M1 MAY 2022 With Per Brgy Breakdown
M1 MAY 2022 With Per Brgy Breakdown
M1 MAY 2022 With Per Brgy Breakdown
Number of Barangays:
Number of BHS:
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1) MUN
*To be accomplished by PHA/FHSIS Focal
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 5 239 244 0 0 3 3 0 0 0 0 0 0 0 0 0 5 242 247 0 0 7 7
d. Pills - Total 0 2 294 296 0 0 31 31 0 0 0 0 0 0 0 0 0 2 325 327 0 0 17 17
d.1 Pills-POP - Total 0 0 78 78 0 0 25 25 0 0 0 0 0 0 0 0 0 0 103 103 0 0 9 9
d.2 Pills-COC - Total 0 2 216 218 0 0 6 6 0 0 0 0 0 0 0 0 0 2 222 224 0 0 8 8
e. Injectables (DMPA/POI)-Tot. 0 0 168 168 0 0 5 5 0 0 0 0 0 0 0 0 0 0 173 173 0 0 7 7
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.1 IUD-I- Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 3 255 258 0 0 35 35 0 0 0 0 0 0 49 49 0 3 241 244 0 0 40 40
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 13 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 13 0 0 0 0
m. Total Current Users 0 10 975 985 0 0 74 74 0 0 0 0 0 0 49 49 0 10 1000 1010 0 0 71 71
91
92
93
94
22. Newborns initiated on breastfeeding immediately 28 23 51 27. Infants 6-11 mos. given 1 dose of Vitamin A 5 10 15
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 10 6 16
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 19 26 45 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 5 3 8
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 10 12 22 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 3 3 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0 2
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total 0 Total 2
b. No. of HHs with Level II - Total 0 b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
0 system - Total 0
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
122 (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 3 3 0 0 0 0 0 0 2 2 0 0 26 26 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 2 2 0 0 0 0 0 0 0 0 0 0 9 9 0 0 1 1
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 1 1
d.2 Pills-COC - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 4 4 0 0 0 0 0 0 2 2 0 0 29 29 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 0
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 20 20 0 0 1 1 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 2 2
d. Pills - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 0 0 0 0 16 16 0 0 2 2
d.1 Pills-POP - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.2 Pills-COC - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 2 2
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 49 49 0 0 2 2 0 0 0 0 0 0 2 2 0 0 49 49 0 0 8 8
91
92
93
94
22. Newborns initiated on breastfeeding immediately 2 2 4 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 3 3 6 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 1 5 6 0 0 1 1 0 0 0 0 0 0 0 0 0 1 6 7 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 1 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 1 4 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 17 18 0 0 3 3 0 0 0 0 0 0 1 1 0 1 19 20 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 2 2
d. Pills - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 1 1 0 0 10 10 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 31 31 0 0 2 2 0 0 0 0 0 0 1 1 0 0 32 32 0 0 3 3
91
92
93
94
22. Newborns initiated on breastfeeding immediately 2 0 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
m. Total Current Users 0 0 16 16 0 0 3 3 0 0 0 0 0 0 1 1 0 0 18 18 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 0 1
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 0 0
d.1 Pills-POP - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 1 7 8 0 0 1 1 0 0 0 0 0 0 1 1 0 1 7 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 34 35 0 0 1 1 0 0 0 0 0 0 1 1 0 1 34 35 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 2 0 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 1 1 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 22 22 0 0 1 1 0 0 0 0 0 0 1 1 0 0 22 22 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 7 8 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 8 0 0 0 0
d. Pills - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 0 0
d.1 Pills-POP - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 2 2 0 0 3 3 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 1 30 31 0 0 1 1 0 0 0 0 0 0 2 2 0 1 29 30 0 0 3 3
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 2 1 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
33. Sick Infants 6-11 mos. old received Vitamin A - Total >Given MultiVit. and Paracetamol
37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 11 12 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 12 0 0 0 0
d. Pills - Total 0 0 11 11 0 0 1 1 0 0 0 0 0 0 0 0 0 0 12 12 0 0 3 3
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 1 1
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 2 2
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
m. Total Current Users 0 1 48 49 0 0 3 3 0 0 0 0 0 0 2 2 0 1 49 50 0 0 4 4
91
92
93
94
22. Newborns initiated on breastfeeding immediately 3 1 4 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 2 2 4 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 20 20 0 0 2 2 0 0 0 0 0 0 1 1 0 0 21 21 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 0 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 1 1 2
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
2
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 2
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 23 23 0 0 2 2 0 0 0 0 0 0 1 1 0 0 24 24 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 21 21 0 0 2 2 0 0 0 0 0 0 1 1 0 0 22 22 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 2 0 2
