FAMILY PLANNING (PART 1 OF 2)

INDICATORS
1. Totla New Acceptors * Female Sterilization * Male Sterilization * Pills * IUD * Injectibles (DMPA) * NFP-CM * NFP-BBT * NFP-LAM * NFP-SDM * NFP-STM * Condom * LAM 2. Total other Acceptors * Female Sterilization * Male Sterilization * Pills * IUD * Injectibles (DMPA) * NFP-CM * NFP-BBT * NFP-LAM * NFP-SDM * NFP-STM * Condom * LAM
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 3
NOV M F DEC M F 4th Q M F TOTAL M F

FAMILY PLANNING (PART 2 OF 2)

INDICATORS
3. Total Drop-out * Female Sterilization * Male Sterilization * Pills * IUD * Injectibles (DMPA) * NFP-CM * NFP-BBT * NFP-LAM * NFP-SDM * NFP-STM * Condom * LAM 4. Total Current Users * Female Sterilization * Male Sterilization * Pills * IUD * Injectibles (DMPA) * NFP-CM * NFP-BBT * NFP-LAM * NFP-SDM * NFP-STM * Condom * LAM
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 4
NOV M F DEC M F 4th Q M F TOTAL M F

CHILD CARE (PART 1 OF 3)

INDICATORS
1. Immunization given <1 yr given * BCG * DPT1 * DPT2 * DPT3 * OPV 1 * OPV 2 * OPV 3 * Hepa b1 w/in 24 hrs * Hepa B1> 24 hrs * Hepatitis B2 * Hepatitis B3 * Measles 3. Fully Immunized Child 4. Completely Immunized Child (1223 mos) 5. Child Protected at Birth 6.MMR 7.livebirth (Natality report)
TARGET JAN M F M FEB F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 5
NOV M F DEC M F 4th Q M F TOTAL M F

CHILD CARE (PART 2 OF 3)

INDICATORS
6. Infant 6 mon. seen 7. Infant exclusivley breastfed until 6 mo. 8. Infant 0-11 mons. referred for NBScreening 9. Diarehea (0-59 mons. Old) * No. of Cases * Given ORT * Given ORS * Given Ors w/ zinc 10. Pneumonia (0-59 mons. Old) * No. of Cases * Given Treatment 11.Newborns screening done at DHU/CHO (w/ normal result) * Congenial Hyperthyroidism (CH) * Congenital Adrenal Hyperplasia(CAH) * Galactosemia(GAL) * Phenylketonuria (PKU) * Glucose-6-Phosphate Dehydrogenase Dediciency (G6PD def) 12.Newborn screening done outside CHO w/ (normal result) * Congenial Hyperthyroidism (CH) * Congenital Adrenal Hyperplasia(CAH) * Galactosemia(GAL) * Phenylketonuria (PKU) * Glucose-6-Phosphate Dehydrogenase Dediciency (G6PD def)
TARGET

JAN M F

FEB M F

MAR M F

1st Q M F

APR M F

MAY M F

JUN M F

2nd Q M F

JUL M F

AUG M F

SEPT M F

3rd Q M F

OCT M F

Page 6
NOV M F DEC M F 4th Q M F TOTAL M F

CHILD CARE (PART 3 OF 3)

INDICATORS
11. Sick Children seen * 6-11 mons. * 12-59 mons. * 60-71 mons. 12. Sick Children given Vit. A * 6-11 mons. * 12-59 mons. * 60-71 mons. 13. Infant 2-6 mons. w/ LBW given seen 14. Infant 2-6 mons. w/ LBW given iron 15. Anemic Children 259 mons. seen 16. Anemic Child 2-59 mons given iron
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F NOV M F

Page 7
DEC M F 4th Q M F TOTAL M F

NATALITY (PART 1 OF 2)
INDICATORS
1. Livebirths(Total) 2. Birthweight: * 2500 grmss & greater * Less than * 2500 grams * Not known 4. Attended by: * Doctors * Nurses * Midwives * Trained Hilot * Others * Unknown
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 29
NOV M F DEC M F 4th Q M F TOTAL M F

NATALITY (PART 2 OF 2)
INDICATORS
4. Type of Pregnancy: * Normal * Risk * Not Known 5. Normal Delivery * Home * Hospital * Others 6. other Type of Delivery * Home * Hospital * Others
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q JUL M F M F AUG M F SEPT M F 3rd Q M F OCT M F NOV M

