supplementation
postpartum check-ups
26. No. of postpartum women who completed iron with folic acid supplementation
25. Infants exclusively breastfed until 6th month 1 1 2 28. Infants 6-11 months given 1 dose of 31. Children 12-23 months who completed
Vitamin A 100,000 I.U MNP supplementation
C3. Deworming Services for Infants, Children and Adolescents
32. 1-19 years old given 2 doses of deworming drug 385 342 727 b. SAC, 5-9 years old dewormed (2 doses) 106 104 210
a. PSAC, 1-4 years old dewormed (2 doses) 86 59 145 c. Adolescents, 10-19 years old dewormed (2 doses) 193 179 372
C4. Management of Sick Infants and Children
33. Sick infants 6-11 months old seen 36. Sick children 12-59 months old received 39. Diarrhea cases 0-59 months old received
Vitamin A ORS with zinc
34. Sick infants 6-11 months old received Vitamin A 37. Diarrhea cases 0-59 months old seen 40. Pneumonia cases 0-59 months old
35. Sick children 12-59 months old seen 38. Diarrhea cases 0-59 months old received 41. Pneumonia cases 0-59 months completed
ORS treatment
Page 4 of 27
Section E. Infectious Disease Prevention & Control Services
E3. Soil Transmitted Helminthiasis Prevention and Control Male Female Total E5. Tuberculosis Prevention and Control Male Female Total
1. No. of WRA 20-49 years old who completed 2 doses of deworming tablet 1. No. of notified TB cases, all forms
E8. Rabies Prevention and Control Male Female Total 2. No. of registered bacteriologicaly confirmed drug resistant TB (RR/MDR-TB Cases)
1. No. of animal bites 3. No. of TB, all forms that are cured and completely treated
2. No. of deaths due to Rabies 4. No. of registered bacteriology confirmed drug resistant TB Cases (RR/MDR-TB) cured and
completed treatment
Section F. Non-Communicable Disease Prevention and Control Services
Promotion of Healthy Lifestyle Male Female Total Cancer Male Female Total
1. No. of adults risk-assessed using PhilPEN 4 10 14 5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear
No. of adult women found positive / suspect for Cervical Cancer using VIA/Pap
2. Current smokers 4 4 6.
Smear
3. Alcohol binge drinkers 2 2 7. No. of women screened for breast mass
4. Overweight/Obese 2 2 4 8. No. of women with suspicious breast mass
Cardio Vascular Disease Male Female Total Diabetes Mellitus Male Female Total
9. No. of newly-identified hypertensive adults 10. No. newly-identified adults with Type 2 DM
Eye Blindness Male Female Total SC Immunization Male Female Total
11. No. of senior citizens screened for visual acuity 13. No. of senior citizens who received one (1) dose of PPV
12. No. of senior citizens diagnosed with eye disease/s 14. No. of senior citizens who received one (1) dose of influenza vaccine
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
1. No. of HHs with access to basic safe water supply 4. No. of HHs with basic sanitation facility
a. No. of HHs with Level I a. No. of HHs with pour/flush toilet connected to septic tank
b. No. of HHs with Level II b. No. of HHs with pour/flush toilet connected to community sewer/sewerage
system or any other approved treatment system
c. No. of HHs with Level III c. No. of HHs with ventilated improved pit latrine (VIP)
2 No. of HHs using safely managed drinking water services 5. No. of industrial establishments issued with sanitary permit
3. No. of HHs using safely managed sanitation services 6. No. of barangays declared ZOD
Section H. Mortality Section I. Natality
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
Page 5 of 27
FHSIS REPORT for the MONTH: FEBRUARY YEAR: 2021
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
Cholera A00.0-A00.9 0 0 0
A09.0
Acute Watery Diarrhea 0 0 0
(watery)
A09.0
Acute Bloody Diarrhea 0 0 0
(bloody)
Typhoid and Paratyphoid Fever A01.1-A01.4 0 0 0
Leptospirosis A27.0-A27.9 0 0 0
Leprosy A30.0-A30.9 0 0 0
Diphtheria A36.0-A36.9 0 0 0
Meningococcemia A39.2-A39.4 0 0 0
Syphilis A50-A53 0 0 0
Gonorrhea A54.0-A54.9 0 0 0
Malaria B50-B54 0 0 0
Schistosomiasis B65.0-B65.9 0 0 0
Filariasis B74.0-B74.9 0 0 0
Influenza J11.1 0 0 0
Pneumonia J18.90-J18.99 0 0 0
Acute Lower Respiratory Tract
J22 0 0 0
Infection
Other Diseases
Chickenpox B01.89 0 0 0
Chronic Obstructive Pulmonary
J44.0-J44.9 0 0 0
Disease (COPD)
Hypertension I10.0-I10.9 3 4 7
1 3 2 1
Skin Diseases 0 0 0
Tuberculosis, Respiratory 0 0 0
Whooping Cough 0 0 0
I00-I09, I11,
Diseases of the Heart 0 0 0
I13, I20-I51
Anemia 0 1 1
1
Allergy 1 1 0 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
2. ARI in below 5 7
3. Hypertension 7
4. Bronchitis, Acute 4
5. Anemia 1
6. Allergy 1
7.
