For Submission To PHA For Consolidation
For Submission To PHA For Consolidation
For Submission To PHA For Consolidation
M1
Name of Barangay: BAHAY
Name of BHS: MAIN HEALTH CENTER
Name of Municipality/City: SAN POLICARPO
BRGY
Name of Province: EASTERN SAMAR
Projected Population of the Year:
For submission to PHA for consolidation
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total A3. Deworming Services SES Total
• NHTS 0 0 15 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 15 0 0 0 0
• Non-NHTS 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
f. Implant - 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
• NHTS 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
• Non-NHTS 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) -
Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
• NHTS 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A2. Use of FP Method Current User Acceptors Dropout Current User New Acceptors
(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 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
• NHTS 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
• Non-NHTS 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 88 88 0 0 4 4 0 0 0 0 0 0 0 0 0 0 88 88 0 0 4 4
• NHTS 0 0 86 86 0 0 4 4 0 0 0 0 0 0 0 0 0 0 86 86 0 0 4 4
• Non-NHTS 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
Section B. Maternal Care and Services
Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col 3) (Col. 4) (Col. 1) (Col. 2) (Col 3) (Col. 4)
91
92
• NHTS 0 0 2 2 • NHTS 0 1 2 3
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
B2. Intrapartum Care and Delivery Outcome B3. Postpartum and Newborn Care
27c. No. of fetal deaths - Total 28. No. of postpartum women together
0 0 0 0 with their newborn who completed at 0 0 1 1
least 2 postpartum check-ups - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
29. No. of postpartum women who
27d. No. of abortion/ 0 completed iron with folic acid 0 0 1 1
0 0 0
miscarriage - Total supplementation - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
30. No. of postpartum women with
0 0 1 1
Vitamin A supplementation – Total
• NHTS 0 0 1 1
• Non-NHTS 0 0 0 0
Section C. Child Care and Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C1. Immunization Services
1. CPAB - Total 1 0 1 6. DPT-HiB-HepB 3 - Total 0 0 0 11. PCV 1 - Total 0 2 2
• NHTS 1 0 1 • NHTS 0 0 0 • NHTS 0 2 2
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
2. BCG - Total 0 0 0 7. OPV 1 - Total 0 0 0 12. PCV 2 - Total 1 1 2
• NHTS 0 0 0 • NHTS 0 0 2 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
3. HepB, within 24 hours. - Total 0 0 0 8. OPV 2 - Total 0 1 1 13. PCV 3 - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 1 1 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
4. DPT-HiB-HepB 1 - Total 0 0 0 9. OPV 3 - Total 2 2 4 14. MMR 1 - Total 0 2 2
• NHTS 0 0 0 • NHTS 2 2 4 • NHTS 0 2 2
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
5. DPT-HiB-HepB 2 - Total 0 1 1 10. IPV - Total 2 2 4 15. MMR 2 - Total 2 2 4
• NHTS 0 0 0 • NHTS 2 2 4 • NHTS 2 2 4
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
16. FIC - Total 2 2 4 18. Td, Grade 1 (November) - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0
• NHTS 2 2 4 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
17. CIC - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0 21. MR, Grade 7 (November) - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
C2. Nutrition Services
22. Newborns initiated on breastfeeding
0 0 34. Children 12-23 mos. who completed 0
immediately after birth lasting to 90 mins - 28. Infants 6-11 mos. old seen - Total
MNP supplementation - Total
Total 0 0 0 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
23. Preterm/LBW infants given iron 0 29. Infants 6-11 mos. given 1 dose of 0 0 0 0
35. Children 0-59 mos. seen - Total
supplementation - Total 0 0 Vitamin A 100,000 I.U. - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
24. Infants 6 mos. old seen - Total 0 0 0 30. Children 12-59 mos seen - Total 0 0 0 36. Stunted - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
25. Infants exclusively breastfed until 6th month - 0 31. Children 12-59 mos. old given 2 0 0 0 0
37. Wasted - Total
Total 0 0 doses of Vitamin A 200,000 I.U. - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
26. Infants 6 mos. old initiated to complementary 0 32. Infant 6-11 months old who completed 0 0 0 0
38. Overweight/Obese - Total
feeding with continued breastfeeding - Total 0 0 MNP supplementation - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
27. Infants 6 mos. old initiated to complementary
feeding but no longer or never been breastfed 0 33. Children 12-23 mos. seen - Total 0 0 0 39. Normal - Total 0 0 0
- Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C3. Deworming Services
40. 1-19 y/o given 2 doses of deworming drug - 57 60 117 42. SAC, 5-9 y/o dewormed (2 doses) - 0 0 0 43. Adolescents, 10-19 y/o dewormed 0 0 0
Total Total (2 doses) - Total
• NHTS 57 60 117 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
41. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