Page 30
NOV F DEC M F 4th Q TOTAL M F M F

MORTALITY
INDICATORS
1.Total Deaths 2.Infant Deaths 3.Maternal Deaths 4.Deaths due to Neonatal Tetanus 5.Perinatal Deaths 6.Deaths among Child under 5 yo 7.Neonatal death
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 34
NOV M F DEC M F 4th Q M F TOTAL M F

PROGRAM:____________________________ _______ JAN FEB MAR 1st Q APR

INDICATORS
TARGET M F M F M F M F M F

MAY M F

JUN M F

2nd Q M F

JUL M F

AUG M F

SEPT M F

3rd Q M F

OCT M F

NOV M

NOV F

DEC M F

4th Q M F

TOTAL M F

MORBIDITY DISEASE REPORT FOR MONTH:___________

NAME OF DISEASE
Under 1 M F 1-4 M F 5-9 M F 10-14 M F 15-19 M F 20-24 M F 25-29 M F BY AGE-GROUP AND BY SEX 30-34 35-39 40-44 45-49 M F M F M F M F 50-54 M F 55-59 M

55-59 F

60-64 M F

65 & over M F

TOTAL M F

ENVIRONMENTAL HEALTH
INDICATORS
1. Household with access to improved or safe water * Level I * Level II * Level III 2.HH w/ sanitary toilet 3.HH w/satisfactory disposal of solid waste 4.HH w/complete basic sanitation facilities 5.Food establishment 6.Food Establishment w/ sanitary permit 7.Food Handlers 8.Food handlers with health certficates 9.Salt Samples Tested 10.Salt Samples tested found (+) for iodine
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 28
NOV M F DEC M F 4th Q M F TOTAL M F

FILARIASIS
INDICATORS
1.Case examined 2.Case Positive 3.MF in the slides found positive 4.Persons given MDA 5.Adenolympahangitis Cases
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 24
NOV M F DEC M F 4th Q M F TOTAL M F

SCHISTOSOMIASIS
INDICATORS
1.Symptomatic case 2. Positive Case 3.Case Examined Low intensity * Medium intensity * High intensity 4.Cases treated 5.Cases reffered to hospital Facilities *
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 23
NOV M F DEC M F 4th Q M F TOTAL M F

MALARIA
INDICATORS
1.Malaria Case * 5 yo * > 5 yo 2.Confirmed malaria case By Species *P.faciparum *P.vivax *P.malariae *P.ovale By Method: * Slide * RDT 3.ITNs distributed 4.Malaria Deaths
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 22
NOV M F DEC M F 4th Q M F TOTAL M F

LEPROSY
INDICATORS
1.Leprosy Cases 2.Leprosy Cases below 15 yo 3.Newly detected Leprosy cases 4.Newly detected cases w/Grade 2 disability 5.Cases cured
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 18
NOV M F DEC M F 4th Q M F TOTAL M F

TUBERCULOSIS
INDICATORS
1.TB symptomatics who underwent DSSM 2.Smear positive discovered 3.New smear cases initiated Tx 4.New smear (+) case cured 5.Smear (+) retreatment case initiated Tx 6.Smear (+) retreatment case got cured
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 14
NOV M F DEC M F 4th Q M F TOTAL M F

DENTAL HEALTH
INDICATORS
1.Orally fit Child 71 mos. old 2.Child 12 - 71 mos provided w/BOHC 3.Adolescent & Youth (10-24 yo) given BOHC 4.Preg women provided w/BOHC 5.Older person 60 yrs old & above provided w/ BOHC 12TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Page 10
NOV M F DEC M F 4th Q M F TOTAL M F

MATERNAL CARE-PRENATAL CARE (PART 1 OF 2)

INDICATORS
1. Pregnant with 4 or more prenatal visits 2. Pregnant women given 2 doses of TT 3. Pregnant women given TT2 plus 4. Pregnat women given complete iron with folic acid 5. Pregnant women given Vit. A supplimentation AP seen for 1st TR1 * 2nd TR1 * 3rd TR1 AP given Iron given this month AP given TT1 * TT2 * TT3 * TT4
TARGET JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT 3rd Q OCT

* TT5

Page 1
OCT NOV DEC 4th Q TOTAL

MATERNAL CARE-POSTPARTUM (PART 2 OF 2)