8.
9.
10.
Section A.2.b Ten Leading Causes of Morbidity in Males
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. ARI for 5 and above 7
2. ARI in below 5 4
3. Bronchitis, Acute 4
4. Hypertension 3
5. Allergy 1
6.
7.
8.
9.
10.
Section A.2.c Ten Leading Causes of Morbidity in Females
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. Hypertension 4
2. ARI in below 5 3
4. Anemia 1
5.
6.
7.
8.
9.
10.
Section A.2.d Ten Leading Causes of Morbidity in Under-Five Children
Name of Disease Number of Cases Rate per 100,000 population
No.
FHSIS ver. 2018 M2-Morbidity | Page 1 of 27
FHSIS REPORT for the MONTH: FEBRUARY YEAR: 2021
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
2. Bronchitis, Acute 2
3. Allergy 1
4.
5.
6.
7.
8.
9.
10.
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
Section A.2.e Ten Leading Causes of Morbidity in Adolescents 10-19 Years Old
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Section A.2.f Ten Leading Causes of Morbidity in Senior Citizens ≥ 60 years old
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1. Hypertension 7
2.
3.
4.
5.
6.
7.
8.
9.
10.
Section A.2.g Ten Leading Causes of Morbidity in Pregnant Women
Name of Disease Number of Cases Rate per 100,000 population
No.
(Col. 1.) (Col. 3) (Col. 4)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
M2
Name of Health Facility: BIKAL HEALTH CENTER
Name of Barangay: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1460
g.1 IUD-I
g.2 IUD-PP
h. NFP-LAM
i. NFP-BBT
j. NFP-CMM
k. NFP-STM
l. NFP-SDM
m. Total Current Users
Section B. Maternal Care and Services
By Age Group By Age Group
Maternal Care Indicators Maternal Care Indicators
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
Section B.1 Prenatal Care
1. No. of pregnant women with at least 4 prenatal visits 8. No. of pregnant women given one dose of deworming tablet
No. of pregnant women assessed of their nutritional status during the 1st
2. trimester 9. No. of pregnant women screened for syphilis
a. No. of pregnant women seen in the first trimester who have normal BMI 10. No. of pregnant women tested positive for syphilis
b. No. of pregnant women seen in the first trimester who have low BMI 11. No. of pregnant women screened for Hepatitis B
c. No. of pregnant women seen in the first trimester who have high BMI 12. No. of pregnant women tested positive for Hepatitis B
3. No. of pregnant women for the first time given at least 2 doses of Td 13. No. of pregnant women screened for HIV
4. No. of pregnant women for the 2nd or more times given at least 3 doses of Td 14. No. of pregnant women tested for CBC or Hgb & Hct count
(Td2 Plus)
No. of pregnant women who completed dose of iron with folic acid No. of pregnant women tested for CBC or Hgb & Hct count diagnosed with
5. 15.
