maternal care 1 of 2
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M F M F M F M F M F M F M F M F M F M F M F M F M F
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
JUN 2nd Q JUL AUG SEPT 3rd Q
FAMILY PLANNING (PART 1 OF 2)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY OCT
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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
3rd Q
FAMILY PLANNING (PART 2 OF 2)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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1. Immunization given
24 hrs
* Hepatitis B2
* Hepatitis B3
* Measles3. Fully Immunized
Child
4. Completely
Immunized Child (12-
23 mos)
5. Child Protected at
Birth
6.MMR
7.livebirth (Natality
report)
3rd Q
CHILD CARE (PART 1 OF 3)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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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
3rd
CHILD CARE (PART 2 OF 3)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT
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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 2-
59 mons. seen
16. Anemic Child 2-59
mons given iron
3rd Q
CHILD CARE (PART 3 OF 3)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT NOV
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1. Livebirths(Total)
2. Birthweight:
* 2500 grmss & greater
* Less than
* 2500 grams
* Not known
4. Attended by:
* Doctors
* Nurses
* Midwives
* Trained Hilot
* Others
* Unknown
3rd Q
NATALITY (PART 1 OF 2)INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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4. Type of Pregnancy:
* Normal* Risk
* Not Known
5. Normal Delivery
* Home
* Hospital
* Others
6. other Type of Delivery
* Home* Hospital
* Others
3rd Q
NATALITY (PART 2 OF 2)
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT N
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M F M F M F M F M F M F M F M F M F M F M F M F M F
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
OCT3rd Q
MORTALITYINDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT
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NOV DEC 4th Q TOTAL
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M F M F M F M F M F M F M F M F M F M F M F M F M F M
OCT NSEPT 3rd Q INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY
PROGRAM:____________________________
JUN 2nd Q JUL AUG
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F M F M F M F
V DEC 4th Q TOTAL
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M F M F M F M F M F M F M F M F M F M F M F M F M
30-34NAME OF DISEASE 35-39 40-44Under 1 1-4 5-9 10-14BY AGE-GROUP AND BY SEX
MORBIDITY DISEASE REPORT FOR MONTH:___________
45-49 50-54 55-15-19 20-24 25-29
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F M F M F M F
59 60-64 65 & over TOTAL
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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 basicsanitation 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
3rd Q
ENVIRONMENTAL HEALTH
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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1.Case examined
2.Case Positive
3.MF in the slides found
positive
4.Persons given MDA
5.Adenolympahangitis
Cases
3rd Q
FILARIASIS
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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1.Symptomatic case
2. Positive Case
3.Case Examined *
Low intensity
* Medium intensity
* High intensity
4.Cases treated
5.Cases reffered to
hospital Facilities
3rd Q
SCHISTOSOMIASIS
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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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
SEPT 3rd Q INDICATORS TARGET
JAN FEB MAR 1st Q APR MAY
MALARIAJUN 2nd Q JUL AUG OCT
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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
3rd Q
LEPROSYINDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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1.TB symptomatics who
underwent DSSM
2.Smear positive
discovered
3.New smear cases
initiated Tx
4.New smear (+) case
cured
5.Smear (+) retreatmentcase initiated Tx
6.Smear (+) retreatment
case got cured
3rd Q
TUBERCULOSISINDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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DENTAL HEALTH
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1.Orally fit Child 12-
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 yrsold & above provided
w/ BOHC
3rd Q
DENTAL HEALTHINDICATORS TARGET
JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT OCT
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MATERNAL CARE PRENATAL CARE (PART 1 OF 2)
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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
SEPT 3rd Q INDICATORS TARGET AUG
MATERNAL CARE-PRENATAL CARE (PART 1 OF 2)JAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL O
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* TT5
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MATERNAL CARE-POSTPARTUM (PART 2 OF 2)
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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
3rd Q
MATERNAL CARE POSTPARTUM (PART 2 OF 2)
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT O
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T NOV DEC 4th Q TOTAL
PROGRAM: NUTRITION
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A. Breastfeeding
* Exclusive 0-6 months*6 months above
B.Mixed feeding
*0-6 months
*6 months above
C. Bottle feedingD. Complementary
feeding
*Below 6 months
*6 months above
MAY JUN 2nd Q JUL AUG SEPT 3rd Q OCTINDICATORS TARGET
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TOTALNOV DEC 4th Q
PROGRAM: CANCER CONTROL
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M F M F M F M F M F M F M F M F M F M F M F M F M F
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
TARGETJAN FEB MAR AUG SEPT 3rd Q OCT1st Q APR MAY JUN 2nd Q JUL
INDICATORS
Bone Marrow Test
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M F M F M F M F
4th Q TOTALNOV DEC
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PROGRAM: HEALTH EDUCATION
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M F M F M F M F M F M F M F M F M F M F M F M F M F
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 participants5).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
MAY JUN 2nd Q JUL AUG SEPT 3rd Q OCTINDICATORS TARGET
JAN FEB MAR 1st Q APR
7.Dengue activities pta
meeting
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TOTALNOV DEC 4th Q
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Month:_______________________
FHSIS Nutrition Program 2011 DHU_____BRGY_________________________
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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 SUPPLEMENTATIONNo.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 saltFORTIFIED FOODS PROMOTION
HH using Fortified foods
Sari-sari Store selling Fortified foods
DEWORMING
12-24 mons
25-71 mons
6-11 y/o
SEPTAPRNUTRITION PROGRAM TARGET
JAN FEB MAR OCT NOVMAY JUN JUL AUG
12 y/o & above
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M F M F TOTAL
DEC TOTAL
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PROGRAM: NUTRITION
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M F M F M F M F M F M F M F M F M F M F M F M F M F
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 saltFORTIFIED 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
INDICATORS TARGETJAN FEB MAR 1st Q APR MAY JUN 2nd Q JUL AUG SEPT 3rd Q OCT
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TOTALNOV DEC 4th Q