Field Health Information System

Field Health Services
Information System
FHSIS VER. 2012
Public Health Surveillance and Informatics Division

National Epidemiology Center
Department of Health
Manila, Philippines
Message from the Director
The Field Health Services Information System (FHSIS) continues to

strengthen its goal for evidence-based decision-making at all levels of the
health management systems. FHSIS ver 2012 updates the Department of
Healths core health indicators, recording and reporting forms for better documentation. These data shall be utilized for policy directions and systems
improvement. This huge endeavour was made possible through the efforts
and collaboration with the National Epidemiology Center, National Center
for Disease Prevention and Control, Centers for Health Development and
the National Statistics Office.
Operational since 1989, FHSIS has been the official system of the DOH
and designated as national health statistics as per Executive Order 352 and
provides health services data to monitor activities in each of these programs
on routine basis (monthly, quarterly or annually) from the Barangay Health
Stations, municipality, province, cities and regions.
I am proud to present this update to enhance the data quality of the
Field Health Services Information System.
ENRIQUE A. TAYAG, MD, FPSMID, PHSAE, CESO III

Director IV
EDITORIAL BOARD
Enrique A. Tayag MD, PHSAE, FPSMID, CESO III

Director IV, NEC
Vito G. Roque, Jr. RMT, MD, PHSAE

Medical Specialist IV
Public Health Surveillance & Informatics Division, NEC
Vikki Carr D. de los Reyes, MD, PHSAE

Medical Specialist III
FHSIS National Coordinator, NEC
Jose M. Hernaez
Information Systems Analyst III, NEC
Joel V. Cantero
Computer Programmer III, NEC
Levi L. Lameda, RN
Nurse II, NEC
Kristine Dianne T. Toledo, RN

Nurse I, NEC
Francis Raize Nicholas Bautista, RN

Nurse I, NEC
ACKNOWLEDGEMENTS
Program Managers
Dr. Florencia Apale
Mr. Edgardo Erce
Family Planning Program, NCDPC
Soil Transmitted Helminthiasis Control

Program, IDO, NCDPC
Dr. Juanita Basilio

Family Health Office, NCDPC
Dr. Francesca Gajete

Leprosy Program, IDO, NCDPC
Dr. Mario Baquilod

Malaria Control Program, IDO, NCDPC
Dr. Leda Hernandez

Filariasis Program, IDO, NCDPC
Dr. Gerard Bellimac

National AIDS and STI Prevention and Control
Program (NASPCP), IDO, NCDPC
Ms. Liberty Importa
Dr. Anthony Calibo
Ms. Ruth Martinez
Newborn Care, FHO, NCDPC
Schistosomiasis Program, IDO, NCDPC
Dr. Manuel Calonge
Engr. Joselito Riego de Dios
Dental Program, FHO, NCDPC
Environmental Program, NCDPC
Dr. Anthony Cu
Dr. Genesis Samonte
National TB Program, IDO, NCDPC
HIV Surveillance, NEC
Ms. Frances Precilla Cuevas
Engr. Roland Santiago
Non-Communicable Disease Program, DDO,

NCDPC
Environmental Program, NCDPC
Nutrition Program, FHO, NCDPC
Dr. Rosalind Vianzon

Dr. Diego Danila
National TB Program, IDO, NCDPC
Maternal Care Program, FHO, NCDPC
Dr. Ernesto Eusebio S. Villalon

Dr. Joyce Ducusin
Leprosy Program, IDO, NCDPC
EPI Program, FHO, NCDPC
Regional FHSIS Coordinators
Ms. Myrna Gurtiza
Mr. James Valencia
Statistician III
CHD - Ilocos
Statistician II
CHD - Zamboanga Peninsula
Dr. Marian Lynn de Laza
Ms. Gloria Rodriguez
Medical Specialist III

CHD - Cagayan Valley
Statistician III
CHD - Northern Mindanao
Ms. Luz Campos
Engr. Ma. Elizabeth Baba
Statistician III
CHD - Central Luzon
Statistician III
CHD - Davao
Mr. Mariano Selorio Jr.
Mr. Leonardo Bautista
Statistician III
CHD - CALABARZON
Statistician III
CHD - Central Mindanao
Ms. Genoveva Vias
Ms. Maria Angeles de Guzman
Statistician II
CHD - MIMAROPA
Statistician III
CHD - CAR
Ms. Suenia Loria
Mr. Paulito Ofiasa, RN
Statistician III
CHD - Bicol
Statistician III
CHD - CARAGA
Ms. Alma Dumasis
Ms. Maria Luz dela Cuadra
Statistician III
CHD - Western Visayas
Statistician III
CHD - Metro Manila
Ms. Hermela Tan
Ms. Delia Ramos
Nurse III
CHD - Central Visayas
Statistician II
DOH-ARMM
Ms. Lilia Mariano

Statistician III
CHD - Eastern Visayas
Acronyms
AnnualForms
ART
AltraumaticRestorativeTreatment
BBT
BasalBodyTemperature
BEMONC
BasicEmergencyObstetricsandNeonatalCare
BHS
BarangayHealthStations
BHW
BarangayHealthWorkers
BOHC
BasicOralHealthCare
BTL
BilateralTubalLigation
CC
ChangingClinic
CMM
CervicalMucusMethod
CDR
CaseDetectionRate
CEMONC
ComprehensiveEmergencyObstetricsandNeonatalCare
CHO
CityHealthOfficer
CIC
CompletelyImmunizedChild
CM
ChangingMethod
CPAB
ChildProtectedAtBirth
CPR
ContraceptivePrevalenceRate
CU
CurrentUser
CVD
CardiovascularDisease
DO
Dropouts
DSSM
DirectSputumSmearMicroscopy
FHSIS
FieldHealthServicesInformationSystem
FIC
FullyImmunizedChildren
HH
Household
IMR
InfantMortalityRate
ITR
IndividualTreatmentRecord
IUD
IntrauterineDevice
LAM
LactationalAmenorrheaMethod
LB
Livebirth
LBW
LowBirthWeight
LCR
LocalCivilRegistry
LGU
LocalGovernmentUnits
LHB
LocalHealthBoard
LHW
LocalHealthWorkers
LLIN
LonglastingInsecticideNets
MonthlyForms
MCT
MonthlyConsolidationTable
MCV
MeaslescontainingVaccine
MDA
MassDrugAdministration
MDG
MillenniumDevelopmentGoal
MFD
MicrofilariaDensity
MHO
MunicipalHealthOfficer
MMR
MaternalMortalityRatio
MNP
MicronutrientPowder
NA
NewAcceptors
NBS
NewbornScreening
NCDPC
NationalCenterforDiseasePreventionandControl
NEC
NationalEpidemiologyCenter
NHTS
NationalHouseholdTargetingSystem
ORS
OralRehydrationSalt
ORT
OralRehydrationTherapy
OUT
OralUrgentTreatment
PHN
PublicHealthNurse
PN
Prenatal
PP
Postpartum
QuarterlyForms
RHM
RuralHealthMidwife
RDT
RapidDiagnosticTest
RHU
RuralHealthUnits
RPR
RapidPlasmaReagin
RS
Restart/Restarter
SDM
StandardDaysMethod
SSESS
STISentinelEtiologicSurveillanceSystem
ST
SummaryTable
STM
SymptothermalMethod
SY
Syphilis
TCL
TargetClientList
TP
TotalPopulation
TPHA
TreponemaPallidumHemaglutinationAssay
TT
TetanusToxoid
WHO
WorldHealthOrganization
Chapter One
___________________
INTRODUCTION
FHSIS DIC 201201

1.1 Introduction
The Field Health Services Information System (FHSIS) provides the Department of Health
(DOH) with management information on the different public health programs. It is the official
system of the DOH and designated national health statistics as per Executive Order 352.
Field Health Services Information System (FHSIS) was conceptualized in 1987 as a response
to the need for streamlining an existing reporting system that, midwives complained, was
burdensome, time-consuming, and ultimately even prevented them from discharging their service
delivery functions fully. FHSIS was then implemented nationwide by 1989 in a joint effort with many
sectors within and outside the Department of Health (DOH). The FHSIS is a facility-based system,
and data generated by the system comes from the Barangay Health Stations (BHS) and Rural
Health Units (RHU). This means that, data from private or non-government units, clinics, and
institutions rendering the same services as the BHS and RHU are missed.
In 1991, barely a year after the full implementation of FHSIS, the Local Government Code
(LGC) was implemented. With this decentralization, the management and provision of health
services was transferred to the Local Government Units (LGU). In order to make the FHSIS adapt
to the changes brought about by the LGC, the FHSIS technical staff formed study teams and
undertook activities aimed at improving, simplifying, and making the system more responsive and
relevant to devolution. The team focused on simplifying and shortening Summary Tables (ST) and
reducing over-dependence on computers in the production of STs. These changes constituted the
Modified FHSIS (MFHSIS) which was implemented nationwide in 1996. However, despite the
innovations, the system continued to experience problems in its operations including poor
utilization of data for decision making by leaders in various levels of the health system, and the
sub-optimal quality of the data characterized by delayed submissions and incomplete reports.
In 2001, another revision, the Decentralized FHSIS (DFHSIS), was piloted in six areas
nationwide (three provinces and three cities) in an effort to address the shortcomings of the
MFHSIS. However, this was not implemented nationwide and was not sustained due to a very
limited information generation. An evaluation of DFHSIS was undertaken in 2004 for which findings
showed the same problems of inaccuracy, incompleteness and delay from the original FHSIS and
MFHSIS. The recommendation showed DFHSIS should not be implemented nationwide unless the
support systems are enhanced (policy and implementing rules and regulations, skilled data
managers, adequate financing and efficient computerization of the system).
In 2005, The FHSIS started its program enhancement through consultative workshops.
Program managers at the national level were met to determine indicators that would suit their
2
FHSIS DIC 201201
needs. This was followed through in recent years by series of consultations with National Center
for Disease Prevention and Control (NCDPC) Program Managers and selected Rural Health Unit
Physicians, Nurses and Midwives, Provincial Health Officers to further identify information needs
and indicators in all health management systems. FHSIS ver 2008 was developed as a result of
these meetings with Program Managers and Local Government Units (LGU). This version included
the updating of indicators needed at the national level and the FHSIS software developed by the
National Epidemiology Center (NEC).
1.2 Objectives of FHSIS ver. 2012
To update indicators based on the current needs of the health program managers and all
local government units.
1.3 Principles of FHSIS ver. 2012
Indicators needed by program managers and local government units are collected in
consultative manner. Updated FHSIS metadata are featured. FHSIS ver. 2012 shall be implemented
by 2013 with the updated indicators reports published in 2014.
1.4 Components of FHSIS ver. 2012
a. Recording Tools
Facility-based documents with more detailed data and contains day to day activities of
the health workers.
Individual Treatment Record (ITR)
Target Client List (TCL)
Summary Table (ST)
Monthly Consolidation Table (MCT)
b. Reporting Tools
These are summary data that are transmitted or submitted on a weekly, monthly,
quarterly and on annual basis to the next higher level).
Monthly Forms (M)
Quarterly Forms (Q)
Annual Forms (A-BHS, A1, A2, A3)

3
Chapter Two
___________________
COMPONENTS OF FHSIS
FHSIS DIC 201201

2.1 RECORDING TOOLS:
These are facility based documents. Data are more detailed and contains day to day
activities of the health workers. The source of data for this component is the services delivered
to patients/clients.
2.1.1 Individual Treatment Record (ITR)
The Individual Treatment Record is a document, form or piece of paper upon which is
recorded the date, name, address of patient, presenting symptoms or complaint of the
patient on consultation and the diagnosis (if available), treatment and date of treatment. This
record will be maintained as part of the system of records at each health facility on all
patients seen. This record may be as simple as the following example prepared on plain
bond paper:
Sample of ITR:
DELA CRUZ, ROSE M.

2106 Rizal Avenue, Siniloan, Laguna
Age: 32 years
Birthday: February 7, 1980
Religion: Catholic
Weight: 52 kg
Occupation: Housekeeper
4/15/2012
Complaint: Headache & vomiting
Vital signs: BP = 120/80 mmHG
Diagnosis:
Treatment/Recommendations:
NOTE: Do not rely on records maintained by the client/patient. In areas where the
home based maternal record is in use, there must still be a treatment record available in
the facility.
2.1.2 Target Client List (TCL)
The Target Client Lists constitute the second recording tool of the FHSIS and are
intended to serve several purposes. The tool enables the midwife or nurse to plan and
carries out patient care and service delivery. Such lists will be of considerable value to
midwives/nurses in monitoring service delivery to groups of patients identified as targets or
eligibles for a particular health program. TCL also facilitate the monitoring and supervision
of service delivery activities, report services delivered. TCL data may provide a clinic-level
data base which can be accessed for further studies.
FHSIS DIC 201201

The Target Client Lists to be maintained in the FHSIS version 2012 are as follows:
Target Client List for Prenatal Care
Target Client List for Post-Partum Care
Target Client List for Nutrition and Expanded Program for Immunization
Target Client List for Family Planning
Target Client List for Sick Children
Registry Forms for Filariasis, Leprosy, Malaria, Schistosomiasis and Tuberculosis shall
be the source for all Disease Control Indicators instead of a separate TCL.
2.1.3 Summary Table

The Summary Tables is a form with 12-month columns retained at the facility (BHS)
where the midwife records all monthly data. The Summary Table is composed of; a) Health
Program Accomplishment; b) Morbidity Diseases.
a. Summary Tables the midwife records a summary of all the data from TCL or
registries. This summary table is an easy source of data for reports being
prepared by the midwife. It would be wise to keep this updated as this can
serve as proof of accomplishments to show LGU officials whenever they visit
the facility. This also serves as the data source for any survey, special study,
or research that may include the facility. This can serve as a tool for the
midwife to assess her own accomplishments.
b. Morbidity Diseases the midwife accomplish this table on a monthly basis. This
summary table can also be the source of ten leading causes of morbidity and
reportable disease for the municipality/city. This summary table will help the Health
Centers staff get the monthly trend of diseases.
2.1.4 Monthly Consolidation Table (MCT)

The Monthly Consolidation Table - the Public Health Nurse (PHN) records data from all
barangays. This is the source document of the nurse for the Quarterly Form. The MCT shall
serve as the output table of the RHU as it already contains listing of indicators by barangay.
2.2 REPORTING TOOLS:

These are summary data that are transmitted or submitted on a monthly, quarterly and
on annual basis to higher level. The source of data for this component is dependent on the ST
and MCT.
FHSIS DIC 201201

2.2.1 The Monthly Form
2.2.1.1 Program Report (M1)
The Monthly Form contains selected indicators categorized as maternal care, child
care, family planning and disease control. The same indicators found in the TCL and
Summary Tables are found in M1. The midwife should copy the data from the Summary
Table to the Monthly Form which she regularly submits monthly to the public health nurse.
It helps the midwife capture the monthly data so that it would be easier for the nurse to
consolidate and prepare the quarterly report.
2.2.1.2 Morbidity Report (M2)
The Monthly Morbidity Disease Report contains a list of all diseases by age and
sex. The midwife uses the form for the monthly consolidation report of Morbidity Diseases
and is submitted to the PHN for quarterly consolidation.
2.2.2 The Quarterly Form

2.2.2.1 Program Report (Q1)
The Quarterly Form is the municipality/city health report and contains the threemonth total of indicators categorized as maternal care, family planning, child care, dental
health and disease control. There should only be one Quarterly Form per municipality/city.
In the event that there are two or more RHUs/MHCs in the municipality/city, the
consolidation shall be done by or under the direction of the MHO/CHO who sits as
vice chairperson of the Local Health Board (LHB). The Quarterly Form is submitted to
the Provincial Health Office (PHO) for consolidation.
2.2.2.2 Morbidity Report (Q2)
The PHN uses the form for the Quarterly Consolidation Report of Morbidity
Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table.
The Quarterly Consolidation Report of Morbidity Diseases is submitted every third week of
the first month of the succeeding quarter.
2.2.3
The Annual Forms (A-BRGY, A1, A2 & A3)
The Annual Form 1 (A1) consists of data and indicators needed only on a yearly
basis. A-BRGY Form is the report of midwife which contains data on demographic,
environmental, natality and mortality. Annual Form 2 (A2) is the report that lists all
diseases and their occurrence in the municipality/city. The report is disaggregated by
age and sex. Annual Form 3 (A3) is the report of all deaths occurred in the
municipality/city disaggregated by age and sex.
FHSIS DIC 201201
2.3 RECORDING AND REPORTING TOOLS GUIDE
Locus of
Responsibility
Office
Person
BHS
Midwife
RHU
PHN
PHO/
CHO
Prov./City
FHSIS
Coordinator
CHD
Regional
FHSIS
Coordinator
Recording
Tools
Reporting Tools
Frequency
ITR
TCL
ST
Monthly Form
(M1 & M2)
A-BRGY Form
Monthly
ST
MCT
Quarterly Form
(Q1 & Q2)
Annual Forms
> A1
> A2
> A3
Quarterly
Quarterly Report
(Q1 & Q2)
Annual Report
> A1
> A2
> A3
- Quarterly Report
Quarterly
- Annual Report
> A1
> A2
> A3
Annually
Annually
Annually
Annually
Quarterly
Schedule of Submission
to higher level
every second week of succeeding
month
every second week of January
every third week of the first month

of the succeeding quarter
every third week of January
every fourth week of the first

month of the succeeding quarter
every fourth week of January
every second week of the second

month of the succeeding quarter
every second week of March
FHSIS DIC 201201
2.4 REPORTING FLOW:
FHSIS DIC 201201

TARGET CLIENT LIST:
2.5 Target Client List for Prenatal Care
The target client list for prenatal care will include all pregnant women eligible for prenatal care/service. The individual patient record or pre-natal record must still be maintained
together with this list to record information of importance to the patient which otherwise is not
included in the client list (e.g. the FHB, Wt., BP) for every pre-natal visit.
The target client list must be properly filled-up and updated as soon as possible following
a patients visit by the midwife in the BHS and the nurse/midwife in the RHU. The trained BHW
can also be given the responsibility of recording provided they are under the direct supervision of
the nurse or midwife.
Column 1 DATE OF REGISTRATION Write in this column the month, day and year a pregnant
woman was first seen at the clinic for pre-natal visit.
Column 2 FAMILY SERIAL NUMBER Enter in this column the number that corresponds to the
number of the family folder or envelope or individual treatment record. This column
will help you facilitate retrieval of clients record.
Column 3 - NAME Write the given name, middle initial and family name of the woman.
Column 4 ADDRESS Write the complete address: number of the house, name of the street,
barangay, municipality and province. This column will help you to monitor or
follow-up the client.
Column 5 AGE Write the age of the woman at her last birthday.
Column 6 LAST NORMAL MENSTRUAL PERIOD /GRAVIDA-PARITY

LMP/GP - Write in this column 2 entries. First is the date of the last menstrual
period (month, first day of LMP and the year) followed by gravida-parity (G-P) of
the client. LMP is important because this is the basis for computing the EDC of the
mother while GP is important to know if pregnancy is of risk.
Example:
(5)
LMP/G-P
(6)
2-14-12/
4-3
(7)
This means that the last menstrual period of the woman was 2-14-07 and she had
4 pregnancies (gravida) including the current pregnancy and 3 deliveries (parity).
Column 7 EDC or EXPECTED DATE OF CONFINEMENT Write in this column the expected
date of delivery. This column is important for follow-up visits to prevent post maturity.
Formula for Computing EDC:
LMP:
January-March
April-December
Example:
LMP
Formula
EDC
=
=
+ 9 mos. +7 days + 0
- 3 mos. +7 days + 1 year
=
=
=
4
- 3
1
10
14
2012
7 +
1
21
2013
FHSIS DIC 201201

Column 8 PRENATAL VISIT (DATES) This has 3 sub-columns representing the trimester of
pregnancy. All dates of pre-natal visits either clinic or home of a particular
pregnant woman must be entered in this column corresponding to the trimester of
pregnancy when the visit was undertaken. If a pregnant woman comes in the clinic
in the first 3 months of her pregnancy (i.e. first trimester) enter the date of that
check-up under column 8, 1st trimester. Dates of all succeeding visits should be
indicated in the appropriate trimester column. It is possible that more than one
date appears in each column. Also, visits from other DOH facilities, private
hospital/clinic should also be recorded in this column as long as there is a way to
validate that the visit is a PNV. This column is important for early detection of risk
pregnancies thus protecting both the mother and the baby.
Trimesters of Pregnancy:
The First Trimester = the first 3 months (up to 12 weeks)
The Second Trimester = the middle 3 months (13-27 weeks)
The Third Trimester = the last 3 months (28 weeks and more)
Column 9 TETANUS STATUS Write in this column the tetanus toxoid immunization already
received by the pregnant woman (either from the past pregnancy or present
pregnancy) when she made her first visit to the facility. The record of past
pregnancies can be used to obtain this information. Use the following codes:
Code
TT1
TT1 & TT2
TT3
TT4
TT5
TTL
NONE
UNKNOWN
The woman has received only one dose of tetanus

toxoid during this pregnancy from other DOH facility
(e.g. transferred residence)
The woman has received 2 doses of tetanus toxoid during
this pregnancy from other DOH facility (e.g.
transferred residence) and any woman who has
received TT1 and TT2 during the past pregnancy.
The woman has received TT1 and TT2 together with TT3
The woman has received TT1, TT2, TT3 and TT4
The woman has received TT1, TT2, TT3, TT4 and TT5
Presently pregnant woman who already received
the 5 doses tetanus toxoid (Fully Immunized Mother)
Women without previous history/record of
tetanus immunization or women having her pre-natal
visit for her first pregnancy
If no information can be obtained from the records or
history of the woman.
Column 10 - TETANUS TOXOID VACCINATION GIVEN Write in this column

the date each tetanus toxoid is given during the course of the
present/current pregnancy.
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FHSIS DIC 201201

Tetanus Toxoid (TT) Immunization Schedule
TT Dose
Interval
TT1
As early as possible during first pregnancy or even in

a non-pregnant child bearing age woman
TT2
4 weeks after first dose within the same pregnancy
TT3
6 months after TT2
TT4
1 year after TT3
TT5
1 year after TT4
Column 11 MICRONUTRIENT SUPPLEMENTATION This has 2 sub columns, iron and

Vitamin A supplementation. For Vitamin A column, write the date and for iron
column write the date and number of iron with folic acid supplementation was
given to pregnant woman during visit.
Column 12 STI SURVEILLANCE This has 3 sub columns. For TESTED FOR SY column, put
Y for pregnant women tested for Syphilis using Rapid Plasma Reagin (RPR) or
Rapid Diagnostic Test (RDT) and put N for pregnant women not tested. For
RESULT FOR SY TESTING column, Put + if RPR or RDT result is Positive and
put - if RPR or RDT result is Negative. For GIVEN PENICILLIN column, put Y if
positive for Syphilis pregnant women was given Penicillin and put N if not.
Column 13 PREGNANCY Write the date (month, day and year) when the current pregnancy
was terminated in the sub-column DATE TERMINATED and in the OUTCOME
sub-column, write the outcome of the pregnancy whether it is a live birth, fetal
death or abortion and the sex. It is possible that two codes appear in this subcolumn. Use the following codes:
Code
LB
FD
AB
Definition
Live birth - the complete expulsion or extraction from the mothers
womb of a product of conception, irrespective after such
separation, breathes or shows any other evidence of life such
as beating of the heart, pulsation of the umbilical cord or
definite movement of muscles.
Fetal Death - death of the fetus prior to the complete
expulsion from the mother; the death is indicated by the
fact that after separation, the fetus does not breath or
show any evidence of life such as beating of the heart,
pulsation of the umbilical cord or definite movement of
voluntary muscles. (20 weeks and above)
Abortiontermination of pregnancy before the fetus becomes
viable. (before the 20th week or 5 months of pregnancy)
Code
T
Definition
Term newborn infants delivered more than or equal to 37 weeks completed
age of gestation (AOG) using Ballards Score Physical and Neurological
Maturity rating scale if available or through LMP or Ultrasound baby
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FHSIS DIC 201201
Pre-term/Premature any newborn infants delivered less than 37 weeks

using the same definition as above.
PT
Column 14 LIVE BIRTHS In case of Live birth, the weight of the infant in grams must appear
in the BIRTH WEIGHT sub-column. If there is more than one birth, all birth weights
in grams must appear. In the PLACE OF DELIVERY sub-column, write health
facility if delivery occurred in RHU, BeMONC, CeMONC, Hospital and lying-in
clinics; write Non-Institutional Delivery if delivery occurred otherwise (home, taxis,
etc). It is possible that two entries appear in this sub-column in case of multiple
births at different places. In the ATTENDED sub-column, write the corresponding
code of the persons designation with the highest professional rank.
Code
Designation
MD
RN
RM
H
O
Doctor
Nurse
Midwife
Hilot/TBA
Others
Column 15 REMARKS Make a note under this column why a pregnant woman failed to return
for the next prenatal care. Indicate dates and reasons such as transferred to
another province, presently ill, hospitalized, etc. Also include other data of
importance to the patient.
13
NAME OF BARANGAY/RHU:
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
FHSIS v. 2012
TCL-PN
DATE OF
REGISTRATION
mm/dd/yy
FAMILY
SERIAL
NO.
(1)
(2)
TARGET CLIENT LIST FOR PRENATAL CARE

NAME
ADDRESS
(3)
(4)
AGE
LMP/
G-P
EDC
(5)
(6)
(7)
D A T E
PRENATAL VISITS
(8)
FIRST
SECOND
THIRD
TRIMESTER
TRIMESTER
TRIMESTER
NOTE: First Trimester = the first 3 months (up to 12 weeks)

Second Trimester = the middle 3 months (13-27 weeks)
Third Trimester = the last 3 months (28 weeks and more)
15
TARGET CLIENT LIST FOR PRENATAL CARE

DATE TETANUS TOXOID VACCINE
GIVEN
(10)
TETANUS
STATUS
(9)
TT1
TT2
TT3
TT4
Micronutrient Supplementation
TT5
DATE & NO.