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 2 2 0 0 7 7 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 29 29 0 0 1 1 0 0 0 0 0 0 2 2 0 0 28 28 0 0 4 4
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d. Pills - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 26 26 0 0 2 2 0 0 0 0 0 0 1 1 0 0 27 27 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 2 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 19 19 0 0 2 2 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 0
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 1 1 0 0 10 10 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 32 32 0 0 3 3 0 0 0 0 0 0 1 1 0 0 34 34 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 1 1 0 0 7 7 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 2 2 0 0 0 0 0 0 1 1 0 0 28 28 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 2 2 0 0 0 0 0 0 1 1 0 0 26 26 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 2 1 3 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 2 2 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 17 17 0 0 3 3 0 0 0 0 0 0 1 1 0 0 19 19 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 31 31 0 0 2 2 0 0 0 0 0 0 2 2 0 0 31 31 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 2 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 1 1
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 19 19 0 0 2 2 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 0 1
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 21 21 0 0 2 2 0 0 0 0 0 0 1 1 0 0 22 22 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 1 0 1
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 2 2 0 0 8 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 1 1 0 0 0 0 0 0 2 2 0 0 24 24 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 1 1
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 1 1
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 2 2
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 2 2
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 30 30 0 0 2 2 0 0 0 0 0 0 2 2 0 0 30 30 0 0 4 4
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 16 17 0 0 0 0 0 0 0 0 0 0 0 0 0 1 16 17 0 0 1 1
d. Pills - Total 0 1 15 16 0 0 2 2 0 0 0 0 0 0 0 0 0 1 17 18 0 0 0 0
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 1 11 12 0 0 1 1 0 0 0 0 0 0 0 0 0 1 12 13 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 3 3
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
m. Total Current Users 0 2 57 59 0 0 3 3 0 0 0 0 0 0 2 2 0 2 58 60 0 0 4 4
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 2 1 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 1 1 2
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 2 2 0 0 8 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 2 2 0 0 0 0 0 0 2 2 0 0 25 25 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 1 1 0 0 7 7 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 22 22 0 0 3 3 0 0 0 0 0 0 1 1 0 0 24 24 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 12 13 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12 13 0 0 0 0
d. Pills - Total 0 0 14 14 0 0 1 1 0 0 0 0 0 0 0 0 0 0 15 15 0 0 1 1
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 14 14 0 0 1 1 0 0 0 0 0 0 2 2 0 0 13 13 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 47 48 0 0 2 2 0 0 0 0 0 0 2 2 0 1 47 48 0 0 3 3
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 11 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0
d. Pills - Total 0 0 13 13 0 0 1 1 0 0 0 0 0 0 0 0 0 0 14 14 0 0 1 1
d.1 Pills-POP - Total 0 0 3 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
d.2 Pills-COC - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 2 13 15 0 0 1 1 0 0 0 0 0 0 2 2 0 2 12 14 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 2 42 44 0 0 2 2 0 0 0 0 0 0 2 2 0 2 42 44 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 2 3
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 3 0 3
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 3 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 1 1
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 21 22 0 0 2 2 0 0 0 0 0 0 1 1 0 1 22 23 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 24 24 0 0 2 2 0 0 0 0 0 0 1 1 0 0 25 25 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 2 2 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.1 IUD-I- Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 1 1 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 26 26 0 0 3 3 0 0 0 0 0 0 1 1 0 0 28 28 0 0 1 1
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d. Pills - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 2 2 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 1 1 0 0 0 0 0 0 2 2 0 0 26 26 0 0 2 2
91
92
93
94
22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0
4. Overweight/Obese - Total 0 0 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total
9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
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 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
91
92
93
94
22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total
23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total
25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total
2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0
95
96
3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0
4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0
5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o
3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total
4. Overweight/Obese - Total 0
97
98
Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total
9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total