INDICATORS
1. Postpartum women with at least 2 PPV 2. Postpartum women given complete iron 3. Postpartum women given Vitamin A 4. Postpartum women initiated breast feeding 5. PP women with 1 PPv
TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M

Page 2
OCT F NOV M F DEC M F 4th Q M F TOTAL M F

PROGRAM: NUTRITION
INDICATORS
A. Breastfeeding * Exclusive 0-6 months *6 months above B.Mixed feeding *0-6 months *6 months above C. Bottle feeding D. Complementary feeding *Below 6 months *6 months above TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

NOV M F

DEC M F

4th Q M F

TOTAL M F

PROGRAM: CANCER CONTROL

INDICATORS
A. BREAST CANCER (BHC/MHC) No. of breast Exam done No. of Patient / breast mass identified No. of patient referred No. of cases confirmed & referred (MHC) B. CERVICAL CANCER (MHC Only) No. of Pap Smear collected No. of abnormal smear detected No. of patient referred to treatment Other DEGEN: Diabetes Mellitus No. of FBS done No. of new DM No. referred for Tx No. of Follow-up FBS done Other Laboratory Examinations: Cholesterol TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

Bone Marrow Test

NOV M F

DEC M F

4th Q M F

TOTAL M F

PROGRAM: HEALTH EDUCATION

INDICATORS
1) Total Ind. Health Counseling (all programs) 2) Bench Conferences No. of sessions No. of participants 3) No. of IEC Materials received 4) Total no. of Barangay assemblies No. of sessions No. of participants 5).Childbirth Education No. of Session No. of participants Nutrition Celebration Nutri Bingo PPD Testing Session Participants special act.nutritin month h1n1 imm.ap 6)pre marriage counseling No of sessions no of participants TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

7.Dengue activities pta meeting

NOV M F

DEC M F

4th Q M F

TOTAL M F

FHSIS Nutrition Program 2011 DHU_____BRGY_________________________ Month:_______________________

NUTRITION PROGRAM
VITAMIN A SUPPEMENTATION Given to 6-11 mons Given to 12-71 mons AP women given complete Vit.A PP women given complete Vit.A No. of sick children seen 6-11 mons 12-56 mons 60-71 mons No. of sick children given VAC 6-11 mons 12-59 mons 60-71 mons IRON SUPPLEMENTATION No.of LBW babies 2-6 mons seen No.of LBW babies 2-6 mons given iron No of anemic children seen (2-59 mons) No of anemic children given (2-59 mons) AP women given complete Iron w/ folic PP women given complete Iron w/ folic IODIZED SALT PROMOTION HH using Iodized salt Sari-sari Store selling Iodized salt FORTIFIED FOODS PROMOTION HH using Fortified foods Sari-sari Store selling Fortified foods DEWORMING 12-24 mons 25-71 mons 6-11 y/o

TARGET

JAN M F

FEB M F

MAR M F

APR M F

MAY M F

JUN M F

JUL M F

AUG M F

SEPT M F

OCT M F

NOV M F

12 y/o & above

DEC M F

TOTAL F TOTAL

PROGRAM: NUTRITION
INDICATORS
VITAMIN A SUPPEMENTATION Given to 6-11 mons Given to 12-71 mons AP women given complete Vit.A PP women given complete Vit.A No. of sick children seen 6-11 mons 12-56 mons 60-71 mons No. of sick children given VAC 6-11 mons 12-59 mons 60-71 mons IRON SUPPLEMENTATION No.of LBW babies 2-6 mons seen No.of LBW babies 2-6 mons given iron No of anemic children seen (2-59 mons) No of anemic children given (2-59 mons) AP women given complete Iron w/ folic PP women given complete Iron w/ folic IODIZED SALT PROMOTION HH using Iodized salt Sari-sari Store selling Iodized salt FORTIFIED FOODS PROMOTION HH using Fortified foods Sari-sari Store selling Fortified foods DEWORMING 12-24 mons 25-71 mons 6-11 y/o 12 y/o & above TARGET JAN M F FEB M F MAR M F 1st Q M F APR M F MAY M F JUN M F 2nd Q M F JUL M F AUG M F SEPT M F 3rd Q M F OCT M F

NOV M F

DEC M F

4th Q M F

TOTAL M F