IRON W/ FOLIC ACID
WAS GIVEN
TESTED
FOR SY
Y/N
STI SURVEILLANCE
(12)
RESULT FOR
SY TESTING
+/-
* Outcome:
GIVEN
PENICILLIN
Y/N
LB = Livebirth
SB = Stillbirth
AB = Abortion
16
PREGNANCY
(13)
DATE
OUTCOME*
TERMINATED
** Health
Facility or
NonInstitutional
BIRTH
WEIGHT
(grams)
LIVEBIRTHS
(14)
PLACE OF Delivery
Health Facility**
code:
RHU
BeMONC
CeMONC
Hospital
lying-in clinics
NID
*** Attended by:

MD = Doctor
RN = Nurse
RM = Midwife
H = Hilot/TBA
O = Others
REMARKS
ATTENDED
BY ***
(15)
FHSIS DIC 201201
2.6 Target Client List for Post-Partum Care

The Target Client List for Post-Partum Care will include all the women within the
catchment area who had a delivery. This list should be considered as an extension of the
TARGET CLIENT LIST FOR PRE-NATAL CARE. The names of women are entered upon
termination of pregnancy or women, whose terminations of pregnancy were not attended by the
midwife or nurse, their names are also entered in the list upon knowledge of a birth in the
catchment area, visit to facility or a home visit.
The list must be properly updated and exact dates indicated in each column by
responsible personnel i.e. the midwife in the BHS, the nurse or the midwife in the RHU or the
trained BHW under the direct supervision of the nurse or midwife.
Column 1 DATE AND TIME OF DELIVERY Write in this column the month, day, year and time
of termination of pregnancy of the mother.
Column 2 FAMILY SERIAL NUMBER Enter in this column the number that corresponds to the
number of the family folder or envelope or individual treatment record. This column will
help facilitate retrieval of clients record.
Column 3 - NAME Write the given name, middle initial and family name of the woman.
barangay, municipality and province. This column will help you to monitor or follow-up the
client.
Column 5 DATE OF POSTPARTUM VISITS This column is divided into two sub-columns.
Write the date of postpartum visits at home or at the clinic within 24 hours upon delivery
and within one week after delivery.
Column 6 DATE AND TIME INITIATED BREASTFEEDING write the date and the time postpartum mother initiated breastfeeding.
Column 7 DATE SUPPLEMENTATION WAS GIVEN This column is divided into iron and
vitamin supplementation. For iron supplementation column, write the date/s and number of
tablet given to post-partum women. For Vitamin A, write only the date supplementation
was given.
Column 8 REMARKS Under remarks column enter information which you feel important for
post-partum care mothers.
17
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
FHSIS v. 2012
TCL-PP
DATE &
TIME OF
DELIVERY
FAMILY
SERIAL
NO.
(1)
(2)
CLIENT LIST FOR POSTPARTUM CARE

NAME
ADDRESS
(3)
(4)
DATE POST-PARTUM VISITS

(5)
W/IN 24 HOURS
WITHIN ONE
AFTER
WEEK AFTER
DELIVERY
DELIVERY
20
DATE AND
TIME
INITIATED
BREASTFEEDING
(6)
MICRONUTRIENT SUPPLEMENTATION
REMARKS
(7)
(8)
IRON
VITAMIN A
DATE / NO. TABLETS
DATE
FHSIS DIC 201201

2.7 Target Client List for Family Planning
The Target Client List for Family Planning will include all eligible women aged 15-49 and
men who are receiving a family planning service provided by the reporting clinic. The Family
Planning Service provided by the reporting clinic will include Condom, injectables (DMPA/CIC),
Intra-Uterine Device (IUD), NFP-Lactational Amenorrhea Method (NFP-LAM), NFP-Basal Body
Temperature (NFP-BBT), NFP-Cervical Mucus Method (NFP-CM), NFP-Sympothermal Method
(NFP-STM), NFP-Standard Days Method (NFP-SDM), Pills, Female Sterilization/Bilateral Tubal
Ligation (FSTR/BTL) and Male Sterilization/Vasectomy.
The Target Client List should be by Family Planning Method and be updated immediately
after a client visits the facility.
Column 1 DATE OF REGISTRATION Indicate in this column the date (month, day and year)
an eligible person made the first clinic visit or the date when client fail to comeback after a
year, the client has to be registered again.
Column 2 - FAMILY SERIAL NUMBER Indicate in this column the number that corresponds to
the number of the family folder or envelope or individual treatment record. This column will
help you facilitate retrieval of clients record.
Column 3 NAME Write the given name, middle initial and family name of the client.
barangay, municipality and province. This column will help you monitor or follow-up the
client.
Column 5 AGE Indicate in this column the age of the client as of last birthday.
Column 6 TYPE OF CLIENT Indicate in this column any of the applicable categories:
Code
NA
CU
Type of Client
New Acceptors a client who has NEVER accepted
any FP method at any clinic before
Current Users current users carried over from last
month client list. Includes:
Changing Method (CM) a continuing user who is shifting

to another Method
Changing Clinic a continuing user using the same

method, however the client is new to the clinic
Restart a client who have stopped FP practice for at least

1 month and have resumed using the same method in the
same clinic.
NOTE: For clients who are changing methods/changing clinic, they should be
recorded as a DROP-OUT from their previous method and indicate the reason
as CHANGING METHOD/Changing Clinic. The client is still categorized as
current users.
20
FHSIS DIC 201201

Column 7 PREVIOUS METHOD refers to the last method used prior to accepting the new
method. Using the following codes, add code for NONE to cover New to Program.
Codes
PILLS
FSTR/BTL
INJ
IUD
NFP-BBT
NFP-CM
NFP-STM
SDM
LAM
MSTR/VASECTOMY
Methods
Pills
Female Sterilization/Bilateral Tubal Ligation
Depo-medroxy Progestone Acetate(DMPA)/ Combined
Injectables Contraceptives(CIC)
Intra-Uterine Device
Natural Family Planning-Basal Body Temperature
Natural Family Planning-Cervical Mucus Method
Natural Family Planning-Symptothermal Method
Natural Family Planning-Standard Days Method
Lactational Amenorrhea Method
Male Sterilization/Vasectomy
CON
Implants
Condom
Implants
Column 8 FOLLOW-UP VISITS Write in this column 2 entries; in the upper space is the
scheduled date of visit and at the lower space is the actual date of visit. A client who is
scheduled for a particular month and failed to make the clinic visit will only have one date
entered in that particular month.
Column 9 DROP-OUT write the date client has been dropped from the TCL based on the
following method.
The following are the definitions for each method drop-out:
a. Pill - A client is considered drop-out from the method if she:
i
fails to come and get her re-supply from the last 21 white
pills up to the last brown pill (if the pills have a set of brown tablets/Iron);
or within 7 days from the 21st pill / last pill (if the pills contain only a set
of white tablets)
ii
gets supply or transfers to another provider or clinic: in this case, the

client is listed under the other acceptor (changed clinic) in the clinic
where she transferred and a drop out in her former clinic.
iii
decided to stop the use of pills for any reason

Note: The service provider should undertake follow-up visits of the client
within this period before dropping her from the method.
b. Injectables A client is considered drop-out if she:

i
fails to have a follow-up visit on the last day of 2 weeks before or after
the scheduled date of visit for DMPA; fails to have a follow-up visit on
the last day of 1 week before or after scheduled date of visit.
ii
gets supply or transfers to another provider; the client is under the Other
Acceptor (Changed Clinic) in the clinic where she transferred and
considered a drop-out in her former clinic
iii
stops receiving injection for any reason

21
FHSIS DIC 201201
Note: the service provider should undertake a follow-up visit during the above
period prior to dropping her out of the method.
c.
IUD client is considered drop-out if:

i
client decided to have it removed
ii
had expelled IUD that was not re-inserted and
iii
client did not return on the scheduled date of follow-up visits 3-6 weeks
after insertion from when the procedure was done. It is best medical
practice to follow-up on the client yearly, but the client is dropped out if
she does not return for two years.
d. Condom client is considered drop-out if she/he fails to return for re-supply on

scheduled visit; or decides not to use condom for any reason
e. LAM client is considered drop-out if any one of the three (3)
conditions is not met as follows:
f.
Mother has no menstruation or amenorrheic within six months. Spotting

or bleeding during the last fifty-six (56) days postpartum is not
considered return of menses.
ii
Fully/exclusive breastfeeding means no other liquid or solid except

breastmilk be given to the infant, intervals should not exceed four hours
during the day and six hours at night.
iii
Baby is less than six (6) months old
NFP
for Standard Days Method A client is considered a drop-out if she fails to
return on the follow-up date to identify her own fertile and infertile periods, has
no indication SDM use through beads or no knowledge of first day of
menstruation or cycle length, or decides to stop the use of the method. The
service provider should undertake a follow-up visit during the above period prior
to dropping her out.
for BBT / Billings / Symptothermal Method A client is considered a drop-out if
client fails to return on the follow-up date to check on the correct charting and/or
the proper use of the method, fails to identify her own fertile and infertile periods,
decides to stop the use of the method.
Note:
Client is given a period of time (2 months) as a learning user to practice

correct charting with assistance before recording the client as a new
acceptor. A new acceptor is considered if the client can identify and
chart her fertile and infertile period correctly.
An autonomous user can be considered a Current User as these clients
no longer need assistance in charting from the health workers.
22
FHSIS DIC 201201
The service provider should undertake a follow-up visit during the above
period prior to dropping her out.
g. Female Sterilization/ BTL - client is considered drop-out if she reaches the age beyond 49
years or experiences the following conditions: menopausal, underwent hysterectomy
or bilateral salpingo-oophorectomy.
NOTE: Follow up of clients should be undertaken prior to the dropping out of the client
from the method.
Column 10 REMARKS Indicate in this column the date and reason for every referral MADE to
other clinic and referral RECEIVED from other clinic which can be due to medical
complications or unavailable family planning services and other pertinent findings significant
to client care.
23
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
FHSIS v. 2012
TCL-FP
TARGET CLIENT LIST FOR FAMILY PLANNING - ___________________

(PUT NAME OF FP METHOD
DATE OF
REGISTRATION
mm/dd/yy
FAMILY
SERIAL
NO.
(1)
(2)
* Type of Client:
TYPE
NAME
ADDRESS
AGE
(3)
(4)
(5)
PREVIOUS
OF
METHOD**
CLIENT*
(use codes)
(use codes)
CU = Current Users
NA = New Acceptors
CU = Current Users
Other Acceptors
* CU-CM = Changing Method
*CU-CC = Changing Clinic
* CU-RS = Restarter
** Previous Method:
CON=Condom
INJ= DMPAor CIC
IUD = Intra-uterine Device
PILLS= Pills
NONE or New Acceptor
NFP-BBT= Basal Body Temp

NFP-CM= Cervical Mucus Method
NFP-STM= Sympothermal Method
LAM = Lactational Amenorrhea Method
27
(6)
(7)
SDM = Standard Days Method

MSTR/Vasec = Male Ster/Vasectomy
FSTR/BTL = Female Ster/Bilateral Tubal Ligation
TARGET CLIENT LIST FOR FAMILY PLANNING

FOLLOW-UP VISITS
(Upper Space: Next Service Date / Lower Space: Date Accomplished)
DROP-OUT
(9)
(8)
1ST
2ND
***Reasons:
3RD
4TH
5TH
6TH
7TH
8TH
9TH
10TH
11TH
12TH
DATE
REMARKS/
ACTION
TAKEN
Reason
(10)
A = Pregnant
F = Husband disapproves
K = Change Method
For LAM:
B = Desire to become pregnant

C = Medical complications
G = Menopause
H = Lost or moved out of the area or residence
L = Underwent Hysterectomy
M= Underwent Bilateral Salpingo-oophorectomy
A - Mother has a menstruation or not amenorrheic within 6 mos. or

B - No longer practicing fully/exclusively breastfeeding or
D = Fear of side effects

E = Changed Clinic
I = Failed to get supply

J = IUD expelled
N = No FP Commodity
O = Unknown
P = Age out for BTL
C - Baby is more than six (6) months old
27
FHSIS DIC 201201
2.8 Target Client List for Nutrition and Expanded Program for Immunization Part I
The Target Client List for Nutrition and Expanded Program for Immunization should include all children under
one year old eligible for immunization against the most common vaccine-preventable disease that results to
permanent disability or death among infants and the under-five children, iron supplementation, newborn
screening and breastfeeding. An entry should be made on this list when a delivery is made by pregnant
women on the TCL-PN. Also, include list of eligible newborns and infants from the local birth registration
office and from births that occurred within the community including transferees to have a complete list of
expected number of children.
The updated recording of this list is the responsibility of the midwife in the BHS and the nurse/midwife in the
RHU. A trained BHW or volunteer can also be given the responsibility of recording provided they are under
the supervision of the nurse/midwife.
Column 1
DATE OF REGISTRATION Write in this column the month, day and year an infant was
seen at the clinic or at home for health services.
Column 2
DATE OF BIRTH Write in this column the month, day and year of birth. This column is
important for immunization schedule.
Column 3
FAMILY SERIAL NUMBER Indicate in this column the number that corresponds to the
number of the family folder or envelope or individual treatment record. This column will help
you facilitate retrieval of the clients record.
Column 4
NHTS Write the symbol (*) to indicate that the infant is from the NHTS list provided by the
DSWD
Column 5
NAME OF CHILD Write the complete name of the child.
Column 6
SEX Write the sex of infant; M for male and F for female.
Column 7
COMPLETE NAME OF MOTHER Write in this column the name of the mother (Family
Name, First Name, and Middle Initial)
Column 8
COMPLETE ADDRESS Record the clients permanent place of residence. This column
will help you to monitor or follow-up the client.
Column 9
DATE OF NEWBORN SCREENING This is divided into two sub-columns. The first subcolumn refers to those given with referral only and on the second sub-column refers to
newborn screening done in the health center. Write the date only.
Column 10
CHILD PROTECTED AT BIRTH (CPAB) Write the Tetanus Toxoid Status of the mother in
the sub-column TT STATUS - TT1, TT2, TT3, TT4, TT5 or Fully immunized mother (FIM)
and if the mother received TT2 only, write the month and year TT2 was given. Write the
month and year the child was classified as CPAB.
Column 11
DATE IMMUNIZATION RECEIVED Indicate in these columns the exact date the child
received each antigen or vaccine.
27
FHSIS DIC 201201
Routine Immunization Schedule for Infants

Vaccine
Age
No. of
Doses
1
BCG
Birth or
Anytime after birth
PENTA1
PENTA2
PENTA3
6 weeks
10 weeks
14 weeks
OPV1
OPV2
OPV3
Hepa B Birth Dose
6 weeks
10 weeks
14 weeks
Birth (w/in 24 hrs)
Measles
9 months
MMR
12 months
ROTA1
ROTA2
6-15 weeks
10-32 weeks
Note:
Reason
BCG is given at the earliest
possible age protects against
the possibility of infection
from other family member
An early start with Pentavalent vaccine
reduces the chance of
severe pertussis, diphtheria,
tetanus, Hepa B and H Influenza
Type B (HIB)
The extent of protection
against polio is increased
the earlier the OPV is given
Reduces the chance of being
infected and becoming a
carrier of Hepatitis B infection
At least 85% of measles can
be prevented by
immunization at this age
Hepa B Birth Dose Write the date and time Hepa B vaccination was given
Rotavirus Vaccine Write the date vaccination was given. In case the child is under immunized or
missed a dose, write not given
Column 12
DATE FULLY IMMUNIZED Write the exact date the child was given the last dose of the
scheduled immunization which makes the child a fully immunized child.
Note:
A Fully Immunized Child (FIC) is a child that has received all of the following:
a.
One dose of BCG at birth or anytime before reaching 12 months
b.
3 dose each of Pentavalent, OPV and Hepa B as long as the 3rd dose is given before the
child reaches 12 months of age.
c.
One dose of anti-measles vaccine before reaching 12 months
Note:
If the infant was given the vaccine in other health facilities, ask for the immunization card and write
the date and name of the facility the infant was given the specific dose of the vaccine.
Column 13
CHILD WAS EXCLUSIVELY BREASTFED This column is divided into 6 sub-columns. For
sub-columns 1st to 5th month, put a check if the child was exclusively breastfed while for
sub-column 6th month, write the date if the child was exclusively breastfed.
Column 14
COMPLEMENTARY FEEDING This column is divided into 2 sub-columns. Place a check

if the child was given complementary food at 7th and 8th month.
Column 15
REMARKS Write the reasons why a child failed to return for the
next immunization schedule or why a child reaching 1 year of age was not fully immunized,
to include illnesses, hospitalization, and other data of importance to the child.
28
FHSIS DIC 201201
2.9 Target Client List for Nutrition and Expanded Program for Immunization Part II
Column 1
DATE OF REGISTRATION Write in this column the month, day and year an infant was
seen at the clinic or at home for health services.
Column 2
DATE OF BIRTH Write in this column the month, day and year of birth. This column is
important for immunization schedule.
Column 3
Column 4
Column 5
SEX Write the sex of infant; M for male and F for female.
Column 6
COMPLETE NAME OF MOTHER Write in this column the name of the mother (Family
Name, First Name, Middle Initial)
Column 7
will help you monitor or follow-up the client.
Column 8
MICRONUTRIENT SUPPLEMENTATION This column consists of 3 sub-columns. For

Vitamin A Supplementation column, write the age in months and the date Vitamin A was
received by the infant, and on the Iron column, write the birth weight and date iron was
received by the infant, and on the MNP column write the date MNP was received by the
infant.
Note:
Vitamin A received means 1 dose of 100,000 I.U. (one capsule) is given anytime during the 6-11
months. Iron completely received means dosage is 0.3 ml once a day to start at two months of age
until 6 months when complementary foods are given. (Preparation is 15 mg. elemental iron/0.6 ml)
MNP received means 60 sachets is given anytime during 6-11 months and 120 sachets is given
anytime during 12-23 months children.
Micronutrient Supplementation Schedule for Infants
Micronutrient
Vitamin A Capsule
(100,000 I.U.)
Iron
Micronutrient
Powder - Vitamix
Age
6 11 months
No. of Dose
1 dose
Reason
12- 59 months
6 - 11 months
1 capsule every 6 mos.

15 mg. elemental iron
/0-6 ml once a day for
3 months
6 11 months
60 sachets over a period o 60 sachets are adequate to rapidly

6 months
improve hemoglobin concentration
and iron stores in a large proportion
=10 sachets/ months
of infants.
VAC is given starting 6 months to reduce

child mortality. It also
reduces the severity of the disease
=30 sachets/ quarter

=60 sachets/ 6 months
Column 9
DEWORMING Put a check if the child was given de-worming tablet.
29
FHSIS DIC 201201
2.10 Target Client List for Sick Children

The Target Client List for Sick Children should include all children under 6 years of age (1) who are
sick with Measles, Severe Pneumonia, persistent Diarrhea, Malnutrition, Xerophthalmia, Night Blindness,
Bitots spots, Corneal Xerosis, Corneal Ulcerations and Keratomalacia and are eligible for Vitamin A
supplementation (2) Anemic children who are eligible for Iron; (3) Children with Diarrhea and (4) Children
with Pneumonia.
The updated recording of this list is the responsibility of the midwife in the BHS and the
nurse/midwife in the RHU. A trained BHW or volunteer can also be given the responsibility of recording
provided they are under the supervision of the nurse/midwife.
Column 1
DATE OF REGISTRATION Indicate in this column the date (month, day and year) the
child was identified to be sick.
Column 2
Column 3
Column 4
DATE OF BIRTH Write in this column the month, day and year of birth.
Column 5
SEX Write the sex of infant. M for male and F for female.
Column 6
help you monitor or follow-up the client.
Column 7
VITAMIN A On the first sub-column, put a check in the column that corresponds to the
following age-group: 6-11 and 12-59 months. For the second sub-column, write the
corresponding code for the diagnosis/findings and on the last column write the date Vitamin
A was given. Use the following codes for diagnosis/findings:
Code
Diagnosis/Findings
Measles
Severe Pneumonia
Persistent Diarrhea
Severely Underweight
Xerophthalmia
Definition
History of fever (38C or more) or hot to
touch; and
generalized non-vesicular rash of 3
or more days duration and
at least one of the following: cough,
coryza or conjunctivitis
Presence of any general danger sign or chest
indrawing or stridor in calm child
An episode of soft to watery stools lasting more
than 14 days
Children whose weight are classified as very
much lower than normal for his/her age. Has less
than 3 standard deviation.
Used to include all signs and symptoms affecting
the eye that can be attributed to Vitamin A
deficiency. It Includes ocular manifestation of
VAD
like
nightblindness,
conjunctival
xerosis,bitots spots, corneal xerosis, corneal
ulcer/keratomalacia and corneal scar.
30
FHSIS DIC 201201
Is a principal clinical sign of VAD. It is

characterized by changes in the conjunctiva,
which is the membrane that covers the white
area of the eye, leading to Bitots spots.
Night Blindness
Bitots spots
Corneal Xerosis
Corneal Ulcer
Keratomalacia
Corneal Scar
When the severity of VAD increases, this may be

followed by changes in the cells of the cornea,
which is the part of the eye that covers the iris
and the pupil, and will result in corneal, which is
the part of the eye that covers the iris and the
pupil; and will result in corneal ulcer and
blindness.
Described as having difficulty in seeing in the
dark, gropes and bumps in furniture and other
objects along the way, asks questions at dusk
like: It is already dark? Where is the door? Some
local names for night blindness are matangmanok, kurap, harapon, halap.
These are foamy, soapy, whitish patches seen on
the white part of eye/ sclera conjunctiva).
Frequently associated with nighblindness. It can
be removed but may re-accumulate later. These
patches are caused by the shedding of dead
epithelial cells. It may not disappear completely
after high doses of Vit. A capsule treatment
especially in older children and adults.
Cornea is cloudy and dry with an orange-peel
appearance. Some people call this fish scale
over the years. Childs vision is diminished even
at daytime
Cornea becomes soft, bulges with large
perforation or holes in the surface. Children with
prolonged diarrhea and measles frequently
develop this stage. Cornea looks dull and has a
small crater
Cornea is soft and no longer flat. It may budge
because of its excessive softness. The cornea is
in danger of rupturing.
Cornea has a whitish/ grayish discoloration. This
is due to the healed ulcer or previous VAD.
31
TARGET CLIENT LIST FOR