• NHTS 0 0 0
• Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C4. Management of Sick Infants and Children
39. Sick Infants 6-11 mos. old seen - Total 42. Sick Children 12-59 mos. old 45. Diarrhea cases 0-59 mos. received
0 0 0
0 0 received Vitamin A - Total 0 0 ORS w/ zinc - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
40. Sick Infants 6-11 mos. old received 0 43. Diarrhea cases 0-59 months old seen 0 46. Pneumonia cases 0-59 mos. old 0
Vitamin A - Total 0 0 - Total 0 0 seen - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
0 44. Diarrhea cases 0-59 months old 0 47. Pneumonia cases 0-59 mos. old 0
41. Sick Children 12-59 mos. old seen - Total
0 0 received ORS - Total 0 0 completed treatment - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Section D. Oral Care and Services
To be submitted Quarterly
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
1. Orally fit children 12-59 months old upon oral 0 0 0 4. Children 1-4 years old who received 0 0 0 7. Adults 20-59 years old who received 0 0 0
exam plus orally fit after rehab - Total BOHC - Total BOHC - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
93
94
2. Clients 5 years old and above with new cases 0 0 0 5. Children 5-9 years old who received 0 0 0 8. Senior citizens 60 years old and above 0 0 0
of DMFT - Total BOHC - Total who received BOHC - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators 20-49 20-49 20-49 Total
3. Infants 0-11 months old who received BOHC - 0 0 0 6. Adolescents 10-19 years old who 0 0 0
Total received BOHC - Total 9. Pregnant women who received BOHC 0 0 0 0
- Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0 0
Section E. Infectious Disease Prevention and Control Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
0 0 0 0 0 0 7. No. of confirmed cases (acute and 0 0 0
1. No. of patients seen - Total 4. No. of confirmed acute cases - Total
chronic) - Total
0 0 0 5. No. of chronic clinically diagnosed 0 0 0 0 0 0
2. No. of suspected cases seen 8. No. of cases treated - Total
cases - Total
0 0 0 0 0 0 9. No. of confirmed chronic cases 0 0 0
3. No. acute clinically diagnosed cases - Total 6. No. confirmed chronic cases - Total
referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (reflected under Child Care, Family Planning and Maternal Care)
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
3. Number of TB, all forms that are cured 4. No. of registered bacteriology
1. Number of notified TB cases, all forms - Total 0 0 0
and completely treated - Total 0 0 0 confirmed drug resistant TB Cases 0 0 0
(RR/MDR-TB) cured & completed
2. No. of registered bacteriologically confirmed 0 0 0 treatment - Total
drug resistant TB (RR/MDR-TB Cases)-Total
E6. Malaria Prevention and Control
1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths -
0 0 0 0 0 0
diagnosed malaria and confirmed case-Total Total
• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0
• ≥ 5 y/o - Total 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of Leprosy Cases on treatment during 2. No. of newly detected cases during 1. No. of deaths due to rabies - Total
0 0 0 0 0 0 0 0 0
reporting period - Total reporting period - Total
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
3. Alcohol binge drinker - Total 5. No. of adult women screened for
1. No. of adults risk-assessed using PhilPEN - 20 20 40 0 0 0 Cervical Cancer using VIA/Pap Smear 0
Total - Total
• NHTS 20 20 40 • NHTS 0 0 0 • NHTS 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0
2. Current smoker - Total 4. Overweight/Obese - Total 6. No. of adult women found positive /
0 0 0 0 0 0 suspect for Cervical Cancer using VIA 0
or Pap Smear - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0
Smokers provided with brief tobacco intervention Adults 20 years old and above who are Physically inactive adults 20 years old and
(BTI) 0 0 0 physically inactive 0 0 0 above given initial management 0 0 0
N48.5, N50.8,
Genital ulcer N76.5, N76.6,
N89.8
Other Diseases
ARI in below 5
ARI for 5 and above
FUO
Diseases of the heart
Skin diseases
UTI
COPD
Tuberculosis (All forms)
Lacerated/punctured wound
Animal Bite
Oral Diseases
A. Bronchitis
B. Asthma
AGE
M2
BIDITY DISEASES REPORT
For submission to the RHU
BRGY
45-49 50-54 55-59 60-64 65-69 ≥ 70 TOTAL TOTAL
M F M F M F M F M F M F M F M F
FHSIS REPORT FOR MONTH: JULY YEAR: 2021
Name of Barangay: BAHAY
Municipality/City Name: SAN POLICARPO
Province: EASTERN SAMAR
Projected Population of the Year:
Section I. Mortality
Number Ratio to
Indicators Interpretation
Male Female Total Population
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6
1. Livebirths 1 0 1
2. Total Deaths 0 0 0
3. Maternal Deaths 0 0 0
4. Under-five deaths 0 0 0
5. Infant Deaths 0 0 0
6. Neonatal Deaths 0 0 0
7. Fetal Deaths 0 0 0
9. Perinatal Deaths 0
Denominator: - population - live births
Section II. Natality
10. Livebirths 1 0 1
Recommendation/
Actions Taken
Col. 7
FHSIS REPORT FOR MONTH: JULY YEAR: 2021
Name of Barangay: BAHAY
Municipality/City Name: SAN POLICARPO
Province: EASTERN SAMAR
Projected Population of the Year:
NONE
Ratio to
Population
Col. 5