supplementation anemia
Page 5 of 27
No. of pregnant women who completed doses of calcium carbonate
6. supplementation 16. No. of pregnant women screened for gestational diabetes
7. No. of pregnant women given iodine capsule 17. No. of pregnant women tested positive for gestational diabetes
26. No. of postpartum women who completed iron with folic acid supplementation
35. Sick children 12-59 months old seen 38. Diarrhea cases 0-59 months old received 41. Pneumonia cases 0-59 months completed
ORS treatment
Page 6 of 27
Section E. Infectious Disease Prevention & Control Services
E3. Soil Transmitted Helminthiasis Prevention and Control Male Female Total E5. Tuberculosis Prevention and Control Male Female Total
1. No. of WRA 20-49 years old who completed 2 doses of deworming tablet 1. No. of notified TB cases, all forms
E8. Rabies Prevention and Control Male Female Total 2. No. of registered bacteriologicaly confirmed drug resistant TB (RR/MDR-TB Cases)
1. No. of animal bites 3. No. of TB, all forms that are cured and completely treated
2. No. of deaths due to Rabies 4. No. of registered bacteriology confirmed drug resistant TB Cases (RR/MDR-TB) cured and
completed treatment
Section F. Non-Communicable Disease Prevention and Control Services
Promotion of Healthy Lifestyle Male Female Total Cancer Male Female Total
1. No. of adults risk-assessed using PhilPEN 5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear
No. of adult women found positive / suspect for Cervical Cancer using VIA/Pap
2. Current smokers 6.
Smear
3. Alcohol binge drinkers 7. No. of women screened for breast mass
4. Overweight/Obese 8. No. of women with suspicious breast mass
Cardio Vascular Disease Male Female Total Diabetes Mellitus Male Female Total
9. No. of newly-identified hypertensive adults 10. No. newly-identified adults with Type 2 DM
Eye Blindness Male Female Total SC Immunization Male Female Total
11. No. of senior citizens screened for visual acuity 13. No. of senior citizens who received one (1) dose of PPV
12. No. of senior citizens diagnosed with eye disease/s 14. No. of senior citizens who received one (1) dose of influenza vaccine
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
1. No. of HHs with access to basic safe water supply 4. No. of HHs with basic sanitation facility
a. No. of HHs with Level I a. No. of HHs with pour/flush toilet connected to septic tank
b. No. of HHs with Level II b. No. of HHs with pour/flush toilet connected to community sewer/sewerage
system or any other approved treatment system
c. No. of HHs with Level III c. No. of HHs with ventilated improved pit latrine (VIP)
2 No. of HHs using safely managed drinking water services 5. No. of industrial establishments issued with sanitary permit
3. No. of HHs using safely managed sanitation services 6. No. of barangays declared ZOD
Section H. Mortality Section I. Natality
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
Page 7 of 27
FHSIS REPORT for the MONTH: 1ST QUARTER YEAR: 2020
Name of Barangay: BIKAL
Name of BHS: BIKAL
Name of Municipality/City: CARAMOAN
Name of Province: CAMARINES SUR
Projected Population of the Year: 1,463
For submission to RHU/MHC
Section A. Family Planning Services for Women of Reproductive Age
Age Total for WRA 15-49
A1. Modern FP Unmet Need (Col. 2) Remarks
(Col. 1) (Col. 3) (Col. 4)
10-14 15-19 20-49
1. No. of WRA with unmet need for modern FP
Acceptors Current User
Current User Other Acceptors Dropout New Acceptors
(Beginning of Month) New Acceptors (Present Month) (End of Month) (Present Month)
A2. Use of FP Method (Previous Month) (Present (Col.