NUTRITION AND EXPANDED
PROGRAM FOR IMMUNIZATION
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
FHSIS v. 2012
TCL - N/EPI
TARGET CLIENT LIST FOR NUTRITION AND EPI PROGRAM PART I
DATE OF
DATE
FAMILY
REGISTRA- OF BIRTH SERIAL
TION
(mm/dd/yy) NUMBER
(mm/dd/yy)
(1)
(2)
(3)
NHTS*
Y/N
NAME OF CHILD
SEX
COMPLETE NAME
OF MOTHER
COMPLETE ADDRESS
(4)
(5)
(6)
(7)
(8)
NHTS* - to indicate that the infant belongs to the

CCT/NHTS families listed by DSWD.
Child Protected at Birth (CPAB)** -
DATE
NEWBORN
SCREENING
(9)
REFERRAL DONE
**CHILD PROTECTED
AT BIRTH (CPAB)
(10)
TT
DATE
STATUS ASSESS
refers to a child whose (1) Mother has received 2 doses of TT during this
pregnancy, provided TT2 was given at least amonth prior to delivery, or
(2) Mother has received at least 3 doses of TT anytime prior to pregnancy
with this child.
Date Assess - refers to the month and year the child was classified as CPAB based on the definition
39
TARGET CLIENT LIST FOR NUTRITION AND EPI PROGRAM PART I

DATE IMMUNIZATION RECEIVED
(11)
HEPA B1
BCG
w/in
More than
24 HRS
24 HRS
***FULLY IMMUNIZED CHILD =
PCV
PENTA
OPV
1
DATE
ROTA VIRUS
VACCINE
FULLY
MCV
IMMUNIZED
MCV1 MCV2
(FIC) ***
(AMV) (MMR)
(12)
CHILD WAS EXCLUSIVELY BREASTFED***
COMPLEMENTARY FEEDING
REMARKS
(13)
(14)
(15)
Put a () check
3
Put a
Put a () check
1st
2nd
3rd
4th
5th
Date
7th
8th
MO
MO
MO
MO
MO
6th mo.
MO
MO
**** Exclusively breastfed - means no other food (including

water) other than breastmilk. Drops of vitamins and
prescribed medication given while breastfeeding is
still "exclusively breastfed".
An infant who received 1 dose of BCG, 3 doses each of

OPV, 3 doses each of Pentavalent vaccines and 1 dose
of Measles-containing vaccine before reaching one year
old.
39
FHSIS v. 2012
TARGET CLIENT LIST FOR NUTRITION AND EPI PROGRAM PART II

DATE OF
DATE
FAMILY
REGISTRA- OF BIRTH SERIAL
TION
(mm/dd/yy) NUMBER
(mm/dd/yy)
(1)
(2)
(3)
MICRONUTRIENT SUPPLEMENTATION
NAME OF CHILD
(4)
SEX
(5)
COMPLETE NAME
OF MOTHER
COMPLETE ADDRESS
(6)
(7)
(8)
VITAMIN A
12-59 mos.
6-11
MOS. Dose 1 Dose 2
IRON
MNP
2-5 6-11 12-23 24-35 36-47 48-59 6-11 12-23
MOS. MOS. MOS. MOS. MOS. MOS. MOS. MOS.
DEWORMING
(9)
Put a () check
12-59
MOS.
FHSIS DIC 201201

Schedule of High Dose of Vitamin A for High Risk Children
Diagnosis
Preparation per
capsule
Vit. A Dosage & Schedule of

Administration
Measles
100,000 IU for infants

6-11 months old
200,000 IU for children
12-59 mos. old
Give one capsule upon diagnosis

regardless of when the last dose
of vitamin A capsule (VAC) was
given. Give another capsule after
24 hrs.
Severe pneumonia,
persistent diarrhea or
severely underweight

6-11 months old
12-59 mos. old
Give one capsule upon

diagnosis, except when the child
was given VAC less than 4 weeks
before diagnosis
Cases with
Xerophthalmia,including
night blindness, Bitots
spots, corneal xerosis,
corneal ulcerations,
and keratomalacia

6-11 mos old
12-59 mos. old
Give one capsule Immediately

upon diagnosis. Give one
capsule the next day, and another
1 capsule 2 weeks after.
COLUMN 8
ANEMIC CHILDREN GIVEN IRON SUPPLEMENTATION On the first column, write

the age in months of the sick children followed by the date started iron and date
completed.
COLUMN 9
DIARRHEA CASES Write the age in months of the sick children followed by the dates
ORT, ORS and ORS with zinc was given.
COLUMN 10
PNEUMONIA CASES Write the age in months of the sick children followed by the
date antibiotic treatment was given.
COLUMN 11
REMARKS Write other data of importance to child care.
32
TARGET CLIENT LIST FOR
SICK CHILDREN
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
FHSIS v. 2012
TCL- SICK
DATE OF
REGISTRATION
mm/dd/yy
(1)
2.10 TARGET CLIENT LIST FOR SICK CHILDREN
FAMILY
SERIAL
NUMBER
NAME OF CHILD
DATE
OF BIRTH
(mm/dd/yy)
SEX
COMPLETE ADDRESS
(2)
(3)
(4)
(5)
(6)
* Diagnosis/Findings :
A = Measles
B = Severe Pneumonia
C = Persistent Diarrhea
D = Malnutrition
E = Xerophthalmia
F = Night Blindness
G = Bitot's spots
H = Corneal Xerosis
I = Corneal Ulcerations
J = Keratomalacia
** Recommended Vitamin A Supplementation Given to High Risk/Sick Children

DIAGNOSIS
PREPARATION PER CAPSULE
Measles cases
100,000 IU for infants 6-11 months old
Severe pneumonia, persistent diarrhea

and severely underweight
Cases with Xerophthalmia,incldg night
blindness, Bitot's spots, corneal xerosis,
200,000 IU for children 12-59 months old

200,000 IU for children 12-59 months old
corneal ulcerations and keratomalacia
35
VITAMIN A SUPPLEMENTATION
(7)
Put a () check
DATE
DIAGNOSIS/
GIVEN**
6-11
12-59
FINDINGS*
MOS.
MOS.
(use code)
VIT. A DOSAGE AND SCHEDULE OF ADMINISTRATION

Give one capsule upon diagnosis regardless of when the
last dose of vitamin A capsule (VAC) was given.
Give another capsule after 24 hours
Give one capsule upon diagnosis, except when the child
was given VAC less than 4 weeks before diagnosis
Give one capsule immediately upon diagnosis. Give one
capsule the next day, and 1 capsule 2 weeks after.
TARGET CLIENT LIST FOR SICK CHILDREN

ANEMIC CHILDREN GIVEN
IRON SUPPLEMENTATION*** (6- 59 months)
(8)
DATE
AGE IN MONTHS
6-11 mos
12-59 mos
STARTED
COMPLETED
AGE IN
MONTHS
DIARRHEA CASES
(9)
DATE GIVEN
ORS
ORS/ORT
ZINC
W/
PNEUMONIA CASES
SEEN
(10)
AGE IN
DATE GIVEN
MONTHS
TREATMENT
REMARKS
(11)
* ** Iron Supplementation : Dosage is 1 tsp once a day for 3 months or

30 mg once a week for 6 months with supervised administration
DIAGNOSIS
PREPARATION
DOSAGE AND SCHEDULE OF ADMMINISTRATION
low birth weight infants (<2.5kg)
drops 15 mg elemental iron/0.6 ml
give 0.3 ml once a day starting at 2 mos up to 6 mos
6-11 mos old clinically diagnosed with Iron Deficiency Anemia (IDA)
drops 15 mg elemental iron/0.6 ml
give 3-6 mg/Kg/day elemental Iron in 3 divided doses a day for 3 mos
12-23 mos clinically diagnosed with Iron Deficiency Anemia (IDA)
syrup 30 mg elemental Iron/5ml
give approximately 5ml 2-3 times a day for 3 mos. If available, continue
MNP supplementation after 3 mos
12-59 mos clinically diagnosed with Iron Deficiency Anemia (IDA)
syrup 30 mg elemental Iron/5ml
give approximately 5ml 2-3 times a day for 3 mos. If available, continue
MNP supplementation after 3 mos. Assess children after 3 mos for
further management
35
note: after completing 3 mos therapeutic

supplementation infants should continue
preventive supplementation regimen
or
: give approximately 0.6ml 2-3 times a day for 3
mos
FHSIS DIC 201201

2.11 SUMMARY TABLES:
The Summary Tables are intended to record data in the facility to facilitate the capture and
recall of data.
2.11.1 Summary Table Health Program Accomplishments
The Summary Table Health Program Accomplishments is a health facility-based document
which records the performance of the barangay per month for one year, is filled up by the midwife,
and is her source of data for the Monthly Form. The table has provision for quarterly totals which
should be equivalent to the quarterly total of the PHN in her Consolidation Table. The quarterly totals
are also provided in this Summary Table so that the midwife can already make preliminary analysis of
her performance using these data.
Filling up the table
The first column lists exhaustively the indicators of your health service delivery in the barangay.
The next column is the Target column where you will place, at the start of the year, the targets of your
barangay for each Indicator. Please consult your PHN for the figure you will enter in this column.
Under each succeeding monthly columns, record the number being asked that corresponds to each
indicator for the month. Under each quarter, write the totals required.
2.11.2 Summary Table - Morbidity Report

The Summary Table Morbidity Report records all the diseases that occur for the entire year.
The diseases are recorded on a monthly basis disaggregated by age group and sex. This Summary
Table shall also be the source of data for the Annual Report 2 Morbidity Report.
Filling up the table
On the Summary Table Monthly Morbidity, write on the space provided the month, the name
of disease and the number of cases per disease disaggregated by age group and sex.
2.12 MONTHLY CONSOLIDATION TABLE:

Monthly Consolidation Table - is a health facility-based document in which the PHN records the
report of the midwives in the municipality. At the end of every quarter, the PHN gets the totals of the
different indicators to fill-up the Quarterly form for submission to the PHO.
The month and year which corresponds to the Monthly Report of each Barangay. The first
column lists the indicators/diseases in the Monthly Form. On the succeeding column, write the name of
each BHS on top and the corresponding monthly data of each BHS.
40
Summary Table
for
BARANGAY
NAME OF BARANGAY:
NAME OF HEALTH CENTER:
MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
2.13.1 MATERNAL CARE - PRENATAL and POSTPARTUM CARE

INDICATORS
TARGET
JAN
FEB
MAR
1st Q
APR
MAY JUNE 2nd Q JULY AUG SEPT 3rd Q
PRENATAL CARE
1. Pregnant women with 4 or

more prenatal visits
2. Pregnant women given
2 doses of TT
TT2 plus
complete iron with folic acid
5. Pregnant given Vit. A
POSTPARTUM CARE
1. Postpartum women with

at least 2 PPV
2. Postpartum women
given complete iron
3. 10-49 years old women given
Iron supplementation
4. Postpartum women
given Vitamin A
5. Postapartum women
initiated breastfeeding
STI SURVEILLANCE
1. No. of pregnant women seen

2. No. of pregnant women
tested for syphilis
positive for syphilis
4. No. of pregnant women (+)
for syphilis given Penicillin
51
OCT
NOV DEC
4th Q
TOTAL
2.13.2 FAMILY PLANNING

INDICATORS
TARGET
(Part 1 of 2)
JAN
FEB
MAR
1st Q
APR
MAY JUNE 2nd Q
1. Total New Acceptors

Female Sterilization
Male Sterilization
Pills
IUD
Injectables (DMPA/CIC)
NFP-CM
NFP-BBT
NFP-LAM
NFP-SDM
NFP-STM
Condom
Implant
2. Total Other Acceptors
Male Sterilization
Pills
IUD
NFP-CM
NFP-BBT
NFP-LAM
NFP-SDM
NFP-STM
Condom
Implant
38
JULY AUG SEPT 3rd Q
OCT
NOV
DEC
4th Q
TOTAL
2.14.3 FAMILY PLANNING

INDICATORS
TARGET
(Part 2 of 2)
JAN
FEB
MAR
1st Q
APR
MAY JUNE 2nd Q
3. Total Drop-out
Male Sterilization
Pills
IUD
NFP-CM
NFP-BBT
NFP-LAM
NFP-SDM
NFP-STM
Condom
Implant
4. Total Current Users
Male Sterilization
Pills
IUD
NFP-CM
NFP-BBT
NFP-LAM
NFP-SDM
NFP-STM
Condom
Implant
62
JULY AUG SEPT 3rd Q
OCT
NOV
DEC
4th Q
TOTAL
2.13.4 CHILD CARE
(Part 1 of 3)
JAN
M
1. Immunization given
FEB
MAR
1st Q
APR
MAY
<1 yr
BCG
Hepa B1
w/in 24 hrs
> 24 hrs
1
PENTA
2
3
1
OPV
2
3
MCV
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
INDICATORS
MCV1 (AMV)
MCV2 (MMR)
1
ROTA
2
3
1
PCV
2
3
2. Fully Immunized Child

3. Completely Immunized
Child (12-23 mos)
4. Child Protected at Birth (CPAB)
59
2.13.5 CHILD CARE (Part 2 of 3)

JAN
INDICATORS
FEB
MAR
1st Q
APR
JUN
MAY
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ TOTAL
TARGET
5. Infant age 6 mo. seen

6. Infant exclusively
breastfed until 6 mo.
7. Infants 6-8 months of age who
received solid, semi-solid and
soft food during previous day
8. Infant for newborn screening
referred
done
9. Infant/Children received Vit. A
6-11 mos.
12-23 mos.
24-35 mos.
36-47 mos.
48-59 mos.
10. Infant/Children received Iron
2-5 mos.
6-11 mos.
12-23 mos.
24-35 mos.
36-47 mos.
48-59 mos.
11. Infant/Children received MNP
6-11 mos.
12-23 mos.
12. Sick Children seen
6-11 mos.
12-59 mos.
13. Sick Children received Vit A
6-11 mos.
12-59 mos.
58

JAN
INDICATORS
FEB
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
14. Children 12-59 mos. old

given de-worming tablet/syrup
15. Infant 2-6 mos. w/ LBW seen
received full dose Iron
16. Anemic infant
6-11 mos seen
Anemic children
12-59 mos seen
17. Diarrhea (0-59 mos. old)
No. of Cases
received ORS
received ORT/ORS w/zinc
18. Pneumonia (0-59 mos. old)
No. of Cases
No with Completed Treatment
57
2.13.7 DENTAL HEALTH

JAN
INDICATORS
FEB
MAR
1st Q
APR
JUN
MAY
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
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 yrs old & above
provided w/BOHC
56
2.13.8 MALARIA
JAN
MAR
FEB
APR
1st Q
JUN
MAY
JUL
2nd Q
SEPT
AUG
OCT
3rdQ
DEC
NOV
4thQ
TOTAL
INDICATORS
M
1.Total Population
2. Population at risk
3.Annual Parasite
Incidence
4. Total No. of
Confirmed Malaria
Cases
< 5 yo
5 yo
Pregnant
5. Total No of Lab
Confirmed Malaria
Cases by species
P.falciparum
P. vivax
P.ovale
P.malariae
6. Total No of
Confirmed Malaria
Cases by method
Slide
RDT
7. Total No. of LLIN
given
8. Total No. of
Malaria Deaths
45
2.13.9 TUBERCULOSIS
1st Q
2nd Q
3rdQ
4thQ
TOTAL
INDICATORS
M
1. TB symptomatics who
underwent DSSM
2. Smear positive
discovered and identified
3. New smear positive
cases initiated tx and
registered
4. New smear (+) cases
cured
5. Smear(+) retreatment
cases cured
6. Smear (+) retreatment
cases initiated tx and
registered
Relapse
Treatment failure
Return after default
Other type of TB
7. No, of Smear (+)
retreatment cured
Relapse
Treatment failure
8.. Total No. of TB cases
(all forms) initiated tx
47
2.13.10 FILARIASIS
JAN
MAR
FEB
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
INDICATORS
M
M F
T M F
T M F
Total Population
1.No. Cases with

hydrocele, lymphedema,
Elephantiasis, Chyluria
2. Clinical Rate
3. No of Cases examined
found Positive for MF
5. Average MFD
6. Eligible population given
MDA (94.6% of TP)
7. Total population given
MDA
43
T M F
T M F
T M F
T M F
T M F
2.13.11 LEPROSY
JAN
MAR
FEB
APR
1st Q
MAY
JUN
JUL
2nd Q
AUG
SEPT
OCT
3rdQ
NOV
DEC
4thQ
TOTAL
INDICATORS
M
M F
T M F
T M F
1. Total Population
2. Total No. of Leprosy

cases (undergoing TXT)
3. No. of Newly detected
Leprosy cases
< 15 yo
Grade 2 disability
4. No of Leprosy Cases
cured
46
T M F
T M F
T M F
T M F
T M F
2.13.12 SCHISTOSOMIASIS
JAN
MAR
FEB
APR
1st Q
MAY
JUN
JUL
2nd Q
AUG
SEPT
OCT
3rdQ
NOV
DEC
4thQ
TOTAL
INDICATORS
M
M F
T M F
T M F
1. No. of
Symptomatic case
2. No. of Cases
Examined
3. No. of Positive
Cases
Low intensity
Medium intensity
High intensity
4. No. of Cases
treated
5. No of Complicated
Cases
6. No. of Complicated
Cases referred to
hospital facility
44
T M F
T M F
T M F
T M F
T M F
2.13.13 MORBIDITY DISEASE REPORT FOR MONTH: ____________

BY AGE-GROUP AND BY SEX
NAME
OF
ICD Code
DISEASE
Under 1
M
Acute Watery Diarrhea
A09 (watery)
Acute Bloody Diarrhea
A09 (bloody)
Inluenza-like Illness
J11
Influenza
J11
Acute Flaccid Paralysis
G83.9
Acute Hemorrhagic Fever Syndrome (Dengue)
A91
Acute Lower Respiratory Track Infection
J22
Pneumonia
J18.9
Cholera
A00
Diphtheria
A36
Filarisis
B74
Leprosy
A30
Leptospirosis
A27
Malaria
B50-B54
Measles
B05
Meningococcemia
A39
Neonatal Tetanus
A33
Non-neonatal Tetanus
A35
Paralytic Shellfish Poinosning
T61.2
Rabies
A82
Schistosomiasis
B65
Typhoid and paratyphoid
A01
Viral Encephalitis
A83-86
Acute Viral Hepatitis
B15-B17
Viral Meningitis
A87
Syphilis
A50-A53
Gonorrhea
A54.9
Urethral Discharge
R36
Genital Ulcer
N48.5, N76.5, N76.6
1-4
M
5-9
F
10-14
F
15-19
M
20-24
M
25-29
61
30-34
M
35-39
M
40-44
M
45-49
M
50-54
M
55-59
M
60-64
M
65-69
M
70 & over
TOTAL
M
2.13.14 MORBIDITY DISEASE REPORT FOR MONTH: ____________

NAME
OF
DISEASE
Under 1
M
1-4
M
5-9
F
10-14
F
15-19
M
20-24
M
25-29
M
30-34
M
60
35-39
M
40-44
M
45-49
M
50-54
M
55-59
M
60-64
M
65-69
M
70 & over
TOTAL
M
2.13.15 NATALITY (from TCL)

JAN
INDICATORS
FEB
(Part 1 of 2)
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
1. Livebirths (Total from

TCL)
2. Birthweight:
2500 grms &
greater
Less than
2500 grams
Not known
3. Attended by:
Doctors
Nurses
Midwives
Trained Hilot
Others
Unknown
55
2.13.16 NATALITY (from TCL) (Part 2 of 2)

JAN
INDICATORS
FEB
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
Total No. of
Deliveries
by Place
Health Facility
RHUs
Hospitals
BHS
lying-in
NID
Home
Others
by Type
Normal
Others
Total Number of
Pregnancy
by Outcome
Livebirth
Fetal Death
Abortion
53
2.13.17 NATALITY (from LCR)

JAN
INDICATORS
FEB
(Part 1 of 2)
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
1. Livebirths (Total from

TCL)
2. Birthweight:
2500 grms &
greater
Less than
2500 grams
Not known
3. Attended by:
Doctors
Nurses
Midwives
Trained Hilot
Others
Unknown
54
2.13.18 NATALITY (from LCR)

JAN
INDICATORS
FEB
(Part 2 of 2)
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
4. Normal Delivery
Home
Hospital
Others
5. Other Type Delivery
Home
Hospital
Others
52
2.13.19 ENVIRONMENTAL HEALTH

INDICATORS
TARGET JAN FEB MAR 1st Q APR MAY JUNE 2nd Q JULY AUG SEPT 3rd Q OCT NOV DEC 4th Q
1. Households with access

to improved 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 certificates
9. Salt Samples Tested
10. Salt Samples Tested
found (+) for iodine
50
TOTAL
2.13.20 MORTALITY (From LCR or RHU log books)

JAN
INDICATORS
FEB
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
1. Total Deaths
2. Infant Deaths
3. Maternal Deaths
4. Neonatal Deaths
5. Deaths due to
neonatal tetanus
6. Pernatal Deaths
7. Deaths among
child under 5 yo
48
2.13.21 PROGRAM: ______________________________

JAN
ACTIVITIES
FEB
MAR
1st Q
APR
MAY
JUN
2nd Q
JUL
AUG
SEPT
3rdQ
OCT
NOV
DEC
4thQ
TOTAL
TARGET
49
Monthly Consolidation Table

for
HEALTH CENTER
NAME OF HEALTH CENTER:

MUNICIPALITY OF:
PROVINCE/CITY:
REGION:
2.14.1 MATERNAL CARE
Month:
N A M E
INDICATORS
1. Pregnant women
W/4 or more prenatal visits
Given 2 doses of TT
Given TT2plus
Given complete iron with
folic acid
Given Vitamin A
2. Postpartum women
With at least 2 PPV
Given complete iron
10-49 years old women
given Iron supplementation
Given Vitamin A
Initiated Breastfeeding

tested for SY
positive for SY
given Penicillin
75
___________ __ Year: ___________________

OF
B A R A N G A Y
Month:
N A M E
OF
_____________ Year: ___________________

B A R A N G A Y
Total
2.14.2 FAMILY PLANNING (Part 1 of 4)
Month:
N A M E
INDICATORS

Female Ster/BTL
Male Ster/Vasectomy
Pills
IUD
NFP-CM
NFP-BBT
NFP-STM
NFP-SDM
NFP-LAM
Condom
Implant
74
_____________ Year: ___________________

OF
B A R A N G A Y
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
Total
Month:
N A M E
INDICATORS

Female Ster/BTL
Male Ster/Vasectomy
Pills
IUD
NFP-CM
NFP-BBT
NFP-STM
NFP-SDM
NFP-LAM
Condom
Implant
_____________ Year: ___________________

OF
B A R A N G A Y
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
Total
Month:
N A M E
INDICATORS
3. Drop-out
Female Ster/BTL
Male Ster/Vasectomy
Pills
IUD
NFP-CM
NFP-BBT
NFP-STM
NFP-SDM
NFP-LAM
Condom
Implant
73
OF
_____________ Year: ___________________

B A R A N G A Y
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
Total
Month:
N A M E
INDICATORS
4. Total Current Users

Female Ster/BTL
Male Ster/Vasectomy
Pills
IUD
NFP-CM
NFP-BBT
NFP-STM
NFP-SDM
NFP-LAM
Condom
Implant
72
OF
_____________ Year: ___________________
B A R A N G A Y
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
Total
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
INDICATORS
M
1. Immunization given <1 yr:

BCG
Hepa B1
w/in 24 hrs
> 24 hrs
1
PENTA
2
3
1
OPV
2
3
MCV
MCV1 (AMV)
MCV2 (MMR)
1
ROTA
2
3
1
PCV
2
3
2. Fully Immunized Child

3. Completely Immunized Child (12-23 mos)
4. Child Protected at Birth (CPAB)
69
Month:
N A M E
OF
_____________ Year: ___________________
B A R A N G A Y
Total
Month:
N A M E
___________ __ Year: ___________________
OF
B A R A N G A Y
INDICATORS
M
5. Infant age 6 mos. Seen

6. Infant exclusively breastfed
until 6 months
7. Infants 6-8 months of age who
received solid, semi-solid and soft
food during previous day
8. Infant referred for
newborn screening
9. Infant/Children received Vit. A
6-11 mos.
12-23 mos.
24-35 mos.
36-47 mos.
48-59 mos.
10. Infant/Children received Iron
2-5 mos.
6-11 mos.
12-23 mos.
24-35 mos.
36-47 mos.
48-59 mos.
11. Infant/Children consumed MNP
6-11 mos.
12-23 mos.
12. Sick Children seen
6-11 mos.
12-59 mos.
13. Sick Children received Vit. A
6-11 mos.
12-59 mos.
68
Month:
N A M E
OF
_____________ Year: ___________________

B A R A N G A Y
Total
Month:
N A M E
_____________ Year: ___________________
OF
B A R A N G A Y
INDICATORS
M
14. Children 12-59 mos. old

given de-worming tablet
15. Infant 2-6 mos. w/ LBW seen
16. Anemic Children
6-11 mos seen
Anemic children
12-59 mos seen
17. Diarrhea (0-59 mos. old)
No. of Cases
received ORS
received ORS/ORT w/zinc
18. Pneumonia (0-59 mos. old)
No. of Cases
No with Completed Treatment
67
Month:
N A M E
OF
_____________ Year: ___________________

B A R A N G A Y
Total
2.14.8 LEPROSY
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
INDICATORS
M
1. Total Population
2. Total No. of Leprosy cases
(undergoing treatment)
Leprosy cases
< 15 yo
Grade 2 disability
4. No of Leprosy Cases cured
90
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
91
2.14.9 TUBERCULOSIS
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
INDICATORS
M
1. TB symptomatics who
underwent DSSM
2. Smear positive discovered
and identified
3. New smear positive cases
initiated tx and registered
4. New smear (+) cases cured
5. Smear(+) retreatment cases

cured
6. Smear (+) retreatment cases
initiated tx and registered
Relapse
Treatment failure
Other type of TB
7. No, of Smear (+)
retreatment cured
Relapse
Treatment failure
8.. Total No. of TB cases (all
forms) initiated treatment
9. TB All forms identified
10. Case Detection Rate
88
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
89
2.14.10 MALARIA
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
INDICATORS
M
1.Total Population
2. Population at risk
3.Annual Parasite Incidence
4. Total No. of Confirmed

Malaria Cases
< 5 yo
5 yo
5. Total No. of Confirmed
Malaria Cases
Pregnant
6. Total No of Lab Confirmed
Malaria Cases by species
P.falciparum
P. vivax
P.ovale
P.malariae
7. Total No of Confirmed
Malaria Cases by method
Slide
RDT
8. Total No. of LLIN given
9. Total No. of Malaria Deaths
86
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
2.14.11 FILARIASIS
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
INDICATORS
M
1.No. Cases with hydrocele,

lymphedema, Elephantiasis,
Chyluria
2. Clinical Rate
3. No of Case examined
found Positive for MF
5. Average MFD
6. Eligible population given
MDA (94.6% of TP)
7. Total population given MDA
84
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
85
2.14.12 SCHISTOSOMIASIS
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
INDICATORS
M
1. No. of Symptomatic case

2. No. of Cases Examined
3. No. of Positive Cases
Low intensity
Medium intensity
High intensity
4. No. of Cases treated
5. No of Complicated Cases
6. No. of Complicated Cases
referred
82
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
83
2.14.13 DISEASE: ________________________________ Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
AGE GROUP
M
Under 1 year
1-4
5 -9
10 - 14
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 - 64
65 - 69
70 and 0ver
TOTAL
81
Month:___________________________ Year: ___________________

N A M E
OF
B A R A N G A Y
Total
83
2.14.14 PROGRAM: __________________________________

N A M E
OF
B A R A N G A Y
ACTIVITIES
M
80
N A M E
OF
B A R A N G A Y
FHSIS DIC 201201
2.15THEMONTHLYFORMFORPROGRAMREPORT(M1):
TheMonthlyFormisthereportingformthatthemidwifefillsuptoreportheraccomplishments
from the first day to the last day of the month and submits to the nurse at the RHU/MHC for
consolidation.Spacesareleftblankforthoseindicatorsthemunicipality/cityneedstogenerateattheir
level.
HeadingFillupthedataaskedforintheheading:theMonthbeingreportedandtheYear,thenameof
the Barangay, Name of BHS, the Municipality or City, Province and the Projected Population of the
Barangay(exceptduringNationalCensusyears).
2.15.1MaternalCare
Deliverieswriteonthespaceprovidedthetotalnumberofdeliveries
Pregnant women with 4 or more prenatal visits write on the space provided the total number of
pregnantwomenwhohad4ormoreprenatalvisitsduringthemonth/quartersuchthatatleast
onevisitoccursduringthefirsttrimester,oneduringthesecondtrimesterandatleast2visits
duringthethirdtrimester.
Pregnantwomengiven2dosesofTetanusToxoidwriteonthespaceprovidedthetotalnumberof
pregnantwomengiven2dosesofTetanusToxoidduringthemonth/quarter.
PregnantwomengivenTT2pluswriteonthespaceprovidedthetotalnumberofpregnantwomen
givenTT2plusduringthemonth/quarter.TT2plusincludes2nd,3rd,4thand5thdosesofTetanus
Toxoidgiventopregnantwomen.
Pregnantwomengivencompleteironwithfolicacidsupplementationwriteonthespaceprovided
thetotalnumberofpregnantwomengivencompletetabletof60mgofFewith400mcgFolic
acid,onceadayfor6monthsor180tablets.Theirontabletsreferredto,arethosegivenfor
freetothemotherbytheRHUsandBHSsanddonotincludeprescribedirontablets.Irontablet
shouldbegivenassoonaspregnancywasdiagnosed.Ifthepregnantwomendidnottakefull
courseofthe180tablets,shewillnotbeincludedinthereport.
Postpartumwomenwithatleast2postpartumvisitswriteonthespaceprovidedthetotalnumber
ofpostpartumwomenwhowereseenbythemidwife/PHN/MHOathomeorattheclinictwice
ormorethantwiceafterdeliverysuchthatfirstvisitshouldbewithin24hoursupondelivery
andthesecondvisitwithinoneweekafterdelivery.
Post partum women given completeiron supplementation writeon the spaceprovided the total
numberofpostpartumwomengivencompletetabletof60mcgofFewith400mcgFolicacid,
onceadayfor3monthsoratotalof90tablets.Ifpostpartummotherdidnottakefullcourseof
90tablets,shewillnotbeincludedinthereport.
1049yearsoldwomengivenIronsupplementationwriteonthespaceprovidedthetotalnumberof
womengivenIronsupplementation
PostpartumwomengivenVitaminAsupplementationwriteonthespaceprovidedthetotalnumber
ofpostpartumorlactatingwomengiven200,000I.U.ofVitaminAcapsulewithin4weeksafter
delivery
Post partum women initiated breastfeeding within 1 hour after delivery write on the space
provided the total number of postpartum or lactating women who initiated breastfeeding
within1houraftergivingbirth.
92
FHSIS DIC 201201
2.15.2STISurveillance
Numberofpregnantwomenwriteonthespaceprovidedthetotalnumberofpregnantwomenseen
inthehealthcenter.
NumberofpregnantwomentestedforSyphilis(SY)writeonthespaceprovidedthetotalnumberof
pregnantwomentestedforSyphilis.
NumberofpregnantwomenpositiveforSyphiliswriteonthespaceprovidedthetotalnumberof
pregnantwomentestedpositiveforSyphilis.
Number of pregnant women with Syphilis given Penicillin write on the space provided the total
numberofpregnantwomenwithSyphilisgivenPenicillin.
2.15.3FamilyPlanning
Current Users (Beginning Month) write on the space provided the total number of FP clients who
havebeencarriedoverfromthepreviousmonth
Acceptors
NewAcceptorsofpreviousmonthwriteonthespaceprovidedthenumberofnewacceptors
frompreviousmonth.
OtherAcceptorsofpresentmonthwriteonthespaceprovidedthenumberofclientswhoare
ChangedMethod,ChangedClinicandRestart.
Dropouts(presentmonth)writeonthespaceprovidedthenumberofclientswhodropoutduring
themonth.
Current Users (End Month) write on the space provided the total number of FP clients who have
beencarriedoverfromthepreviousmonthafterdeductingthedropoutsofthepresentmonth,
adding the new acceptors of the previous month and adding the other acceptors (RS,CC,CM).
This consists of CU for pills, IUD, injectables, condom, NFP (BBT, CM, STM, SDM and LAM),
femalesterilization,malesterilizationandimplants.
(Note:Inpreparingthemonthlyreportforthisportion,themidwifeintheBHS/Barangaywill
preparethemonthlydataonly.)Memotobepasted
CalculationsampleforMonthofFebruaryReport:
Currentusersfromthepreviousmonth
(Jan2012)
29
+NewAcceptorspreviousmonth
(Jan2012)
+6
+OtherAcceptorsofthepresentmonth
(Feb2012)
+4
Dropoutspresentmonth
(Feb2012)2
=CurrentUsersendingmonthofFeb2012
=37
*SeeAnnex1fortheCalculationoftheCurrentUsers
93
FHSIS DIC 201201

NewAcceptorsofthepresentmonthusingafamilyplanningmethodforthefirsttimeoraclient
whohasneveracceptedanymodernfamilyplanningmethodatanyclinicsbefore(newtothe
program). It includes new acceptors for pills, IUD, injectables, condom, NFP (BBT, CM, STM,
andSDM),LAM,implants,FemaleSTRandMaleSTR.
2.15.4ChildCare
Immunization by antigen (BCG, PENTA1to PENTA3, OPV1 toOPV3, Hepatitis birth dose within 24
hours after birth or after 24 hours after birth, ROTA1 to ROTA3, antiMeasles vaccine and
measlesmumpsrubella(MMR))writeonthespaceprovidedthetotalnumberofinfants011
monthswhoweregiventhespecificantigenduringthemonth/quarter.
FullyImmunizedChildwriteonthespaceprovidedthetotalnumberofchildren011monthsthat
havecompletedtheirimmunizationscheduleduringthemonth/quarter.Tobefullyimmunized,
thechildmusthavebeengivenBCG,3dosesofPENTA,3dosesofOPV,1doseofHepaBBirth
doseandonedoseofantimeaslesvaccinebeforereaching1yearofage.Thechildiscounted
as FIC as soon as all the required vaccines are administered without waiting for the child to
reach1yearofage.
CompletelyImmunizedChild(1223mos.)writeonthespaceprovidedthetotalnumberofchildren
1223 months of age who completed their immunization schedule during the month/quarter.
Tobecompletelyimmunized,thechildmusthavebeengivenBCG,3dosesofPENTA,3dosesof
OPV,1doseofHepaBBirthdose,onedoseeachofantimeaslesvaccineandMMR.
ChildProtectedatBirth(CPAB)writeonthespaceprovidedthetotalnumberofchildrenwhose(1)
Mother has received 2 doses of TT during this pregnancy, provided TT2 was given at least a
month prior to delivery, or (2) Mother has received at least 3 doses of TT anytime prior to
pregnancy with this child. If the mother received TT2 only for this child, write the month and
yearTT2wasgiven.
Infants 6 months of age seen write on the space provided the total number of infants seen at 6th
monthatthefacilityorduringhomevisit.
Infantsexclusivelybreastfeduntil6monthswriteonthespaceprovidedthetotalnumberofinfants
seentobeexclusivelybreastfedfrombirthupto6thmonths.Exclusivelybreastfeedingisgiving
no other food (including water) other than breast milk. Drops of vitamins and prescribed
medication(bydoctoronly)givenwhilebreastfeedingisstillexclusiveBF.
Infants given complimentary food 68 months write on the space provided the total number of
infantsgivencomplimentaryfoodfrom68monthsofage.
Infantreferredfornewbornscreeningwriteonthespaceprovidedthetotalnumberofinfantsgiven
referralfornewbornscreening.
Infant611monthsoldgivenVitaminAwriteonthespaceprovidedthetotalnumberofinfants611
monthsoldgivenVitaminASupplementation.VitaminAsupplementationrefersto1doseof
100,000I.U.Onecapsuleisgivenanytimeduringthe611months.
Children1223,2435,3647,and4859monthsoldgivenVitaminAwriteonthespaceprovidedthe
total number of children 1259 months old given Vitamin A Supplementation. Vitamin A
supplementationrefersto200,000I.U.Dosageanddurationis1capsuleeverysixmonths.
Infant25and611monthsoldgivenIronwriteonthespaceprovidedthetotalnumberofinfants
givenIronSupplement.
94
FHSIS DIC 201201

Children1223,2435,3647,and4859monthsoldgivenIronwriteonthespaceprovidedthetotal
numberofchildrengivenIronSupplement.
Infants611monthsoldreceivedMNPwriteonthespaceprovidedthenumberofinfantswhoseages
rangefrom6to59monthsreceivedMNP.60sachetsweregivenanytimeduring611months.
Children1223monthsoldreceivedMNPwriteonthespaceprovidedthenumberofchildrenwhose
agesrangefrom12to23monthsreceivedMNP.120sachetsweregivenanytimeduring1223
monthschildren
Children1259mos.oldgivendewormingtabletwriteonthespaceprovidedthenumberofchildren
whoseagesrangefrom12to59monthsreceiveddewormingtablet.
Sick Children 611 and 1259 months old seen write on the space provided the number of sick
children whose ages range from 6 to 11 months and 1259 months old seen during the
month/quarter. High Risk or Sick Children are those with the following categories: (1) severe
pneumonia (2) persistent diarrhea (3) measles (4) severely under weight and (5) Cases with
Xerophthalmia, including night blindness, Bitots spots, corneal xerosis, corneal ulcerations,
keratomalaciaandcornealscar.
Sick Children 611 months old given Vitamin A Write on the space provided the number of sick
children whose age range from 6 to 11 months and were given Vitamin A during the
month/quarter.DosageofVitaminAfor611monthsoldinfantsis100,000IU.
NOTE:VitaminAgivenduringGarantisadongPambatashouldnotbeincludedinthisreport.
Sick Children 1259 months old given Vitamin A write on the space provided the number of sick
childrenwhoseagesrangefrom12to59monthsoldandweregivenVitaminAcapsuleduring
themonth.DosageofVitaminAfor1259monthsoldchildrenis200,000IU(1capsuleevery6
months).NOTE:VitaminAgivenduringGarantisadongPambatashouldnotbeincludedinthis
report.
Infant 26months old with low birth weight write on the spaceprovided the number of infant
whoseagesrangefrom2to6monthsoldwithlowbirthweightseenduringthemonth/quarter.
Lowbirthweight(LBW)Infantreferstoinfantwithbirthweightlessthan2.5kilogramsor2,500
grams.
Infant26monthsoldwithlowbirthweightgivenironsupplementswriteonthespaceprovidedthe
numberofinfantswhoseagesrangefrom2to6monthsoldwithlowbirthweightandwasgiven
ironduringthemonth/quarter.Dosageis0.3mlonceadaytostartattwomonthsofageuntil6
monthswhencomplementaryfoodsaregiven.(Preparationis15mg.elementaliron/0.6ml).
AnemicChildren611monthsand1259monthsoldseenwriteonthespaceprovidedthenumberof
anemicchildrenwhoseagesrangefrom2to59monthsoldseenduringthemonth/quarter.6
11monthsdrops1259monthssyrup/MNP
AnemicChildren611monthsand1259monthsoldseengivenironsupplementswriteonthespace
provided thenumber of anemic childrenwhose ages range from 2 to 59 months old and was
givenironsupplementationduringthemonth/quarter.Dosageis1tsp.onceadayfor3months
or30mg.onceaweekfor6monthswithsupervisedadministration.
Diarrhea cases 059 months old seen write on the space provided the total number of diarrhea
children059monthsoldseenduringthemonth/quarter.
Diarrheacases059monthsoldgivenORSwriteonthespaceprovidedthetotalnumberofdiarrhea
children whose ages range from 0 to 59 months old and was given ORS during the
month/quarter.
95
FHSIS DIC 201201
Diarrhea cases 059 months old given ORS/ORT with zinc write on the space provided the total
numberofdiarrheachildrenwhoseagesrangefrom0to59monthsoldandwasgivenORSwith
zinc during the month/quarter. Dosage for children less than 6 months is 10 mg. elemental
Zn/dayandforchildrenmorethan6monthsis20mgelementalZn/dayx1014days.
Pneumoniacases059monthsoldseenwriteonthespaceprovidedthetotalnumberofchildren0
59monthsoldseenwithpneumoniaduringthemonth/quarter.
Pneumoniacases059monthsoldgiventreatmentwriteonthespaceprovidedthetotalnumberof
children059monthsoldseenwithpneumoniaandwasgivenantibiotictreatmentduringthe
month/quarter.
2.15.5Malaria
Malariacaseamonglessthan5yearsofageandabove5yearsofagewriteonthespaceprovided
thetotalnumberofmalariacasesamonglessthan5yearsofageandabove5yearsofage.
LaboratoryConfirmedmalariacasesbyspecies:P.falciparum,P.vivax,P.malariae,P.ovalewrite
on the space provided the total number of malaria cases by species by sex and pregnant
women.(P.falciparum,P.vivax,P.malariae,P.ovale).Incolumn1,writethetotalnumberofmale
clientsconfirmedpositiveofmalaria(P.falciparum,P.vivax,P.malariae,P.ovale).Incolumn2,
writethetotalnumberoffemaleclientsconfirmedpositiveofmalariaexcludingpregnantwomen
(P. falciparum, P. vivax, P. malariae, P. ovale). While in column 3, write the total number of
pregnantwomenpositiveofmalaria(P.falciparum,P.vivax,P.malariae,P.ovale).(SeeAnnex2.9
ITRMalariaPreventionandControlProgram)
Confirmed malaria cases by method: Slide and Rapid Diagnostic Test (RDT) write on the space
provided the total number of malaria cases by method (slide and RDT). (See Annex 2.9 ITR
MalariaPreventionandControlProgram)
Householdsatriskwriteonthespaceprovidedthetotalnumberofhouseholdsatriskofmalaria.
HouseholdsgivenLongLastingInsecticideNets(LLIN)writeonthespaceprovidedthetotalnumber
ofhouseholdsgivenlonglastinginsecticidenets.
2.15.6Tuberculosis
TB symptomatics who underwent Direct Sputum Smear Microscopy (DSSM) write on the space
provided the total number of person who present symptoms or signs suggestive of TB, in
particular cough or long duration (2 or more weeks of cough). In this column, write the total
numberofpersonswithTBsymptomaticswhounderwentDSSMregardlessoftheresults.(See
Annex2.8ITRTuberculosisPreventionandControlProgram)
Smearpositive(+)discoveredwriteonthespaceprovidedthenumberofpatientwiththefollowing:
(SeeAnnex2.8ITRTuberculosisPreventionandControlProgram)
1. atleast2sputumspecimenspositiveforAcidFastBacilli(AFB)ondirectsputumsmear
microscopywithorwithoutradiographicabnormalitiesconsistentwithactiveTB;or
2. with one sputum specimen positive for AFB and with radiographic abnormalities
consistentwithactiveTBasdeterminedbyclinician;or
3. with one sputum specimen positive for AFB with sputum culture positive of
Mycobacteriumtuberculosis
96
FHSIS DIC 201201
AllformsofTBcaseswriteonthespaceprovidedthenumberofpersonswhoarecasepositive
classified as both Pulmonary and Extrapulmonary. (See Annex 2.8 ITRTuberculosis Prevention
andControlProgram)
NewSmear(+)casesinitiatedtreatment.NewsmearpositivecasesareTBpatientsthathavenot
takenantiTBdrugsbeforeoriftheyhavetakenantiTBdrugsforlessthan1month.Writeon
thespaceprovidedthenumberofnewsmearpositivecasesgiventreatmentandregisteredin
aDOTfacility.(SeeAnnex2.8ITRTuberculosisPreventionandControlProgram)
Newsmearpositivecasescuredwriteonthespaceprovidedthenumberofnewsmearpositivecases
whohavecompletedtreatmentandissmearnegativeinthelastmonthoftreatmentandonat
least one previous occasion in the continuation phase. (See Annex 2.8 ITR Tuberculosis
PreventionandControlProgram)
Smear positive retreatment cases initiated treatment write on the space provided the number of
smear positive retreatment cases given treatment and registered in a DOTS facility Re
treatmentcasesrefertoRelapse,ReturnafterDefault,TreatmentFailureandOthertypeofTB
cases(SeeAnnex2.8ITRTuberculosisPreventionandControlProgram)
Relapse
Treatmentfailure
Returnafterdefault
OthertypesofTB
Smearpositiveretreatmentcaseswhogotcuredwriteonthespaceprovidedthenumberofsputum
smear positive (+) re treatment patient who has completed treatment and is now sputum
smearnegative()inthelastmonthoftreatmentandonatleastonepreviousoccasioninthe
continuationphase.(SeeAnnex2.8ITRTuberculosisPreventionandControlProgram)
Relapse
Treatmentfailure
Returnafterdefault
2.15.7Schistosomiasis
Symptomatic Case write on the space provided the number of schistosomiasis cases. (See Annex
2.11SchistosomiasisPreventionandControlProgram)
PositiveCasewriteonthespaceprovidedthenumberofschistosomiasiscasesfoundpositive.(See
Annex2.11SchistosomiasisPreventionandControlProgram)
Case infected with low, medium and high intensity write on the space provided the number of
schistosomiasis cases with low, medium and high intensity. (See Annex 2.11 Schistosomiasis
PreventionandControlProgram)
Casestreatedwriteonthespaceprovidedthenumberofschistosomiasiscasestreated.Treatmentof
casesistheadministrationofPraziquantel,600mggivenjustonedayin23divideddosesat40
60mg/kg.(SeeAnnex2.11SchistosomiasisPreventionandControlProgram)
Casesreferredtohospitalfacilitieswriteonthespaceprovidedthenumberofschistosomiasiscases
referredtohospitalfacilities.(SeeAnnex2.11SchistosomiasisPreventionandControlProgram)
97
2.17 Monthly Form for Program Report (M1)

FHSIS version 2012
FHSIS REPORT for the MONTH________ YEAR: _____

Name of BRGY: __________________________________
Name of BHS: ___________________________________
Municipality/City of: _______________________________
Province: _______________________________________
Projected Population of the Year: ____________________
For submission to RHU
MATERNAL CARE
No.
Deliveries
Pregnant women with 4 or more Prenatal visits
Pregnant women given 2 doses of Tetanus Toxoid
Pregnant women given TT2 plus
Preg.women given complete iron w/folic acid supplementation
Postpartum women with at least 2 postpartum visits
Postpartum women given complete iron supplementation
10-49 years old women given Iron supplementation
Postpartum women given Vitamin A supplementation
PP women initiated breastfeeding w/in 1 hr.after delivery
No. of pregnant women
No. of pregnant women tested for syphilis
No. of pregnant women positive for syphilis
No. of pregnant women given Penicillin
Acceptors
FAMILY PLANNING METHOD
Current User
(Beg Mo.)
New
Acceptors
Other
Acceptors
(Previous
Month)
(Present Month)
Dropout
(Present
Month)
Current
User
(End of
Month)
New
Acceptors
of the
present
Month
a. Female Sterilization/BTL
b. Male Sterilization/Vasectomy
c. Pills
d. IUD
e. Injectables (DMPA/CIC)
f. NFP-CM
g. NFP-BBT
h. NFP-STM
i. NFD-Standard Days Method
j. NFP-LAM
k. Condom
l. Implant
Total
102
Note: Have a separate report for new acceptors for the month/quarter
for method
SEE BACK PAGE
M-Form page 2
CHILD CARE
Male
Female
Total
Immunization given <1 yr
CHILD CARE
Chidren 24-35 months old received Vitamin A
BCG

w/in 24 hrs
Hepa B1
> 24 hrs
Infant 2-5 months old received Iron
Chidren 12-23 months old received Iron
Infant 6-11 months received MNP
PENTA
OPV
MCV1 (AMV)
Children 12-23 months received MNP
MCV2 (MMR)
Sick Children 6-11 months seen
Sick Children 12-59 months seen
Sick Children 6-11 months received Vitamin A
Sick Children 12-59 months received Vitamin A
Children 12-59 months old given de-worming tablet
Infant 2-6 mos w/Low Birth Weight seen
Infant 2-6 mos w/ LBW received full dose iron
MCV
ROTA
PCV
Fully Immunized Child (0-11 mos)
Anemic Children 6-11 months old seen
Completely Immunized Child (12-23 mos)
Anemic Children 6-11 mos received full dose iron
Total Livebirths
Child Protected at Birth (CPAB)
Anemic Children 12-59 mos received full dose iron
Infant age 6 mos. seen
Diarrhea cases 0-59 months old seen
Infant exclusively breastfed until 6th mo.
Diarrhea cases 0-59 mos old received ORS
Infant given complimentary food from 6-8 months
Diarrhea 0-59 mos received ORS/ORT w/ zinc
Infant referred for newborn screening
Pneumonia cases 0-59 months old
Infant 6-11 months old received Vitamin A
Pneumonia cases 0-59 mos old completed