(Col. 1) (Col. 2) Month) (Col. 5) (Col. 7)
(Col. 3) 6)
(Col. 4)
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
a. Bilateral Tubal Ligation
b. Non-Scalpel Vasectomy
c. Condom
d. Pills-Total
d.1 Pills-POP
d.2 Pills-COC
e Injectables (DMPA/POI)
f. Implant
g.1 IUD-I
g.2 IUD-PP
h. NFP-LAM
i. NFP-BBT
j. NFP-CMM
k. NFP-STM
l. NFP-SDM
m. Total Current Users
Section B. Maternal Care and Services
By Age Group By Age Group
Maternal Care Indicators Maternal Care Indicators
10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
Section B.1 Prenatal Care
1. No. of pregnant women with at least 4 prenatal visits 8. No. of pregnant women given one dose of deworming tablet
No. of pregnant women assessed of their nutritional status during the 1st
2. trimester 9. No. of pregnant women screened for syphilis
a. No. of pregnant women seen in the first trimester who have normal BMI 10. No. of pregnant women tested positive for syphilis
b. No. of pregnant women seen in the first trimester who have low BMI 11. No. of pregnant women screened for Hepatitis B
c. No. of pregnant women seen in the first trimester who have high BMI 12. No. of pregnant women tested positive for Hepatitis B
3. No. of pregnant women for the first time given at least 2 doses of Td 13. No. of pregnant women screened for HIV
4. No. of pregnant women for the 2nd or more times given at least 3 doses of Td 14. No. of pregnant women tested for CBC or Hgb & Hct count
(Td2 Plus)
No. of pregnant women who completed dose of iron with folic acid No. of pregnant women tested for CBC or Hgb & Hct count diagnosed with
5. 15.
supplementation anemia
Page 8 of 27
No. of pregnant women who completed doses of calcium carbonate
6. supplementation 16. No. of pregnant women screened for gestational diabetes
7. No. of pregnant women given iodine capsule 17. No. of pregnant women tested positive for gestational diabetes
26. No. of postpartum women who completed iron with folic acid supplementation
35. Sick children 12-59 months old seen 38. Diarrhea cases 0-59 months old received 41. Pneumonia cases 0-59 months completed
ORS treatment
Page 9 of 27
Section E. Infectious Disease Prevention & Control Services
E3. Soil Transmitted Helminthiasis Prevention and Control Male Female Total E5. Tuberculosis Prevention and Control Male Female Total
1. No. of WRA 20-49 years old who completed 2 doses of deworming tablet 1. No. of notified TB cases, all forms
E8. Rabies Prevention and Control Male Female Total 2. No. of registered bacteriologicaly confirmed drug resistant TB (RR/MDR-TB Cases)
1. No. of animal bites 3. No. of TB, all forms that are cured and completely treated
2. No. of deaths due to Rabies 4. No. of registered bacteriology confirmed drug resistant TB Cases (RR/MDR-TB) cured and
completed treatment
Section F. Non-Communicable Disease Prevention and Control Services
Promotion of Healthy Lifestyle Male Female Total Cancer Male Female Total
1. No. of adults risk-assessed using PhilPEN 5. No. of adult women screened for Cervical Cancer using VIA/Pap Smear
No. of adult women found positive / suspect for Cervical Cancer using VIA/Pap
2. Current smokers 6.
Smear
3. Alcohol binge drinkers 7. No. of women screened for breast mass
4. Overweight/Obese 8. No. of women with suspicious breast mass
Cardio Vascular Disease Male Female Total Diabetes Mellitus Male Female Total
9. No. of newly-identified hypertensive adults 10. No. newly-identified adults with Type 2 DM
Eye Blindness Male Female Total SC Immunization Male Female Total
11. No. of senior citizens screened for visual acuity 13. No. of senior citizens who received one (1) dose of PPV
12. No. of senior citizens diagnosed with eye disease/s 14. No. of senior citizens who received one (1) dose of influenza vaccine
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
1. No. of HHs with access to basic safe water supply 4. No. of HHs with basic sanitation facility
a. No. of HHs with Level I a. No. of HHs with pour/flush toilet connected to septic tank
b. No. of HHs with Level II b. No. of HHs with pour/flush toilet connected to community sewer/sewerage
system or any other approved treatment system
c. No. of HHs with Level III c. No. of HHs with ventilated improved pit latrine (VIP)
2 No. of HHs using safely managed drinking water services 5. No. of industrial establishments issued with sanitary permit
3. No. of HHs using safely managed sanitation services 6. No. of barangays declared ZOD
Section H. Mortality Section I. Natality
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
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