Treatment
Chidren 12-23 months old received

Vitamin A
STI SURVEILLANCE
Male
Female
Total
No. of pregnant women

No. of pregnant women tested for syphilis
No. of pregnant women positive for syphilis
No. of pregnant women given Penicillin
103
Male
Female
Total
M-Form page 3
MALARIA
Male
Female
Total
Total Population
SCHISTOSOMIASIS
Male
Female
Total
Male
Female
Total
Male
Female
Total
No. of Symptomatic case
Population at risk
No. of Cases Examined
Annual Parasite Incidence
No. of Positive Cases
Confirmed Malaria Case
Low intensity
< 5 yo
Medium intensity
> = 5 yo
High intensity
Pregnant
No. of Cases treated
Confirmed malaria case
No of Complicated Cases
By Species
No. of Complicated Cases referred
P.falciparum
P.vivax
P.ovale
FILARIASIS
No. Cases with hydrocele, lymphedema,
Elephantiasis, Chyluria
Clinical Rate
P.malariae
Confirmed malaria case
By Method:
No of Case examined
Slide
No of Cases examined found Positive for MF
RDT
Average MFD
Malaria Deaths
Eligible population given MDA (94.6% of TP)
Population given LLIN
TUBERCULOSIS
1. TB symptomatics who underwent DSSM
2. Smear positive discovered and identified
3. New smear positive cases initiated tx and registered
Total population given MDA
Male
Female
Total
LEPROSY
Total Population
Total No. of Leprosy cases (undergoing
treatment
No. of Newly detected Leprosy Cases
< 15 yo
5. Smear(+) retreatment cases cured
Grade 2 disability
6. Smear (+) retreatment cases initiated tx and registered
No of Leprosy Cases cured
Relapse
Treatment failure
Other type of TB
7. No, of Smear (+) retreatment cured
Relapse
Treatment failure
8.Total No. of TB cases (all forms) initiated treatment
104
2.18 Morbidity Disease Report (A2)
FHSIS v. 2012
FHSIS MONTHLY REPORT for:

Name of BRGY and BHS:
Catchment Health Center:
Year:
MORBIDITY DISEASES REPORT

For submission to the PHO
ICD 10
CODE
DISEASE
A09 (watery)
A09 (bloody)
J11
Influenza
J11
G83.9
Acute Hemorrhagic Fever Syndrome

(Dengue)
A91
J22
Pneumonia
J18.9
Cholera
A00
Diphtheria
A36
Filarisis
B74
Leprosy
A30
Leptospirosis
A27
Malaria
B50-B54
Measles
B05
Meningococcemia
A39
Neonatal Tetanus
A33
A35
T61.2
Rabies
A82
Schistosomiasis
B65
A01
Viral Encephalitis
A83-86
B15-B17
Viral Meningitis
A87
Syphilis
A50-A53
Gonorrhea
A54.9
Urethral Discharge
R36
Genital Ulcer
N48.5, N76.5, N76.6,
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
106
30 - 34
35 - 39
M
F
40 - 44
M
F
45- - 49
M
F
50 - 54
M
F
55 - 59
M
F
60 - 64
M
F
65 & above
M
F
T OT AL
F Total
FHSIS v.2008
FHSIS MONTHLY REPORT for:

Name of BRGY and BHS:
Catchment Health Center:
Year:

For submission to RHU
DISEASE
Under 1
M
1 - 4
M
5 - 9
M
10 - 14
M
15 - 19
M
20 - 24
M
25 - 29
M
105
30 - 34
35 - 39
M
40 - 44
M
45- - 49
M
50 - 54
M
55 - 59
M
60 - 64
M
65 & above
M
TOTAL
M
FHSIS DIC 201201
2.19THEQUARTERLYFORMFORPROGRAMREPORT(Q1):
TheQuarterlyFormistheofficialhealthreportofthemunicipality/cityforthequarter.Itcontainsthe
consolidated three month reports of all the BHSs and the RHU/MHC for health service delivery during the
quarter.ThePHNforwardsthisreporttotheProvincialFHSISCoordinatoratthePHOeverythirdweekofthe
first month of the succeeding quarter for provincial consolidation. The municipality/city prepared only one
quarterlyreport.IncasethereismorethanoneRHU/MHCinthemunicipality/city,theMHO/CHOwhositsas
thevicechairmanoftheLHBshallberesponsiblefordirectingtheconsolidationofallthequarterlydatafrom
different RHUs/MHCs and the preparation of one Quarterly Form for the municipality/city. Spaces are left
blankforthoseindicatorsthemunicipality/citywantstogeneratebasedontheirlocalneedsandinterests.
HeadingFilluptheheadingwiththedatabeingaskedfor:IdentifytheQuarterandYear.Placefullnameof
theMunicipality/CityandtheProvincetowhichtheLGUbelongs.
Projectedpopulationfortheyearwriteonthespaceprovidedthecityormunicipalitypopulation.
FillinguptheformTheQuarterlyFormisdesignedbyprogramwiththeindicatorslistedinthefirstcolumn,
followedbytheeligiblepopulation,numberofmaleandfemalecases,thetotalforbothsexes,the
percentageaccomplishment,theinterpretationoranalysisofdataandrecommendationsoractions
taken by your area. Denominators for some indicators are listed below for easy computation. All
indicators found in the Monthly Form should have the same definitions except for Dental Health
whichcanonlybefoundintheQuarterlyForm.
2.19.1MaternalCare
PutthetotalsforthequarterperindicatorandplaceInterpretationand
Recommendations/Actionstaken.
2.19.2FamilyPlanning
2.19.3ChildCare
2.19.4DentalCare
Orally Fit Children 1271 months old write on the space provided the number of children whose ages
ranges from 12 to 71 months old and meet all of the following upon oral examination and/or
completion oftreatment:(1) cariesfree or decayed teethy filled (permanent fillings)(2) has healthy
gums (3) no oral debris and (4) no dentofacial anomaly that limits normal function.(See Annex 2.7
DentalHealthProgramform1)PlaceInterpretationandRecommendations/Actionstaken.
Children1271monthsoldprovidedwithBasicOralHealthCare(BOHC)writeonthespaceprovidedthe
numberofchildrenwhoseagesrangesfrom12to71monthsoldandwereprovidedwithBasicOral
HealthCareduringthequarter.BasicOralHealthCarereferstooneofmoreofthefollowingservices:
(1) Oral Examination (2) 80% Attendance to Supervised Tooth Brushing (3) Atraumatic Restorative
Treatment(ART)and(4)OralUrgentTreatment(OUT)whichincludesremovalofunsavableteethor
referral of complicates cases of treatment of postextraction complications or drainage of localized
oral abscess. (See Annex 2.7 Dental Health Program form 1) Place Interpretation and
AdolescentandYouth(1024yearsold)providedwithBasicOralHealthCare(BOHC)writeonthespace
providedthenumberofyouthandadolescentswhoseagesrangesfrom10to24yearsoldandwere
providedwithBasicOralHealthCareduringthequarter.BasicOralHealthCarereferstooneofmore
of the following services: (1) Oral Examination (2) Education and counseling on health effects of
tobacco/smoking, diet and oral hygiene. (See Annex 2.7 Dental Health Program form 1) Place
105
FHSIS DIC 201201

InterpretationandRecommendations/Actionstaken.
PregnantwomenprovidedwithBasicOralHealthCare(BOHC)writeonthespaceprovidedthenumberof
pregnantwomenwhowereprovidedwithBasicOralHealthCareduringthequarter.BasicOralHealth
Carereferstooneofmoreofthefollowingservices:(1)OralExamination(2)Scaling(3)Permanent
Fillingand(4)GumTreatment.(SeeAnnex2.7DentalHealthProgramform1)PlaceInterpretationand
OlderPersons60yearsoldandaboveprovidedwithBasicOralHealthCare(BOHC)writeonthespace
provided the number of older persons ages 60 years old and above who were provided with Basic
Oral Health Care during the quarter. Basic Oral Health Care refers to one of more of the following
services: (1) Oral Examination (2) Extraction and (3) Gum Treatment. (See Annex 2.7 Dental Health
Programform1)PlaceInterpretationandRecommendations/Actionstaken.
2.19.5Tuberculosis
2.19.6Leprosy
2.19.7Malaria
2.19.8Schistosomiasis
2.19.9Filariasis
2.21THEQUARTERLYCONSOLIDATIONREPORTOFMORBIDITYDISEASES(Q2):
The Quarterly Report of Morbidity Diseases contains a list of all diseases by age and gender. It summarizes
quarterlyofdiseasesthatarereportedinthemunicipality/cityforwhichthePHNisresponsible,thenforwards
this report to the Provincial FHSIS Coordinator at the PHO every third week of the first month of the
succeedingquarterforprovincialconsolidation.
HeadingFilltheYearforwhichthereportisbeingprepared.Writethefullnameofthe
Municipality/CityandProvinceandthequarter.
Fillingupthereport
Writeinthespaceprovidedthediseasename,thequartertotalnumberofmales(M)andfemales(F)
for the corresponding age grouping reported for the particular disease. Data for the quarterly
consolidationcomesfromtheMonthlyReportoftheMidwifeanddatafoundintheRHU.
106
2.20.1 Maternal Care

FHSIS ver 2012
FHSIS REPORT for the QUARTER_________________ YEAR: ______________

Municipality/City Name: _______________________________________________
Province: ___________________Projected Population of the Year: ____________
logo
- MATERNAL
Indicators
Elig
Pop.
No.
Interpretation
Col. 1
Col.2
Col. 3
Col.4
Col. 5
Deliveries
Pregnant women with 4 or more prenatal visits
Pregnant women given 2 doses of Tetanus Toxoid
Pregnant Women given TT2plus
Pregnant women given complete iron with folic acid
supplementation
Post partum women with at least 2 post-partum visits
Post partum women given complete iron
supplementation
Proportion of Post partum women given Vitamin A
supplementation
Proportion Postpartum women initiated breastfeeding
within 1 hour after giving birth
10-49 years old women given Iron supplementation
Eligible Population:
CARE -
TP x 2.7%
109
Recommendation/
Actions Taken
Col. 6
2.20.2 Family Planning
FHSIS v. 2012 - Q Form (page 2 of 8)
- FAMILY
PLANNINGNew
Current
CPR = (Col.
Acceptors
Users End
5/TP x 12.325%)
of the
of Quarter
Quarter
Acceptors
Indicators
Current User
(Beg. of Quarter)
Dropout
New
(end of Qtr)
Col. 1
Col.2
Other
(end of Qtr)
Col.3
Col.4
Col.5
a. Female Ster/BTL
b. Male Ster/Vasectomy
c. Pills
d. IUD
e. Injectables (DMPA/CIC)
f. NFP-CM
g. NFP-BBT
h. NFP-STM
i. NFP-SDM
j. NFP-LAM
k. Condom
l. Implants
110
Col.6
Col.7
Interpretation
Recommendations/ Actions
Taken
Col.8
Col.9
2.20.3 Child Care
- CHILD CARE Elig.

Pop.
Col.2
Indicators
Col. 1
Male
Col. 3
Infants given BCG

w/in 24 hours
Infants given HepatitisB1
> 24 hours
1
Infants given PENTA
2
3
1
Proportion of Infants given OPV
2
3
Proportion of Infants given MCV
MCV1 (AMV)
MCV2 (MMR)
1
Proportion of Infants given ROTA
2
3
1
Proportion of Infants given PCV
2
3
Proportion of Fully Immunized Child (0-11 mos)

Proportion of Completely Immunized Child (12-23 mos)
Total Livebirths
Proportion of Child Protected at Birth (CPAB)
Proportion of Infants age 6 mos. seen
Proportion of Infants exclusively breastfed until 6th month old
Infants given complimentary food from 6-8 months
Proportion of Infants referred for newborn screening
Eligible Population: TP x 2.7%
Total Livebirths
No. Infant seen at 6th month

111
Number
Female
Col. 4
Total
Col. 5
Interpretation
Col. 6
Col. 7
Recommendation/
Actions Taken
Col. 8
- CHILD CARE 112
Elig.
Pop.
Col.2
Indicators
Col. 1
Male
Col. 3
Number
Female
Col. 4
Total
Col. 5
Interpretation
Col. 6
Col. 7
Infant 6-11 months old received Vitamin A

Children 12-23 months old received Vitamin A*
Children 12-23 months old received Iron *
Infant 6-11 months old received MNP
Children 12-23 months old received MNP
Sick Children 6-11 mos. seen
Sick Children 12-59 mos. seen
Sick Children 6-11 mos. received Vit. A
Sick Children 12-59 mos. received Vit.A
Children 12-59 mos. old given de-worming tablet
Infant 2-6 mos.w/ low birthweight seen
Infant 2-6 mos.w/ low birthweight received full dose iron
Anemic Child. 6-11 months old seen received iron
Anemic Child. 12-59 months old seen received iron
Diarrhea cases 0-59 months old
Diarrhea cases 0-59 mos old received ORS
Diarrhea 0-59 mos old received ORS/ORT w/ zinc
Pneumonia cases 0-59 mos. old seen
Pneumonia cases 0-59 mos. old completed Tx
Eligible Pop: TP x 1.35%
* TP x 11%
Infant 2-6 mos.w/LBW seen
TP x 2.7%
Sick Child 6-11 mos. seen
Sick Child 12-59 mos. seen
Anemic Child 12-59 mos. old seen No.Diarrhea cases 0-59 mos old seen No.Pneumonia cases 0-59 mos seen
112
Recommendation/
Actions Taken
Col. 8
2.20.4 Dental Care
- DENTAL
Elig.
Pop.
Col.2
Indicators
Col. 1
Male
Col. 3
Number
Female
Col. 4
CARE Total
Col. 5
Orally Fit Children 12-71 months

old
Children 12-71 months old
provided with BOHC
Adolescent & Youth(10-24 years)
given BOHC
Pregnant women provided
with BOHC
Older Person 60 yrs old & above
provided with BOHC
Eligible Population: TP x 13.5%
TP x 30%
TP x 2.7%
TP x 6.9%
113
Interpretation
Col. 6
Col. 7
Recommendation/
Actions Taken
Col. 8
2.20.5 Disease Control
FHSIS v. 2012- Q Form (page 6 of 8 )
- DISEASE CONTROL TUBERCULOSIS

Col. 1
Male
Number
Female
Col. 2
Col. 3
Interpretation
Total
Actions Taken
Col. 6
Col. 5
Col. 4
Recommendation/
1. TB symptomatics who underwent DSSM

2. Smear positive discovered and identified
3. New smear positive cases initiated tx and registered
5. Smear(+) retreatment cases cured
6. Smear (+) retreatment cases initiated tx and registered
Relapse
Treatment failure
Other type of TB
7. No, of Smear (+) retreatment cured
Relapse
Treatment failure
8.. Total No. of TB cases (all forms) initiated treatment
LEPROSY
Col. 1
Male
Col. 2
Number
Female
Col. 3
1. Total Population
2. Total No. of Leprosy cases (undergoing Treatment)
Leprosy cases
< 15 yo
Grade 2 disability
4. No of Leprosy Cases cured
Denominator TP x 0.00275 (estimated TB All Forms)
114
Total
Col. 4
Rate
Interpretation
Recommendation/
Actions Taken
Col. 5
Col. 6
Col. 7
FHSIS v. 2012- Q Form (page 7 of 8)
- DISEASE CONTROL MALARIA

(endemic areas)
Col. 1
Male
Number
Female
Total
Col. 2
Col. 3
Col. 4
Rate
Interpretation
Recommendation/
Actions Taken
Col. 5
Col. 6
Col. 7
Total Population
Population at risk
Annual Parasite Incidence
Morbidity
Rate
Annual Parasite
Incidence
Mortality
Rate
Case Fatality
Ratio
Confirmed Malaria Case

By age group
< 5 yo
> =5 yo
By pregnancy
Pregnant
By species
P.falciparum
P. vivax
P.ovale
P.malariae
By Method
Slide
RDT
Total no. of LLIN given
Total no. of Malaria Deaths
Denominator:
Morbidity Rate=TP; Annual Parasite Incidence=Endemic Pop

Total Confirmed Malaria Case
Population at risk
>5 & <5 yo Population

Mortality rate=TP; Case Fatality Ratio=Total Malaria Cases
115
- DISEASE CONTROL SCHISTOSOMIASIS

(endemic areas)
Male
Col. 1
Col. 2
Number
Female
Col. 3
Total
Col. 4
Rate
Interpretation
Recommendation/
Actions Taken
Col. 5
Col. 6
Col. 7
Rate
Interpretation
Recommendation/
Actions Taken
Col. 5
Col. 6
Col. 7
Symptomatic cases
Case examined
Positive Cases
Low intensity
Medium intensity
High intensity
Cases treated
Complicated Cases *
Complicated Cases referred
FILARIASIS
(endemic areas)
Male
Col. 1
Col. 2
Number
Female
Col. 3
Total
Col. 4
1.No. Cases with hydrocele,

lymphedema, Elephantiasis,
Chyluria
2. Clinical Rate
4. No of Cases examined found
Positive for MF
5. Average MFD
6. Eligible population given MDA
(94.6% of TP)
7. Total population given MDA
Denominator for Schistosomiasis:
Case examined
Positive Schistosomiasis cases
*Complicated cases
116
2.21.1 Form 1 Notifiable Diseases
FHSIS v. 2012 - Qmorbid (page 2 of 2)
FHSIS v.2012
FHSIS QUARTERLY REPORT for:

Municipality/City of:
ProvInce
Year:

NAME
OF
ICD Code
DISEASE
Under 1
M
A09 (watery)
A09 (bloody)
J11
Influenza
J11
G83.9
Acute Hemorrhagic Fever Syndrome (Dengue)
A91
J22
Pneumonia
J18.9
Cholera
A00
Diphtheria
A36
Filarisis
B74
Leprosy
A30
Leptospirosis
A27
Malaria
B50-B54
Measles
B05
Meningococcemia
A39
Neonatal Tetanus
A33
A35
T61.2
Rabies
A82
Schistosomiasis
B65
A01
Viral Encephalitis
A83-86
B15-B17
Viral Meningitis
A87
Syphilis
A50-A53
Gonorrhea
A54.9
Urethral Discharge
R36
Genital Ulcer
N48.5, N76.5, N76.6
1-4
M
5-9
F
10-14
F
15-19
M
20-24
M
25-29
M
118
30-34
M
35-39
M
40-44
M
45-49
M
50-54
M
55-59
M
60-64
M
65-69
M
70 & over
TOTAL
M
2.21.2 Form 2 Other Diseases
FHSIS v. 2012 - Qmorbid (page 1 of 2)

.
FHSIS QUARTERLY REPORT for:

ProvInce
Year:

DISEASE
ICD 10 Under 1
CODE M
F
1 - 4
5 - 9
10 - 14
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45- - 49
50 - 54
55 - 59
60 - 64 65 & above
T OT AL
117
FHSIS DIC 201201

2.22THEANNUALFORMS:
2.22.1AnnualBHSReport(ABHS)
TheAnnualBHSReportFormcontainsbasicinformationabouttheBHSwhicharesubmittedonlyonceyear.It
consistsofdatacategorizedunderdemographic,environmentalandnatality.ThemidwifeintheBHSfillsup
theformandsubmitstotheRHU/MHCforconsolidation.
Heading
Fill in the required information for the Year, complete name of the BHS, municipality/city and the
province.
Fillinguptheform.
ForDemographicProfile,writethepopulation,numberofbarangaysandhouseholds.Theindicators
arethesamewiththosefoundintheAnnualForm1andsamedefinitionsmustbefollowed.
2.22.2AnnualForm1VitalStatisticsReport(A1RHU)
TheAnnualFormcontainsbasicinformationaboutthemunicipalityorcitywhichisbeingsubmittedonlyonce
ayear.Itconsistsofdatacategorizedunderdemographic,environmental,natalityandmortality.Thenursein
theRHU/MHCfillsuptheformandsubmitstothePHOforcomputerprocessing.
Heading
FillintherequiredinformationfortheYear,completenameoftheRHUandprovince.
Fillinguptheform
The Annual Form consists of the program indicators listed in the first column, followed by the
number,thepercentageaccomplishmentorratio/rate,theinterpretationoranalysisofdataandthe
recommendations or action taken by your area. To facilitate computation of rates/ratios,
denominatorsforsomeindicatorsarelistedbelow.
2.22.2.1DemographicInformation
No. of Barangays Write on the space provided the actual number of barangays within the
municipality/city.
No.ofBHSsWriteonthespaceprovidedtheactualnumberofbarangayhealthstations.ABHS
canbeconsideredareportingunitifthefollowingconditionsaresatisfied:
a. Itrenders/delivershealthservicestoadefinedcatchmentareawhichmaybecomposed
ofoneormorebarangays.
b. Amidwiferendersregularservicetothearea.Incasewherethemidwifeoftheareais
in prolonged leave of absence or resigned but a replacement is expected, the BHS
remainsareportingunit.Thereportsareexpectedtobesubmittedbythenurse(2)or
midwife(s)whotookovertheservicingofthearea.
c. Healthservicesmaybeprovidedfromanyphysicalstructuredesignatedforthe
purposei.e.aBHSbuilding,abarangayhalloraplaceofresidence.
d. ThecatchmentareaservedisnotaserviceareaofanyRHU.Forinstance,Poblacionin
mostcasesisthecatchmentareaservedbytheRHU.Thus,thePoblacionBHScannotbe
consideredareportingunit.ThereportsofthisBHSshouldbepreparedandsubmitted
bytheRHU.
e. ItshouldnotincludesatelliteBHSwhicharevisitedbythemidwifebutpartofthe
catchmentofthemotherBHS.
117
FHSIS DIC 201201

No.ofHealthWorkersinLGUThisincludesnationallypaidpublichealthworkersandthosehired
bythelocalgovernment.Writeonthespaceprovidedthetotalnumberofdoctors,dentists,
nurses, midwives, nutritionists, medical technologists, engineers, sanitary inspectors and
activeBHWs.
NOTE:Hospitalpersonnelarenotincludedinthisindicator.
2.22.2.2ENVIRONMENTAL
No.ofHouseholds(HH)Writeonthespaceprovidedtheactualnumberofhouseholdsinthe
municipality.Thedatashouldbebasedonactualhouseholdsurveywithinthelocality.
Households with access to improved or safe water supply Write on the space provided the
number of households covered by or have access to the following types of drinking water
sources that conforms to the Philippine National Standards for Drinking Water (PNSDW)
(i.e.,freefrombacterial,chemical,physicalandothercontaminants):
LevelI(PointSource)Aprotectedwell(shallowanddeepwell)improveddugwell,
developedspring,rainwatercisternwithanoutletbutwithoutdistributionsystem.
LevelII(CommunalFaucetSystemorStandpost)Referstoasystemcomposedofasource,
areservoir,apipeddistributionnetwork,andacommunalfaucetlocatednotmorethan25
meters from the farthest house. It is generally suitable for rural and urban areas where
houses are clustered densely enough to justify a simple piped water system. Note: For
reportingpurposesLevelIIsystemmayalsoincludeacommunalfaucetconnectedtoLevelIII
wheregroupofhouseholdsgettheirwatersupply.
LevelIII(WaterworksSystem)Asystemwithasource,transmissionpipes,areservoir,
and a piped distribution network for household taps. It is generally suited for densely
populatedareas.ExamplesoftheseareMWSSandwaterdistrictswithindividualhousehold
connections. Note: For reporting purposes of Level III system may also include a Level I
system with piped distribution for household tap serving individual or group of housing
dwellingssuchasapartmentsorcondominiums.
HouseholdswithsanitarytoiletfacilitiesWriteonthespaceprovidedthetotalnumberof
households with sanitary toilets. This refers to households with flush toilets connected to
septic tank and/or sewerage system or any other approved treatment system, sanitary pit
latrineorventilatedimprovedpitlatrine.
HouseholdswithsatisfactorydisposalofsolidwasteWriteonthespaceprovidedthetotal
number of households with garbage disposal through composting, burying, city/municipal
systemstorage,collectionanddisposal.
HouseholdswithcompletebasicsanitationfacilitiesWriteonthespaceprovidedthetotal
numberofhouseholdswhichsatisfythepresenceofthefollowingbasicsanitationelements,
namely: access to safe water, availability of a sanitary toilet and satisfactory system of
garbagedisposal.
FoodEstablishmentsWriteonthespaceprovidedthetotalnumberoffoodestablishments
whichincludesrestaurants,sarisaristores,canteens,coffeeshops,carinderia,refreshment
parlors, bakeries, water refilling stations, food manufacturing, bottling, dairy and canning
establishments.
FoodEstablishmentswithSanitaryPermitWriteonthespaceprovidedthetotalnumberoffood
establishmentswithsanitarypermit.
118
FHSIS DIC 201201
FoodHandlersWriteonthespaceprovidedthetotalnumberoffoodhandlersemployedinfood
establishments
FoodHandlerswithHealthCertificatesWriteonthespaceprovidedthetotalnumberoffood
handlerswithhealthcertificates.
2.22.2.3NATALITY
No.ofPregnanciesWriteonthespaceprovidedthetotalnumberofpregnancies.
Pregnancybyoutcome
Livebirths
writeonthespaceprovidedthetotalnumberoflivebirths
FetalDeaths
Abortion
writeonthespaceprovidedthetotalnumberoffetaldeath
writeonthespaceprovidedthetotalnumberofabortion
No.ofdeliveriesbytype
NormalSpontaneousDelivery(NSD)writeonthespaceprovidedthetotalnumberofNSD
OtherswriteonthespaceprovidedthetotalnumberdeliveriesotherthanNSD
Weightatbirth
2,500gramsandgreater Writeonthespaceprovidedthetotalnumberoflivebirthswith
weightsequaltoorgreaterthan2,500grams.
Lessthan2,500grams
Writeonthespaceprovidedthetotalnumberoflivebirthswith
weightslessthan2,500grams.
Notknown
Writeonthespaceprovidedthetotalnumberoflivebirths
whoseweightsatbirtharenotknown.
DeliveriesAttendedby:
Doctors Writeonthespaceprovidedthenumberofdeliveriesbydoctors.
Nurses Writeonthespaceprovidedthenumberofdeliveriesattendedbynurses.
MidwivesWriteonthespaceprovidedthenumberofdeliveriesattendedbymidwives.
TrainedHilot/TBAWriteonthespaceprovidedthenumberofbirthsattendedbytrained
hilotorhealthworkernotmentionedabove.
OthersWriteonthespaceprovidedthenumberofbirthsattendedbythoseotherthan
theabovementioned.
119
FHSIS DIC 201201

No.oflivebirths
Column2(Male)writeonthespaceprovidedthetotalnumberofmaleswerebornalivein
theHealthCenterfromTCLofprenatalandLCR.
Column 3(Female) write on the space provided the total number of females who were
bornaliveintheHealthCenterfromTCLofprenatalandLCR.
Column4(Total)writeonthespaceprovidedthetotalnumberof
femalesandmaleswhowerebornaliveintheHealthCenterfromTCLofprenatalandLCR.
Column5(Percent)writeonthespaceprovidedthepercentofthetotalnumberoffemales
andmaleswhowerebornaliveintheHealthCenterfromTCLofprenatalandLCR.
DeliveriesbyPlace:
Health Facility Hospital, RHU or Lyingin (including BEMONC, CEMONC) write on the
spaceprovidedthetotalnumberoflivebirthsthatweredeliveredingovernmentorprivate
hospitals,RHUorLyingin(includingBEMONC,CEMONC).
NoninstitutionalDelivery(NID)writeonthespaceprovidedthetotalnumberoflivebirths
thatweredeliveredinhomeorotherthanhealthfacility.
2.22.2.4MORTALITY
Deathsbysex:
Male writeonthespaceprovidedthetotalnumberofmaledeaths
Female writeonthespaceprovidedthetotalnumberoffemaledeaths
MaternalMortalitywriteonthespaceprovidedthetotalnumberofpregnantwomenwhodied
duetocausesrelatedtopregnancy,childbirthandpuerperium.
InfantMortalitywriteonthespaceprovidedthetotalnumberofinfantdeaths.
UnderFiveMortalitywriteonthespaceprovidedthetotalnumberofdeathsamongchildren
underfiveyearsofage.
Fetal Deaths write on the space provided the total number of fetus who reaches the age of
viability(20weeks+),andaweightofmorethan500gramsdelivereddeadordiedinsidethe
womb.
PerinatalDeathswriteonthespaceprovidedthetotalnumberoffetuswhodiedfrom22ndweek
of gestation (the time when birth weight is normally 500mg) and ends 7 completed days
afterbirth.
NeonatalMortalitywriteonthespaceprovidedthetotalnumberofdeathsbetweenbirthsupto
28daysofage.
DeathsduetoNeonatalTetanuswriteonthespaceprovidedthetotalnumberofdeaths3to28
daysofageduetotetanusneonatorum.
120
FHSIS DIC 201201

AnnualForm2MorbidityDiseaseReport
This report is prepared by the PHN as the annual consolidation of the monthly and quarterly
morbiditydiseasereportsfromtheBHSsandtheRHUs.TheSourceofthisreportistheSummaryTable.The
reportconsistsofallreportedcausesofmorbiditydiseaseswithageandsexbreakdown,andsubmittedtothe
PHO.
AnnualForm3MortalityReport
Thisreportistheannualconsolidationofalldeathsoccurredinyourarea.TheSourceofthisreportis
theSummaryTable.ThePHNwhopreparesthisreportbreaksdownthenumberreportedineachdiseaseby
ageandgender.
121
2.22.3.2 Demographic Profile (A1-RHU)

FHSIS version 2012
FHSIS ANNUAL REPORT FOR YEAR: ______________________________________

Municipality/City Name: ___________________________________________________
No. of Health Centers _____________________
Province: _____________________Projected Population of the Year: ___________
- DEMOGRAPHIC PROFILE Indicators

Col. 1
Number
Male
Female
Col. 2
Col. 3
Ratio to
Total
Pop.
Col. 4
Col. 5
Interpretation
Col. 6
Barangays
Barangay Health Stations
Health Centers
Households
Physicians/Doctors
Dentist
Nurses
Midwives
Medical Technologists
Sanitary Engineers
Sanitary Inspectors
Nutritionist
Active Barangay Health Workers
124
Recommendation/
Actions Taken
Col. 7
2.22.3.3 Environmental
FHSIS v. 2012 - A Form (page 2 of 5 )
- ENVIRONMENTAL Indicators
No.
Interpretation
Recommendation/
Actions Taken
Col. 1
Col 2
Col. 3
Col. 4
Col. 5
Total number of Households (HH)

HH w/ access to improved
water supply
- Level I
- Level II
- Level III
HH w/ sanitary toilet facilities
HH w/satisfactory disposal of solid waste
HH w/complete basic sanitation facilities
Food Establishment
Food Establishment w/Sanitary Permit
Food Handlers
Food Handlers w/Health Certificate
Denominator: No. Households
No.Food Establishments
No.Food Handlers
127
2.22.3.4 Natality - Livebirths
FHSIS v. 2012- A Form (page 3 of 5)
NATALITY - LIVEBIRTHS
Indicators
Col. 1
Number
Male Female Total
Col 2
Col 3
Col 4
Interpretation
Recommendation/
Actions Taken
Col. 5
Col. 6
Col. 7
No. of Pregnancies
Pregnacies by outcome
Livebirths (LB)
Fetal Death
Abortion
No. of Deliveries
NSD
Others
LB w/weights 2500 grams & greater
LB w/weights less than 2500 grams
LB - Not known weight
LB delivered by doctors
LB delivered by nurses
LB delivered by midwives
LB delivered by hilot/TBA
LB delivered by others
Denominator:
Livebirths
128
2.22.3.5 Natality - Deliveries
FHSIS v. 2012- A Form (page 4 of 5)
- NATALITY - DELIVERIES Indicators
No.
Interpretation
Recommendation/
Actions Taken
Col. 1
Col 2
Col. 3
Col. 4
Col. 5
Total No. of Pregnancies

Outcome of Pregnancy
Live Births
Fetal death
Abortion
Normal Deliveries
Deliveries at Home
Deliveries at Health Facility
Deliveries - Other Place
Other Deliveries
Deliveries at Home
Deliveries at Health Facility
Deliveries-Other Place
Denominator:
Livebirths
Pregnancies
Normal Deliveries
Other Type of Deliveries

126
2.22.3.6 Mortality
FHSIS v. 2012 - A Form (page 5 of 5)
- MORTALITY Number
Indicators
Male
Col 2
Col. 1
Female
Col 3
Total
Col 4
Rate
Interpretation
Col. 5
Col. 6
Deaths
Maternal Deaths
Perinatal Deaths
Fetal Deaths
Neonatal Deaths
Infant Deaths
Deaths among child. Under 5 yrs old
Deaths due to Neonatal Tetanus
Denominator:
Population
Livebirths
125
Recommendation/
Actions Taken
Col. 7
FHSIS v.2008
FHSIS ANNUAL REPORT for YEAR:

ProvInce

DISEASE
ICD 10
Under 1
CODE
1 - 4
M
5 - 9
M
10 - 14
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 - 44
45- - 49
50 - 54
55 - 59
60 - 64
129
65 & above
M
T OT AL
M
2.22.3.8 Mortality Report (A3-RHU)

.
FHSIS v.2012
FHSIS ANNUAL REPORT for YEAR:

ProvInce
MORTALITY REPORT
DISEASE
Under 1
M
1 - 4
M
5 - 9
M
10 - 14
15 - 19
20 - 24
25 - 29
30 - 34
130
35 - 39
M
40 - 44
M
45- - 49
M
50 - 54
M
55 - 59
M
60 - 64
M
65 & above
M
T OT AL
M
Chapter Three
___________________
FHSIS VER. 2012

METADATA
FHSIS INDICATOR METADATA
TableofContents
Program/Topics
Page
DemographicInformation
.2
Natality
.6
Mortality
EnvironmentalHealth
MaternalCare
.9
.11
.14
FamilyPlanning
.19
ChildCare
.22
DentalHealth
.31
Filariasis
.33
Leprosy
.35
Malaria
.39
Schistosomiasis
.42
Tuberculosis
.44
MorbidityRates
.47
FHSIS v. 2012
Indicator Metadata
3.1 DEMOGRAPHIC INFORMATION
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Source of
Data
Frequencyof
Reporting
No.ofPopulation
NSO
Projected
Population
Annual
Formula
Target
1.Population
Disaggregation:
Region
Province
Cities
Thetotalnumberofinhabitantsconstitutingaparticular
race,class,orgroupinaspecifiedarea.
2.No.ofMain
HealthCenters
MainHealthCenterreferstoanexpandedruralhealth
unit,usuallylocatedinastrategicareawherethereareno
hospitals.Ithasoneortwolyinginbedsandmayhavea
largerpersonnelcomplimentthanaregularRHU
3.No.ofBarangays
Disaggregation:
Region
Province
Cities
Thetotalnumberofbarangayswithinthe
municipality/city.
DefinitionofTerms:
Abarangay(Tagalog:baranggay),alsoknownbyits
formername,thebarrio,isthesmallestlocalgovernment
unitinthePhilippinesandisthenativeFilipinotermfora
village,districtorward.Municipalitiesandcitiesare
composedofbarangays.
No.of Barangays
RHU
FHSIS
Annual
4.No.ofBarangay
HealthStations
Thetotalnumberofbarangayhealthstationswithinthe
municipality/city.
DefinitionofTerms:
BarangayHealthStationsreferstothefirstfacilityinthe
PublicHealthSystems.Itismannedbyacadreof
volunteerBHWsunderthesupervisionoftheRHM.The
MHOnormallyconductsdiagnosticconsultationsand
givesprescriptionsandreferralsonaregularbasisinthe
BHS.TheBHWsaretrainedinpreventivehealthcarewith
astrongemphasisonmaternalandchildcare,family
planningandreproductivehealth,nutritionand
sanitation,aswellas,preventionandcareofcommon
No.ofBHS
RHUs
Reports
Annual
UseandLimitation
Instatisticstheentire
aggregationofitemsfrom
whichsamplescanbedrawn;
"itisanestimateofthemean
ofthepopulation"
Indicator
Definition
Formula
Target
Source of
Data
Frequencyof
Reporting
diseases.
5.No.of
Households
Disaggregation:
Region
Province
Cities
6.RatioofPublic
HealthPersonnel
Thetotalnumberofhouseholdsinthemunicipality/city
Houseto
house
Survey
No.ofHouseholds
DefinitionofTerms:
Ahousehold(NSOdefinition)isasocialunitconsistingofa Note:Intheabsenceof
actualHHsurvey,usethe
personlivingaloneoragroupofpersonswho:
suggestedformulabelow
1)sleepinthesamehousingunit;and
2)haveacommonarrangementforthepreparationand
TotalPopulationdividedby6
consumptionoffood
Thisincludesnationallypaidhealthworkersandthose
hiredbythelocalgovernment.HealthManpowerincludes
Doctors,Dentists,Nurses,Midwives,Medical
Technologists,SanitaryEngineers,SanitaryInspectorsand
ActiveBHWs.
DefinitionofTerms:
Physician/Doctorsallgraduatesofanyfacultyorschool
ofmedicine,actuallyworkinginthecountryinany
medicalfield(practice,teaching,administration,research,
laboratory,etc.)
MunicipalHealthOfficerHe/Sheheadsthedecentralized
healthservicesatthemunicipallevelandservesas
administratoroftheruralhealthunit,theprimaryhealth
facilityinthearea.Asacommunityphysician,he/she
conductsepidemiologicalstudies/investigation,
formulateshealtheducationcampaignsondisease
prevention,andpreparesandimplementscontrol
measuresorrehabilitationplans.He/Shealsoserveas
themedicolegalofficer.Ashealthadministrator,his/her
functionsincludethepreparationofthemunicipalhealth
planandbudget;monitoringtheimplementationofbasic
healthservices,andmanagementoftheRHUstaff.
Dentistsareprofessionalpeoplequalifiedtoperform
Numerator:TotalPopulation
ofagivenarea
Denominator:TotalNo.of
HealthManpower
Annual
Annual
Physician
1:20,000
Dentist
UseandLimitation
Indicator
Definition
proceduresintheOralCavityinordertoprovide
preventive,curativeandrehabilitationservices.
Nursesallpersonswhohavecompletedaprogramof
basicnursingeducationandarequalifiedandregistered
orauthorizedtoprovideresponsibleandcompetent
serviceforthepromotionofhealth,preventionofillness,
careofthesick,andrehabilitation,andareactually
workinginthecountry.ThePublicHealthNurse(PHN)
supervisesandguidesallruralhealthmidwives(RHMs)in
themunicipality.He/Shehandlethehealthrecordsofthe
communityincludingdataonmorbidityandmortality
cases,programaccomplishments,etc.ThePHNalso
preparesmonthlyandquarterlyreportstotheMHO.
Midwivespersonswhohavecompletedaprogramof
midwiferyeducation,andhaveacquiredtherequisite
qualificationstoberegisteredand/orlegallylicensedto
practicemidwifery,andareactuallyworkinginthe
country.TheRuralHealthMidwife(RHM)managesthe
BHSandsupervisesandtrainstheBHWinthecommunity.
He/Sheprovidesmidwiferyservicesandexecuteheath
caretowomenofreproductiveageincludingfamily
planningcounselingandservices,He/Sheconducts
patientassessmentanddiagnosisforreferral/further
management;performshealthIECactivities,organizesthe
community,andfacilitatesBarangayhealthplanningand
othercommunityhealthservices.
MedicalTechnologistisadulylicensedhealthcare
professionalwhoworksonclinicallaboratoriesand
performsdiagnosticanalytictestsonhumanbodyfluids
suchasflood,urine,sputum,stool,cerebrospinalfluid
(CSF),peritonealfluid,pericardialfluid,andsynovialfluid,
aswellasotherspecimens.MedicalTechnologistsworkin
clinicallaboratoriesathospitals,doctorsoffice,reference
labs,andwithinthebiotechnologyindustry.
Formula
Target
1:50,000
Nurse
1:20,000
Midwife
1:5,000
Source of
Data
Frequencyof
Reporting
UseandLimitation
Indicator
Definition
SanitaryEngineersapersondulyregisteredwiththe
BoardofExaminersforSanitaryEngineers(RA1364)and
whoheadsthesanitationdivisionorsectionorunitofthe
province/city/municipalhealthofficeoremployedwith
theDepartmentofHealthoritsregionalfieldhealthunits.
SanitaryInspectorsagovernmentofficialorpersonnel
employedbynational,provincial,cityormunicipal
governmentwhoenforcessanitaryrules,lawsand
regulationsandimplementsenvironmentalsanitation
activitiesunderthesupervisionoftheprovince/city/
municipalhealthofficer/sanitaryengineers.Rural
Sanitaryinspectors(RSI),functionsaredirectedtowards
ensuringahealthymunicipality.Thisentailsadvocacy,
monitoring,andregulatoryactivitiessuchas,inspectionof
watersupplyandunhygienichouseholdconditions.
Nutritionist/Dieticianisahealthspecialistthatdevotes
professionalactivitytofoodandnutritionalscience,
preventivenutrition,diseasesrelatedtonutrient
deficiencies,andtheuseofnutrientmanipulationto
enhancetheclinicalresponsetohumandiseases.Theycan
alsoadvisepeopleondietarymattersrelatingtohealth,
wellbeingandoptimalnutrition.
BarangayHealthWorker(BHW)anindigenousmember
ofthecommunitythatactsasalinkofthehealthsystem
inthecommunity.
Formula
Target
RSI
1:20,000
Nutritionist
1:20,000
BHW
1:20HHs/
1:5,000
Source of
Data
Frequencyof
Reporting
UseandLimitation
3.2 N A T A L I T Y
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
Target
Sourceof
Data
Frequencyof
Reporting
1.CrudeBirthRate
Disaggregation:
Livebirthsby
Sex
Theratioofthetotalnumberoflivebirthsinagiven
populationduringayeartothemidyearpopulation
duringagivenperiodexpressedper1,000population.
Sometimesitisreferredtosimplyasthebirthrateand
alsolivebirthrate
DefintionofTerms:
Livebirthisthecompleteexpulsionorextractionfromits
motherofaproductofconception,irrespectiveofthe
durationofthepregnancy,which,aftersuchseparation,
breathesorshowsanyotherevidenceoflife,suchas
beatingoftheheart,pulsationoftheumbilicalcord,or
definitemovementofvoluntarymuscles,whetherornot
theumbilicalcordhasbeencutortheplacentais
attached;eachproductofsuchabirthisconsideredlive
born.
Numerator:Totalnumberof
Livebirths
Denominator:Total
Population
LCR and
TCL
(ensure
mechanism
forno
double
reporting)
Annual
2.Proportionof
Livebirths
Disaggregation:
Livebirthsby
weight
Thisreferstobabiesbornalivewhoweigh2500gramsand
greater,lessthan2500gramsandunknownweight.
DefinitionofTerms:
Birthweightisthefirstweightoftheinfantobtainedafter
birth.Forlivebirths,birthweightshouldpreferablybe
measuredwithinthefirsthouroflifebeforesignificant
postnatalweightlosshasoccurred.
2500gramsandgreaterlivebirthswithweightsequalto
orgreaterthan2500grams.
Lessthan2500gramslivebirthswithweightslessthan
2500grams
Notknownlivebirthswhoseweightsatbirtharenot
known.
Numerator:No.oflivebirths
byweight
2500grams&greater
lessthan2500grams
notknown
Livebirths
LCRand
TCL
(ensure
mechanism
forno
double
reporting)
Annual
UseandLimitation
TherateofLBWisarough
summarymeasureofmany
factors,includingmaternal,
nutrition,lifestyle(e.g.alcohol,
tobaccoanddruguse)and
otherexposuresinpregnancy
(e.g.infectiousdiseasesand
attitude).LBWisstrongly
associatedwitharangeof
adversehealthoutcomes,such
asperinatalmortalityand
morbidity,disabilityand
diseaseinlaterlife,butisnot
necessarilypartofthecause.
LBWisastrongpredictorofan
individualbabyssurvival.The
lowerthebirthweightthe
highertheriskofdeath.
Formula
Target
Sourceof
Data
Indicator
Definition
3.Proportionof
birthsattended
byskilledhealth
personnel
Disaggregation:
Livebirthsby
BirthAttendant
(doctor,nurse,
midwife)
Thisreferstobirthsattendedbyskilledhealthpersonnel.
Definitionofterms:
Skilledhealthpersonnel(sometimesreferredtoasskilled
attendant)isdefinedasanaccreditedhealthprofessional
suchasmidwife,doctorornursewhohasbeeneducated
andtrainedtoproficiencyintheskillsneededtomanage
normal(uncomplicated)pregnancies,childbirthandthe
immediatepostnatalperiod,andintheidentification,
managementandreferralofcomplicationsinwomenand
newborns.Thisdefinitionexcludestraditionalbirth
attendantswhethertrainedornot,fromthecategoryof
skilledhealthworkers.
MDGindicatorofProportion(%)ofbirthsattendedby
skilledhealthpersonnel:(G5.T6.I17):Percentageofbirths
attendedbyskilledhealthpersonneltototalnumberof
livebirthsinagivenyear.Skilledhealthpersonnelrefer
exclusivelytothosehealthpersonnel(forexample,
doctors,nurses,midwives)whohavebeentrainedto
proficiencyintheskillsnecessarytomanagenormal
deliveriesanddiagnoseorreferobstetriccomplications.
Traditionalbirthattendantstrainedoruntrainedarenot
includedinthiscategory.(WHO)
Numerator:TotalNo.of
90%(NOH LCRand
livebirthsattendedbyskilled
2016)
TCL
healthpersonnel
(ensure
mechanism
forno
livebirths
double
reporting)
4.Proportionof
deliveriesbyplace
HealthFacilityor
Noninstitutional
Delivery
Thisreferstodeliveriesbyplace.
Healthfacility:hospitals,RHUs,lyingins(including
BEMONC,CEMONC)
Noninstitutionaldeliveryincludes:homeandanydelivery
otherthanhealthfacility
Numerator:
No.ofDeliveriesat
home/healthfacility/
others
No.ofOtherTypeof
deliveriesathome/
healthfacility/others
Deliveries
90%of
deliveries
ina
health
facility
(NOH
2016)
LCRand
TCL
(ensure
mechanism
forno
double
reporting)
Frequencyof
Reporting
UseandLimitation
Annual
Theindicatorhelpsprogram
managementatdistrict,
nationalandinternational
levelsbyindicatingwhether
safemotherhoodprogramare
ontargetintheavailabilityand
utilizationofprofessional
assistanceatdelivery.In
addition,theproportionof
birthsattendedbyskilled
personnelisameasureofthe
healthsystemsfunctioning
andpotentialtoprovide
adequatecoveragefor
deliveries.Ontheotherhand,
thisindicatordoesnottake
accountofthetypeandquality
ofcare.
Annual
Proportionofbirthsdelivered
inafacility.Itisameasureof
thehealthsystems
functionalityandpotentialto
provideadequatecoveragefor
deliveries.
Indicator
Definition
5.Proportionof
deliveriesbytype
Disaggregation:
Type
Thisreferstodeliveriesbytype.
Definitionofterms:
DeliveriesbyType:
Normalreferstodeliveriesbynormalspontaneous
delivery(NSD)
OthersreferstodeliveriesdeliveredotherthanNSD
6.Proportionof
pregnancyby
outcome
Thisreferstopregnancybyoutcome.
Livebirthisthecompleteexpulsionorextractionfromits
motherofaproductofconception,irrespectiveofthe
durationofthepregnancy,which,aftersuchseparation,
breathesorshowsanyotherevidenceoflife,suchas
beatingoftheheart,pulsationoftheumbilicalcord,or
definitemovementofvoluntarymuscles,whetherornot
theumbilicalcordhasbeencutortheplacentais
attached;eachproductofsuchabirthisconsideredlive
born
FetalDeathdeathofthefetuspriortothecomplete
expulsionfromthemother;thedeathisindicatedbythe
factthatafterseparation,thefetusdoesnotbreathor
showanyevidenceoflifesuchasbeatingoftheheart,
pulsationoftheumbilicalcordordefinitemovementof
voluntarymuscles.(20weeksandabove)
Abortionistheterminationofapregnancybeforethe
fetushasattainedviability,i.e.becomecapableof
independentextrauterinelife
Formula
Numerator:
No.ofDeliveriesat
home/healthfacility/
others
No.ofOtherTypeof
deliveriesathome/
healthfacility/others
Deliveries
Target
Sourceof
Data
Frequencyof
Reporting
LCRand
TCL
(ensure
mechanism
forno
double
reporting)
Annual
LCRand
TCL
(ensure
mechanism
forno
double
reporting)
UseandLimitation
Whilethisisagoodmeasureof
riskfactoronpregnancyand
childbirth,itdoesnot
adequatelymeasureorpredict
theoutcomeofthepregnancy
orchildbirthperse.Thenew
paradigmshiftisallpregnancy
isatriskforcomplications.

3.3 M O R T A L I T Y
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
Sourceof
Data
Frequencyof
Reporting
LCRand
TCL,RHU
logbook
Annual
50%per
100,000
LB
LCRand
TCL,RHU
logbook
Annual
Thematernalmortalityratiois
themostwidelyusedmeasure
ofmaternaldeath.Itmeasures
obstetricriskinotherwords,
theriskofawomandyingonce
sheispregnant.Itdoesnot
thereforetakeintoaccountthe
riskofbeingpregnant(i.e.
fertility)inapopulation,which
ismeasuredbythematernal
mortalityrateorthelifetime
risk.
Measurestheriskofdying
duringthefirstyearoflife.Itis
agoodindexofthegeneral
healthconditionofa
communitysinceitreflectsthe
changesintheenvironmental
andmedicalconditionofa
community.
Target
1.MortalityRate
Disaggregation:
Sex
Anestimateoftheproportionofapopulationthatdies
duringaspecifiedperiod.
Numerator:No.ofpersons
dyingduringtheperiod
Denominator:Total
Population
2.Maternal
MortalityRatio
(MMR)
Theratioofthenumberofmaternaldeaths per100,000
livebirthsperyear.
Definitionofterms:
Maternaldeathisthedeathofwomanwhilepregnantor
within42daysofterminationofpregnancy,irrespectiveof
thedurationandthesiteofthepregnancy,fromanycause
relatedtooraggravatedbythepregnancyorits
management,butnotfromaccidentalorincidentalcauses.
Numerator:No.ofMaternal
Deaths
Livebirths
3.InfantMortality
Rate(IMR)
Theratioofthenumberofdeathsamonginfants(below
oneyearofage)per1,000Livebirths
Definitionofterms:
InfantMortalityRate:Probabilityofdyingbetweenbirth
andexactlyoneyearofage,expressedper1,000livebirths
Numerator:No.ofinfant
deaths(belowoneyearof
age)
livebirths
17deaths
per1,000
LB
(NOH
2016)
LCRand
TCL
Annual
4.UnderFive
MortalityRatio
Theprobabilityofdyingbetweenbirthandexactlyfive
yearsofage,expressedper1,000livebirths
Numerator:No.ofdeaths
amongchildrenunder5
yearsofage
livebirths
25.5
deaths
per1,000
LB(NOH
2016)
LCRand
TCL
Annual
UseandLimitation
Sourceof
Data
Frequencyof
Reporting
18
Perinatal
Deaths
per1,000
LB(NOH
2016)
LCRand
TCL,RHU
logbook
Annual
Numerator:Noofneonatal
deaths
livebirths
10Deaths
per1,000
LB(NOH
2016)
LCRand
TCL,RHU
logbook
Annual
Numerator:No.ofdeaths
duetoneonataltetanus
livebirths
Lessthan
1case
per1,000
livebirths
LCRand
TCL,RHU
logbook
Annual
Indicator
Definition
Formula
Target
5.Perinatal
MortalityRate
Isthenumberofdeathsoffetusesweighingatleast500g
(or, when birth weight is unavailable, after 22 completed
weeksofgestationorwithacrownheellengthof25cmor
more),plusthenumberofearlyneonataldeaths,per1000
totalbirths.Becauseofthedifferentdenominatorsineach
component,thisisnotnecessarilyequaltothesumofthe
fetaldeathrateandtheearlyneonatalmortalityrate.
Numerator:NumberofFetal
Deathsof28ormoreweeks
gestation+Numberof
Newbornsdyingunder7
daysofage)
Denominator:Numberof
LiveBirths+FetalDeathsof
28ormoreweeksgestation
X1000
6.Neonatal
mortalityrate
Anyneonataldeathbetweenbirthupto28daysofage.
7.NeonatalTetanus
MortalityRate
Anyneonataldeathbetween3and28daysofageinwhich
thecauseofdeathisunknownorduetoneonataltetanus.
UseandLimitation
Theperinatalmortality
indicatorplaysamajorrolein
providingtheinformation
neededtoimprovethehealth
statusofpregnantwomen,new
mothersandnewborns.That
informationallowsdecision
makerstoidentifyproblems,
tracktemporal(relatedtotime)
andgeographicaltrends
(relatedtoplace)and
disparitiesandassesses
changesinthepublichealth
policyandpractice.Thisisthe
mostsensitivemeasurefor
maternalhealthandnewborn
care.
3.4 ENVIRONMENTAL HEALTH
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
1.Proportionof
Householdswith
accesstoimproved
orsafewatersupply
(LevelI,II,III)
Referstohouseholdscoveredbyorhaveaccesstothe
followingimprovedtypesofdrinkingwatersources
Definitionofterms:
LevelI(PointSource)referstoaprotectedwell(shallow
anddeepwell),improveddugwell,developedspring,or
rainwatercisternwithanoutletbutwithoutadistribution
system.
LevelII(CommunalFaucetSystemorStandpost)refersto
asystemcomposedofasource,areservoir,apiped
distributionnetwork,andacommunalfaucetlocatednot
morethan25metersfromthefarthesthouse.Itis
generallysuitableforruralandurbanareaswherehouses
areclustereddenselyenoughtojustifyasimplepiped
watersystem
Note:ForreportingpurposesLevelIIsystemmayalso
includeacommunalfaucetconnectedtoLevelIIIwhere
groupofhouseholdsgettheirwatersupply.
LevelIII(WaterworksSystem)asystemwithasource,
transmissionpipes,areservoir,andapipeddistribution
networkforhouseholdtaps.Itisgenerallysuitedfor
denselypopulatedareas.ExamplesoftheseareMWSS
andwaterdistrictswithindividualhouseholdconnections.
Note:ForreportingpurposesLevelIIIsystemmayalso
includeaLevelIsystemwithpipeddistributionfor
householdtapservinggroupofhousingdwellingssuchas
apartmentsorcondominiums.
Numerator:TotalNo.of
Householdswithaccess
toimprovedorsafewater
supply
LevelI
LevelII
LevelIII
Denominator:TotalNumber
ofHouseholds
2.Proportionof
Householdswith
SanitaryToilet
Facilities
Referstohouseholdswithflushtoiletsconnectedtoseptic
tanksand/orseweragesystemoranyotherapproved
treatmentsystem,sanitarypitlatrineorventilated
improvedpitlatrine.
Numerator:Totalno.of
HouseholdswithSanitary
toilet
ofHouseholds
Target
Sourceof
Data
Frequencyof
Reporting
Annual
91%
(national)
96%
(urban)
86%
(rural)
Annual
UseandLimitation
Indicator
Definition
Formula
Target
41%Metro
Manila
20%other
highly
urbanized
areas
Sourceof
Data
Frequencyof
Reporting
3.Householdswith
satisfactorydisposal
ofsolidwaste
Referstohouseholdswithgarbagedisposalthrough
composting,burying,city/municipalsystem.
Refersontheinformationcollectedonthesanitarystatus
oftwoaspectsofsolidwastemanagement(storageand
collectionordisposal)
Numerator: TotalNo.of
Householdswithsatisfactory
disposalofsolidwaste
ofHouseholds
4.Proportionof
Householdswith
CompleteBasic
SanitationFacilities
Referstohouseholdswhichsatisfythepresenceofthe
followingbasicsanitationelements,namely:
(1)accesstosafewater
(2)availabilityofasanitarytoilet
(3)satisfactorysystemofgarbagedisposal
Numerator:Totalno.of
HouseholdswithComplete
BasicSanitationFacilities
ofHouseholds
5.Proportionof
FoodEstablishment
withSanitary
Permits
Referstotheratioofthenumberoffoodestablishments
withsanitarypermit.
Definitionofterms:
FoodEstablishmentEstablishmentwherefoodordrinks
aremanufactured,processed,stored,soldorserved,
includingthosethatarelocatedinvessels.Itreferstothe
totalnumberoffoodestablishmentswhichincludes
restaurants,sarisaristores,canteens,coffeeshops,
carinderia,refreshmentparlors,bakeries,waterrefilling
station,foodmanufacturing,bottling,dairyandcanning
establishments.
SanitaryPermitthecertificationinwritingofthecityor
municipalhealthofficerorsanitaryengineerthatthe
establishmentcomplieswiththeexistingminimum
sanitationrequirementsuponevaluationorinspection
conductedinaccordancewithPresidentialDecreesNo.522
and856andlocalordinances.
Numerator:Totalno.ofFood
Establishmentswith
SanitaryPermit
Denominator:Totalno.of
FoodEstablishments
100%
Annual
6.Proportionof
FoodHandlerswith
HealthCertificates
Referstotheratioofthenumberoffoodhandlersissued
withhealthcertificates.
Numerator:Totalno.ofFood
HandlersissuedHealth
Certificates
100%
Annual
Annual
Annual
UseandLimitation
Indicator
Definition
Definitionofterms:
FoodEstablishmentReferstothetotalnumberoffood
establishmentswhichincludesrestaurants,sarisaristores,
canteens,coffeeshops,carinderia,refreshmentparlors,
bakeries,waterrefillingstation,foodmanufacturing,
bottling,dairyandcanningestablishments
FoodHandlersReferstoapersonwhohandles,prepares,
servesfood,drinkoricewhocomesincontactwithany
cookingutensilsandfoodvendingmachines
HealthCertificatesacertificationinwriting,usingthe
prescribedform,andissuedbythemunicipalorcityhealth
officertoapersonafterpassingtherequiredphysicaland
medicalexaminationsandimmunizations
Formula
FoodHandlers
Target
Sourceof
Data
Frequencyof
Reporting
UseandLimitation

3.5 MATERNAL CARE
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
1. Totalno.of
deliveries
No.ofdeliveries
NumberofDeliveries
2.Proportionof
Pregnant
womenwith4
ormore
prenatalvisits
Theproportionofpregnantwomenwhohad4ormore
prenatalvisits.
DefinitionofTerms:
SignsofPregnancyaccordingtothreecategories:
a.Presumptive(1)Breastchanges,includingfeelingof
tenderness,fullness,ortinglingandenlargementor
darkeningofareola;(2)Nauseaorvomitinguponarising;
(3)Amenorrhea;(4)Frequenturination;(5)Fatigue;(6)
Uterineenlargementinwhichtheuteruscanbepalpated
overthesymphysispubis;(7)Quickening(fetalmovement
feltbythewoman);(8)Lineanigra(lineofdarkpigmenton
theabdomen);(9)Melasma(darkpigmentontheface);
and(10)Striaegravidarum(redsteaksontheabdomen).
b.Probable(1)Serumlaboratorytestrevealingthe
presenceofhumanchorionicgonadotropin(hCG)
hormone;(2)Chadwickssign(vaginachangescolorfrom
pinktoviolet);(3)Goodellssign(cervixsoftens);(4)Hegar
ssign(loweruterinesegmentsoftens);(5)Sonographic
evidenceofgestationalsacinwhichcharacteristicringis
evident;(6)Ballottement(fetuscanbefelttoriseagainst
abdominalwallwhenloweruterinesegmentistapped
duringbimanualexamination);(7)BraxtonHicks
contractions(periodicuterinetightening);and(8)
Palpationoffetaloutlinethroughabdomen.
c.Positive(1)Sonographicevidenceoffetaloutline;(2)
FetalheartaudiblebyDopplerultrasound;and(3)
Palpationoffetalmovementthroughabdomen
Numerator: Numberof
pregnantwomenwith4or
moreprenatalvisits
Denominator:
TotalPopulationx2.7%
Target
Sourceof
Data
90% (NOH RHU,TCL

2016)
Frequencyof
Reporting
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
levels)
UseandLimitation
Anindicatorofaccessand
utilizationofhealthcareduring
pregnancy
Itisstronglyencouragedthat
the first prenatal visit is
during the first trimester so
that preventive, promotive
healthinterventions(suchas
micronutrient
supplementation,screening
forcomplications)willbegiven
towomenintheearliest
possibletime.
Indicator
Definition
Formula
Target
Sourceof
Data
Frequencyof
Reporting
UseandLimitation
4ormoreprenatalvisitsmeansthatatleastonevisit
occursduringthefirsttrimester,oneduringthesecond
trimesterandatleast2visitsduringthethirdtrimester.If
visitsoccurredoutsidethecatchmentsRHU,thatvisit
shouldbecountedaspartoftheminimumrequirements.
Prenatalservicesinclude(1)completephysical
examinationofpregnantwomen(pregnancystatus)(2)
checkforpreeclampsia(3)checkforanemia(4)checkfor
syphilis(5)check/screenandtreatmentforSTIandHIV
status(6)respondtoobservedsignsorvolunteered
problems(7)givepreventivemeasures(8)adviceand
counselonfamilyplanning(9)checkonbirthand
emergencyplan(10)checkfornutritionalstatusand(11)
advocacyonbreastfeeding.
3.Proportionof Proportionofpregnantwomenimmunizedagainst
Pregnantwomen tetanus,havingatleasttwodosesoftetanustoxoidduring
given2dosesof
pregnancy.
TetanusToxoid
Numerator:No.ofpregnant
womengiven2dosesof
TetanusToxoid
Denominator:
4.Proportionof
PregnantWomen
givenTT2plus
ProportionofpregnantwomengivenTT2plusduringher
lastpregnancy.
DefinitionofTerms:
TT2plusincludes2nd,3rd,4thand5thdosesofTetanus
Toxoidgiventopregnantwomen.
Numerator:Numberof
pregnantwomengivenTT2
plus
Proportionofpregnantwomengivencompleteirontablet
withfolicacidsupplementation.
DefinitionofTerms:
Completeirontabletwithfolicacidsupplementation
refersto60mgofelementalironwith400mcgFolicacid,
onceadayfor6monthsor180tabletsfortheentire
Numerator:Numberof
pregnantwomengiven
completeironwithfolicacid
supplementation
5.Pregnantwomen
givencompleteiron
withfolicacid
supplementation
RHU
NSO
80%(NOH
2016)
Denominator:
Denominator:
80%
RHU
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
AssessthelevelofTT
immunizationprotection
amongpregnantwomen.
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
AssessthelevelofTT
immunizationprotection
amongpregnantwomen.
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Thereisahighprevalenceof
anemiainpregnantmothers.
Thisindicatorwilltellusif
adequateironsupplementation
isgivenortakenbythe
mother.
Indicator
Definition
pregnancyperiod.Theirontabletsreferredtoarethose
givenforfreetothemotherbytheRHUsandBHSsanddo
notincludeprescribedirontablets.Irontabletshouldbe
givenassoonaspregnancywasdiagnosed.Ifthepregnant
womendidnottakefullcourseof180tabletsshewillnot
beconsidered.
6.Proportionof
Postpartum
womenwithat
least2postpartum
visits
Proportionofpostpartumwomengivenatleast2post
partumvisits.
DefinitionofTerms:
Postpartumvisitsreferstovisitsseenbythe
midwife/PHN/MHOathomeorattheclinictwiceormore
thantwiceafterdeliverysuchthatfirstvisitshouldbe
after24hoursupondeliveryandthesecondvisitwithin
oneweekafterdelivery.
Note:Pregnantwomenwhodeliveredinthehospitalis
alreadyconsideredseeninthefirstvisitwhichis24hours
upondelivery.
7.Postpartum
womengiven
completeiron
supplementation
Proportionofpostpartumwomengivencompleteiron
supplementation.
DefinitionofTerms:
CompleteIronSupplementationrefersto60mgofFe
with400mcgFolicacid,onceadayfor3monthsoratotal
of90tablets.Ifpostpartummotherdidnottakefullcourse
of90tablets,shewillnotbeconsidered.
Formula
Sourceof
Data
Frequencyof
Reporting
RHU
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Majorityofmaternalmorbidity
andmortalityoccursatthe
postpartumperiod.Itis
importantthatthis
complicationbedetectedas
soonaspossible.
RHU
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Thereisahighprevalenceof
anemiainpostpartumand
lactatingwomen.
Denominator:
Totalnumberofpopulation
x2.7%
Numerator:Numberofpost
partumwomengiven
completeiron
supplementation
Denominator:
Totalnumberofpopulation
x2.7%
Numerator:
9.Proportionof
Postpartum
womengiven
partumwomengiven
VitaminAsupplementation
Denominator:
UseandLimitation
partumwomengivenat
least2postpartumvisits
8.Proportionof10 CompleteIronSupplementation refersto60mgofFe

49yearsoldwomen with400mcgFolicacid,onceadayoncemenarchestarts
givenIron
anduntilonegetspregnant.
supplementation
Proportionofpostpartumorlactatingwomengiven
VitaminAsupplementation
Target
12.3%
(50%of
age
group)of
TPfor
2013
FHSIS
80%
RHU
NSO
Proxyindicatorforsuccessin
interventiontodecreaseIron
deficiencyamongagegroup
1049yearsold
DatatakenfromIron
DeficiencySurveyFNRI2008
Monthly
(BHSto
RHU)
Numerousstudieshaveshown
thatpregnantand
postpartum/lactatingwomen
Indicator
Definition
Formula
Target
Sourceof
Data
Frequencyof
Reporting
Quarterly
(RHUto
nexthigher
level)
haveanincreaseriskofVitamin
ADeficiencyDisorder(VADD).
AnincreaseinVitaminA
concentrationofthemother,
resultstoanelevatedVitamin
Aconcentrationinher
breastmilkaswellasthe
VitaminAstatusofherbreast
fedchild.
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Successofbreastfeeding
initiationensurescontinuous
breastfeeding.Thisisoneway
ofevaluatingwhetherbirth
attendantsadvocate
breastfeedingandimplement
MilkCodeinallfacilitybased
deliveries.
VitaminA
supplementation
DefinitionofTerms:
VitaminAsupplementationrefersto200,000I.U.of
VitaminAcapsulewithin1monthafterdelivery
10.Proportion
Postpartum
womeninitiated
breastfeeding
within1hour
aftergivingbirth
Proportion of postpartum women who initiated

breastfeedingwithinonehouraftergivingbirth.Initiation
ofbreastfeedingisputtingthenewlydeliveredbabytothe
mothers abdomen in prone position and allowing the
newborntofindthemothersbreast(skintoskincontact)
Numerator:No.of
postpartumwomeninitiated
breastfeedingwithin1hour
aftergivingbirth
Denominator:
Totalnumberofdeliveriesx
3%(x2.7%?)
RHU
NSO
11.Percentageof
pregnant
womentested
forsyphilis
Proportionofpregnantfemaleswhoaretestedforsyphilis
usingRapidPlasmaReagin(RPR)orRapidDiagnosticTest
(RDT)
Disaggregatebyagegroup(<15yo,15to17yo,18to24yo,
>24yo)
Numerator:Numberof
pregnantfemaleswhoare
testedforsyphilisusingRPR
orRDT
Denominator:Totalnumber
ofpregnantfemaleswho
consultthehealthfacilityfor
thefirsttimeduringthat
reportingperiod
SSESS
Biannual
Manualof
Operations
(Appendix
A.1ICR);
FHSISTCL
12. Percentageof
pregnant
womengiven
Penicillin
Proportionofpregnantfemalesdiagnosedwithsyphilis
whoaregivenPenicillin
Disaggregatebyagegroup(<15yo,15to17yo,18to24yo,
>24yo)
Numerator:Numberof
pregnantfemaleswhoare
givenonedoseofPenicillin
forsyphilis
Biannual
SSESS
Manualof
Operations
Denominator:
UseandLimitation
Indicator
Definition
Formula
ofpregnantfemalesare
positiveforTPHA/TPPA;OR
RDT;ORRPRtiterof>1:8
dilution
Target
Sourceof
Data
(Appendix
A.1ICR);
FHSISTCL
Frequencyof
Reporting
UseandLimitation
3.6 FAMILY PLANNING
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
1.Contraceptive
PrevalenceRate
formodernFPuse
Theproportionofmarriedwomenofreproductiveage
(1549 years of age) who are using (or whose partner is
using)anymodernFPmethodatagivenpointintime.
Numerator:
Numberofmarriedwomen
ofreproductiveagewhoare
using(orwhosepartneris
using)amodernFPmethod
atagivenpointintime
Denominator:
Numberofmarriedwomen
ofreproductiveagewhoare
eligibletopractice
contraception(Total
Populationx12.325%)
14.5x85%=12.325%
Sourceof
Data
Frequencyof
Reporting
65%(NOH Family
2016)
Planning
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Target
UseandLimitation
Thisindicatorisusefulfor
measuringutilizationofFP
methods.Itisacomplementary
outputindicatortototal
fertilityrate.
Populationbasedsample
surveysprovidethemost
comprehensivedataon
contraceptivepracticesince
theyshowtheprevalenceofall
methods,includingthosethat
requirednosuppliesormedical
services.Estimatesmayalsobe
obtainedbysmallerscaleor
morefocusedsurveysandby
addingrelevantquestionsto
surveysonothertopics(e.g.
healthprogramprevalenceor
coveragesurveys).
Recordskeptbyorganized
familyplanningprogramare
anothermainsourceof
informationabout
contraceptivepractice.Such
recordsarecrucialtoeffective
monitoringandmanagement
ofprogram,andtheyhavethe
potentialtoprovidetimely
updatesanddetailedtrend
informationaboutnumbers
andcharacteristicsofprogram
Indicator
Definition
Formula
Target
Sourceof
Data
Frequencyof
Reporting
UseandLimitation
clients. Programstatisticshave
theseriousdrawback,however,
ofexcludingtheuseof
contraceptionobtainedoutside
theprogram,includingmodern
methodssupplies
2.
Contraceptive
Prevalence
Ratefor
ModernFamily
Planning
Methoduseof
womenin
reproductive
age.
Theproportionmarriedwomenofreproductiveage(1549
yearsofage)whoareusing(orwhosepartnerisusing)any
modernFPmethodatagivenpointintime.
DefinitionofTerms:
Modern Family Planning Method include Female

Sterilization/BTL and Male Sterilization/Vasectomy,
intrauterine devices IUD, oral pills, injectables and
implants. NFP Methods include Cervical Mucus Method
(CCM), Basal Body Temperature (BBT), Symptothermal
Method (STM), Standard Days Method (SDM) and
Lactational Amenorrhea Method (LAM). Surgical
sterilization (Female and Male Sterilization) is done those
coupleswhoreachedtheirdesirednumberofchildren.
Womenofreproductiveagerefertoallwomenaged1549
yearsold.
Eligiblepopulationorwomenofreproductiveagewhoare
atriskofgettingpregnantare:
sexuallyactive,
fecund
notpregnantandmenstruating
Excludingarethewomenwhohaveunderwent:
hysterectomy
bilateralsalpingooophorectomy,
bilateraltuballigation,and
Formula
Numerator:
No.ofWomenin
ReproductiveAge1549
yearsusingModernFamily
Planning(orwhosepartner
usesModernFamily
Planning)atanygivenperiod
oftime.
Denominator:
TotalNo.ofwomenin
reproductiveage1549
years.
Thisindicatorisusefulfor
measuringutilizationofFP
methods.Itisacomplementary
outputindicatortototal
fertilityrate.
Populationbasedsample
surveysprovidethemost
comprehensivedataon
contraceptivepracticesince
theyshowtheprevalenceofall
methods,includingthosethat
requirednosuppliesormedical
services.Estimatesmayalsobe
obtainedbysmallerscaleor
morefocusedsurveysandby
addingrelevantquestionsto
surveysonothertopics(e.g.
healthprogramprevalenceor
coveragesurveys).
Recordskeptbyorganized
familyplanningprogramare
anothermainsourceof
informationabout
contraceptivepractice.Such
recordsarecrucialtoeffective
monitoringandmanagement
ofprogram,andtheyhavethe
potentialtoprovidetimely
updatesanddetailedtrend
informationaboutnumbers
Indicator
Definition
Formula
CurrentUsers(CU)areFPclientswhohavebeencarried
overfromthepreviousmonthsafterdeductingthedrop
outsofcurrentmonthandaddingthenewacceptorsof
thepreviousmonthandaddingtheOtherAcceptorsofthe
currentmonth
Restarter(RS)
ChangingMethod(CM)
ChangingClinic(CC)
4. No.ofNew
Acceptors
NewAcceptor(NA)aclientusingacontraceptivemethod
forthefirsttimeorhasneveracceptedanyModernFamily
Methodwhoisnewtotheprogram
5. No.ofDropouts
Dropouts Ifaclientfailstoreturnforthenextservice
dateorotherconditions(e.g.BSO,Hysterectomy),sheis
consideredadropout.Theserviceprovidershouldhave
donevalidationpriortodroppingoutoftheclient.
Sourceof
Data
Frequencyof
Reporting
UseandLimitation
andcharacteristicsofprogram
clients.Programstatisticshave
theseriousdrawback,however,
ofexcludingtheuseof
contraceptionobtainedoutside
theprogram,includingmodern
methodssupplies
husbandsorpartnerswhounderwentVasectomy
3. No.ofCurrent
Users
Target
FormulaforCUatEndof
Month/Quarter
=CUofpreviousmonth
+NewAcceptorofprevious
month
+Otheracceptorsofpresent
month
Dropoutofpresentmonth

3.7 CHILD CARE
_____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
Target
Sourceof
Data
Frequencyof
Reporting
UseandLimitation
1.Proportionof
InfantsgivenBCG
Vaccine
AninfantwhohasreceivedBCGvaccineanytimeafterbirth
beforereachingoneyearofage.
Numerator:Numberof
infantsgivenBCG
Denominator:
90%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
BasisforcomputationofFIC,
numberofunimmunized
children,trackingdefaulters,
accesstoimmunization.
2.Proportionof
Infantsgiven
Pentavalent1,
Pentavalent2,
Pentavalent3
vaccines
Aninfantwhoreceived(Pentavalent1,Pentavalent2or
Pentavalent3)beforereachingoneyearold.
Pentavalentvaccinereferstothecombinationvaccineof
DPTHepBHinfluenzatypeB(HiB)
Numerator:Numberofinfant
givenPentavalent1/
Pentavalent2/Pentavalent3
Denominator:
90%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
numberofunimmunized
accesstoimmunization.Assess
populationimmunityineach
cohortofchildrenborn.
3.Proportionof
InfantsgivenOPV1,
OPV2,OPV3
AninfantwhoreceivedspecificOPVantigens(eitherOPV1,
OPV2,orOPV3)beforereachingoneyearold
Numerator: Numberofinfant
givenOPV1/OPV2/OPV3
Denominator:
90%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
numberofunimmunized
Mainindicatorforthe
eradicationofPolio
4.Proportionof
Infantsgiven
HepatitisB1within
24hoursafterbirth
Aninfantwhoreceived1stdoseofHepatitisBvaccine
within24hoursafterbirth
Numerator:Numberofinfant
givenHepaB1w/in24hours
afterbirth
Denominator:
65%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
numberofunimmunized
5.Proportionof
Infantsgiven
Aninfantwhoreceived1stdoseofHepatitisBvaccinemore Numerator: Numberofinfant

than24hoursafterbirth
givenHepaB1morethan24
90%
Children
Monthly
(BHSto
numberofunimmunized
Indicator
Definition
HepatitisB1more
than24hoursafter
birth
Formula
Target
hoursafterbirth
Denominator:
Sourceof
Data
Frequencyof
Reporting
<1
TCL
NSO
RHU)
Quarterly
(RHUto
nexthigher
level)
UseandLimitation
6.Proportionof
Infantsgiven
Measlescontaining
vaccine(MCV1)
AninfantwhoreceivedonedoseofMeaslescontaining
vaccineat911monthsold.Thisshallbereferredtoasthe
1stMeaslesContainingVaccine(MCV1)
Numerator: Numberof911
mos.oldinfantgiven
Measlescontaining
vaccine(MCV1)
Denominator:
90%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
numberofunimmunized
7.Proportionof
Childrengivena
doseofMeasles
MumpsRubella
Vaccine
(MMR)(MCV2)
Achild1215monthsofagewhoreceivedonedoseof
MMR.Thisshallbereferredtoasthe2nddoseofthe
Measlescontainingvaccine(MCV2)
Numerator: Numberof
childrengivenMMR
Denominator:
90%
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
numberofunimmunized
8.Proportionof
infantsgiven
Rotavirusvaccines
Aninfantwhoreceivedeither:
OptionA:2doseregimenofrotavirusvaccineat6weeks
32weeksofage
or
OptionB:3doseregimenofrotavirusvaccineatspecific
recommendedschedule
givenRotavirusVaccine
Denominator:
90%
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Basisforcomputationforthe
totalpopulationimmunityfora
certainbirthcohort
9.Proportionof
infantsgiven
Pneumococcal
ConjugateVaccines
AninfantwhoreceivedPneumococcalConjugateVaccines
(PCV1,PCV2,PCV3)beforereaching1yearold
givenPCV1/PCV2/PCV3
90%
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
certainbirthcohort
(Rota1,Rota2)
Or
Proportionofinfantsgiven
Rotavirusvaccines(Rota1,Rota
2,Rota3)
Indicator
Definition
(PCV1,PCV2,PCV
3)
Formula
Target
Denominator:
Sourceof
Data
Frequencyof
Reporting
(RHUto
nexthigher
level)
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
UseandLimitation
10.Proportionof
FullyImmunized
Child
Aninfantwhoreceived1doseofBCG,3doseseachof
OPV,3doseseachofPentavalentvaccinesand1doseof
Measlescontainingvaccinebeforereachingoneyearold.
11.Proportionof
Completely
ImmunizedChild
Achild12to23monthsofagewhoreceived1doseofBCG, Numerator:No.of
3doseseachofOPV,3doseseachofPentavalentvaccines CompletelyImmunizedChild
and1dosesofMeaslescontainingvaccines
Denominator:
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
certainbirthcohort.
12.Proportionof
ChildProtectedat
Birth(CPAB)
Referstoachildwhose:
(1)Motherhasreceived2dosesofTTduringthis
pregnancy,providedTT2wasgivenatleastamonth
priortodelivery,or
(2)Motherhasreceivedatleast3dosesofTTanytime
priortopregnancywiththischild
Numerator:
TotalNo.ofChildrenwhose
mothersweregivenatleast
TT2ormore
Denominator:
TotalNo.oflivebirths
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
TetanusToxoidImmunizationis
giventopregnantwomenin
ordertoprotectthenewborn
andherselffromtetanus.
AChildwhowasexclusivelybreastfed frombirthto6
Numerator:
13.Proportionof
Numerator:No.ofFully
ImmunizedChild
Denominator:
90%
(Program
yearly
target)
60%by
Anoverallprogramindicatorto
assesstheproportionoffull
complementofimmunization
duringthefirstyearoflife.
Percentofprotectedatbirth
(PAB)isasupplemental
methodofdetermining
coverageprotection
(particularlywhereTT2+is
unreliableandwhereDTP1
coverageishigh).Tomonitor
PABduringDTP1visits,health
workersrecordwhetherinfants
wereprotectedatbirthbythe
mothersTTstatus.%PABis
thenestimatedas:numberof
infantsprotecteddividebythe
totalnumberofbirths
ExclusiveBFprovidesoptimum
Indicator
Infantsexclusively
breastfeduntil6th
month
Definition
monthsofage.Exclusivebreastfeedingmeansnoother
food(includingwater)otherthanbreastmilk.Dropsof
prescribedvitaminsandmedicationwithindicationgiven
whilebreastfeedingisstillexclusivelybreastfed.
Formula
Target
Sourceof
Data
Frequencyof
Reporting
TotalNo.of Infants
exclusivelyBreastfeduntil6th
month
Denominator:
2010
70%by
2015
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
nutritionforthefirst6months
oflifeandthenumberone
preventivestrategytosave
livesofbelowfivechildren.
Thisindicatoralsodetermines
theprogressofBFpracticefor
programplanningandpolicy
directionandbasisforresearch
agendatoimproveBFpractice
inthecountrytoassessthe
implementationofEO51
90%by
2010
95%by
2016
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Thiswilldeterminecontinued
breastfeedingandtimely,
appropriatecomplimentary
feedingtopreventunder
nutrition
100%
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Children
<1
TCL
NSO
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
14.Proportionof
infants68months
ofagewhoreceived
solid,semisolidor
softfood
Complementaryfoodsandfoodsgivenstartingat6months Numerator:Infants68
tocomplimentbreastfeeding
monthswhoreceived
solid,semisolidorsoft
foodsduringtheprevious
day
Denominator:No.ofLive
births
15.Proportionof
Thisreferstoinfantsreferredfornewbornscreening.
Infantreferredfor Referralslipsmaybeused.
newbornscreening
Note:NBSReferralis48hoursofbirthto72hours
16.Infant/Children
givenVitaminA
supplementationby
Agegroup
611
1223
2435
3647and
4859monthsold
ReferstoInfant/ChildrengivenVitaminAsupplementation.
RecommendedDosage:
611monthsold1doseof100,000I.U.Onecapsuleis
givenanytimeduringthe611monthsbutusuallygivenat
9monthsduringthemeaslesimmunization.
1259monthsold200,000I.U.Dosageanddurationis1
capsuleeverysixmonths.
No.ofInfantsreferredfor
newbornscreening
Numerator:No.of
Infant/Children
givenVitaminA
supplementation
Denominatorfor611mos:
90%(NOH
2016)
forage
group
under6
yearsof
age
UseandLimitation
Indicator
17.Infant/
ChildrengivenIron
supplementation
Definition
Referstoinfants611monthsold givenIrondrops, 1223
monthsoldgivenIronsyrup.
Formula
Target
Numerator:No.of
infant/Childrenmonthsold
givenIron
Sourceof
Data
Frequencyof
Reporting
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
18.Children1259
mos.oldgivende
worming
tablet/syrup
Referstochildren1259monthsoldgivendeworming
tablet/syruptwiceayear
No. ofchildren1259months
oldgivendeworming
tablet/syrup
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
19.Infant611
monthsconsumed
60sachetsof
micronutrient
powders(MNP)
Referstoinfants611monthsoldconsumedmicronutrient
powders
DefinitionofTerms:
MicronutrientPowderreferstopremixvitaminsand
mineralsinpowderform.
Everychildwillreceiveatotalof60sachetsoveraperiod
of6months
Numerator:No.ofinfant6
11monthsoldgivenMNP
Denominator:Total
Populationx1.35%
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
20.Children1223
months
consumed120
sachetsof
Micronutrients
powder(MNP)
Referstochildren1223monthsoldconsumed
micronutrientpowder.
DefinitionofTerms:
MicronutrientPowderreferstopremixvitaminsand
mineralsinpowderform.
Everychildwillreceive60sachetsevery6monthsfora
totalof120sachetsinayear.
Numerator:No.ofchildren
1223monthsoldgiven
MNP
Denominator:Total
Populationx2.7%
TCL
21.SickChild/
Children611mos.
and1259mos.
Referstoachild/children611and1259monthsoldseen
andidentifiedassickchild.
Numberofsickchildren6
11,1259oldseen
Sick
Child
Care
Monthly
(BHSto
RHU)
UseandLimitation
Indicator
Definition
Formula
(disaggregatedby
sex)
Definitionofterms:
SickChildrenarethosechildrenwithatleastonethe
followingcategories:
Severepneumonia(referstopresenceofanygeneral
dangersignorchestindrawingorstridorincalmchild)
Severepersistentdiarrhea(referstoanepisodeofsoftto
waterystoolslastingmorethan14days)
Measles(Historyoffeverorhottotouch;generalized
nonvesicularrashof3ormoredaysdurationandat
leastoneofthefollowing:cough,coryzaorconjunctivitis
Severelyunderweight(referstochildrenwhoseweight
areclassifiedasverylowbelownormal)
22.No.ofSick
Childrenbyage
givenVitaminA
capsule
611mos.
and
1259mos.
(disaggregatedby
sex)
Anysickchild/childrengivenVitaminAcapsule.Dosageof
VitaminAfor611montholdinfantis100,000IU,while12
to59montholdinfantsaregiven200,000IU(1capsule
every6months).
Numerator:Numberofsick
children611/1259
monthsgivenVitaminA
capsule
Denominator:Numberofsick
children611,1259
monthsoldseen
23.Infants
withlowbirth
weightseen
(disaggregated
bysex)
Thisreferstoinfants26monthsoldseenwithlowbirth
weight(weightatbirthislessthan2.5kilograms)
No.ofinfants26monthsold
seenwithlowbirth
weight
24.Infantswith
lowbirthweight
giveniron
Thisreferstolowbirthweight(LBW)infants26months
oldwhoseweightatbirthislessthan2.5kilogramsand
wasgivenironsupplementation.Dosageis0.3mloncea
daytostartattwomonthsofageuntil6monthswhen
Numerator:No.ofinfants2
6mos.oldwithlowbirth
weightgiveniron
supplementation
Target
100%
100%
Sourceof
Data
Frequencyof
Reporting
TCL
Quarterly
(RHUto
nexthigher
level)
Sick
Child
Care
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Children
<1
TCL
Monthly
(BHSto
RHU)
Quarterly
UseandLimitation
Vit.Aisgiventohighrisk
childrenbecauseithelpsre
establishbodyreservesdrained
bychronicorrepeated
infections&protectsthe
childrenagainstseverityor
subsequentinfections.Italso
reducesthecomplicationsofan
existingmeaslesinfection&
lowersmeaslesmorbidity&
mortality.
Giveironsupplementstolow
birthweightinfantsat2
months,astheyarebornwitha
lowerironsupplyandareat
Indicator
supplementation
(disaggregated
bysex)
Definition
complementaryfoodsaregiven.(Preparationis15mg.
elementaliron/0.6ml).Needtoassessforfurther
management
Formula
Target
Sourceof
Data
Frequencyof
Reporting
UseandLimitation
(RHUto
highriskforirondeficiency
nexthigher evenifexclusivelybreastfed.
level)
Denominator:No.ofinfants
26mos.oldseenwithlow
birthweight
prevalenceofLBW=19.6%
25.AnemicChildren Thisreferstoanemicchildren6to59monthsoldseen.
611monthsand
1259months
old
seen
(disaggregated
bysex)
No. ofanemicchildren611
monthsand259monthsold
seen
Sick
Child
Care
TCL
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
26.AnemicChildren
611monthsand
1259months
old
giveniron
supplementation
(disaggregated
bysex)
Thisreferstoanemicchildren6to59monthsoldgiven
ironsupplementation(syrup).Dosageis1tsp.onceaday
for3monthsor30mg.onceaweekfor6monthswith
supervisedadministration.
Giveapproximately0.6ml,23timesadayfor3months
Numerator:No.ofanemic
children611monthsand
1259monthsoldgiven
ironsupplementation
anemicchildren6
11monthsand1259
monthsoldseen
Sick
Child
Care
TCL
NSO
ITR
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
27.Diarrheacases
059months
oldseen
(disaggregated
bysex)
Referstochildren059monthsoldseenwithdiarrhea.
No.ofdiarrheacases059
monthsoldseen
Sick
Child
Care
TCL
ITR
IMCI
form
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
28Diarrheacases
059monthsold
givenORSonly
(disaggregated
bysex)
Referstochildren059monthsoldwithdiarrheagivenOral
RehydrationSaltonly.
Definitionofterms:
OralRehydrationSaltisthenonproprietarynamefor
balancedglucoseelectrolytemixtureusefortreatmentof
Numerator:No.ofdiarrhea
cases059monthsold
givenORS
Denominator:No.ofdiarrhea
cases059monthsold
Sick
Child
Care
TCL
ITR
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
Identificationofcommonly
usedrehydrationsolutionin
diarrheamanagementfor
planning/budgetingpurposes
Indicator
Definition
Formula
clinicaldehydration.
Target
Sourceof
Data
seen
Frequencyof
Reporting
level)
IMCI
form
29.Diarrheacases
059monthsold
givenORS/ORT
andzinc
(disaggregated
bysex)
Referstochildren059monthsold withdiarrheagiven
ORS/ORTwithzinc.Dosageforchildrenlessthan6months
is10mgelementalZn/dayandforchildrenmorethan6
monthsis20mgelementalZinc/dayx1014days.
Definitionofterms:
OralRehydrationTherapyreferstoincreaseinfluidintake
andcontinuousfeeding.(advice)
Numerator:No.ofdiarrhea
cases059monthsold
givenORS/ORTwithzinc
Denominator:No.ofdiarrhea
cases059monthsold
seen
Sick
Child
Care
TCL
ITR
IMCI
form
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
30.Pneumonia
cases059mos.
oldseen
(disaggregated
bysex)
Referstochildren059monthsoldseenwithpneumonia
No.ofpneumoniacases059
monthsoldseen
Sick
Child
Care
TCL
ITR
IMCI
form
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
31.Pneumonia
cases059mos.
oldgiven
treatment
(disaggregated
bysex)
Referstochildren059monthsoldseenwithpneumonia
andgivenantibiotictreatment
Numerator:No.of
pneumoniacases059
monthsoldgiven
treatment
Denominator:No.of
pneumoniacases059
monthsoldseen
Sick
Child
Care
TCL
ITR
IMCI
form
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
UseandLimitation
Identificationofcommonly
usedrehydrationsolutionin
diarrheamanagementfor
planning/budgetingpurposes
3.8 DENTAL HEALTH
_____________________________________________________________________________________________________________________________________________________________
Sourceof
Data
Frequency
ofReporting
UseandLimitation
Numerator:No.oforallyfit
children1271monthsold
Denominator:
TPx13.5%
ITR
Oral
Health
Form2
(Consolidated
OralHealth
Statusand
Services
Report)
NSO
Quarterly
(RHUto
nexthigher
level)
Tomeasuretheoutcomeof
totalhealthcareofchildrenless
than6yearsoldforplanning
andevaluation.
Proportionofchildrenwhoseagesrangesfrom12to71
monthsoldandwereprovidedwithBasicOralHealth
Care(BOHC)
Definitionofterms
BasicOralHealthCare(BOHC)providedtochildren12
71monthsoldreferstooneormoreofthefollowing
services:
(1)OralExamination
(2)80%AttendancetoSupervisedToothBrushing
(3)AltraumaticRestorativeTreatment(ART)
(4)OralUrgentTreatment(OUT)
removalofunsavableteeth,or
referralofcomplicatescases,or
treatmentofpostextractioncomplications,or
drainageoflocalizedoralabscess
Numerator:Numberof
children
1271monthsoldprovided
withBOHC
Denominator:
TPx13.5%
ITR
Oral
Health
Form2
NSO
Quarterly
(RHUto
nexthigher
level)
totalhealthcareofchildrenless
than6yearsoldforplanning
andevaluation.
Proportionofadolescentsandyouthwhoseages
rangesfrom10to24yearsoldandwereprovidedwith
BasicOralHealthCare(BOHC)
Numerator:Numberof
AdolescentandYouth
(1024yearsold)provided
Indicator
Definition
1.OrallyFit
Children(1271
monthsold)
(disaggregated
bysex)
Proportionofchildren12to71monthsoldandare
orallyfitduringagivenpointintime
DefinitionofTerms:
OrallyFitChildrenreferstochildrenwhomeetallof
thefollowinguponoralexaminationand/orcompletion
oftreatment:
(1)carriesfreeordecayedteethfilled(permanent
fillings)
(2)hashealthygums
(3)nooraldebris,and
(4)nodentofacialanomalythatlimitsnormalfunction
2.Children1271
monthsold
providedwith
BasicOral
HealthCare
(BOHC)
(disaggregated
bysex)
3.Adolescentand
Youth(1024
yearsold
Formula
Target
ITR
Oral
Quarterly
totalhealthcareofadolescent
(RHUto
nexthigher andyouthforplanningand
Indicator
Definition
Formula
Target
Sourceof
Data
Frequency
ofReporting
UseandLimitation
providedwith
BasicOral
HealthCare
(BOHC)
(disaggregated
bysex)
Definitionofterms
BasicOralHealthCare(BOHC)providedtoAdolescents
andYouth(1024yearsold)referstooneormoreof
thefollowingservices:
(1)OralExamination
(2)Educationandcounselingonhealtheffectsof
tobacco/smoking,diet,andoralhygiene
withBOHC
Denominator:
TPx30%(2008)
Health
Form2
NSO
level)
evaluation.
4.Pregnant
women
providedwith
BasicOral
HealthCare
(BOHC)
Proportionofpregnantwomenwhowereprovided
withBasicOralHealthCare(BOHC)
Definitionofterms
BasicOralHealthCare(BOHC)providedtoPregnant
Womenreferstooneormoreofthefollowing
services:
(1)OralExamination
(2)Scaling
(3)PermanentFilling
(4)GumTreatment
Numerator:Numberof
PregnantWomenprovided
withBOHC
Denominator:
TPx2.7%
ITR
Oral
Health
Form2
NSO
Quarterly
(RHUto
nexthigher
level)
totalhealthcareofpregnant
womenforplanningand
evaluation.
5.OlderPersons
60yearsoldand
aboveprovided
withBasicOral
HealthCare
(BOHC)
(disaggregated
bysex
Proportionofolderpersonages60yearsoldandabove
whowereprovidedwithBasicOralHealthCare(BOHC)
Definitionofterms
BasicOralHealthCare(BOHC)providedtoOlderPerson
referstooneormoreofthefollowingservices:
(1)OralExamination
(2)Extraction
(3)GumTreatment
Numerator:Numberof
OlderPersonsprovided
withBOHC
Denominator:
TPx6.9%
ITR
Oral
Health
Form2
NSO
Quarterly
(RHUto
totalhealthcareofolderperson
nexthigher forplanningandevaluation.
level)
3.9 F I L A R I A S I S
_____________________________________________________________________________________________________________________________________________________________
Formula
Target
Sourceof
Data
1.Prevalencerate Microfilariaprevalence(mf%):Proportionofblood
ofmicrofilariain slides(20microL)foundpositiveformicrofilaria.
endemic
provinces
Numerator:No.of
individuals
whoseslidesarepositive
formf
individualsexaminedfor
mf
N/Dx100=MFR
Prevalenceof
microfilariaof<1%
(Globaland
NationalStandard)
Filariasis
Registry
(44
provinces)
2.Microfilaria
density(MFD)in
endemic
municipalities
MFD:averagenumberofmicrofilariainslides
positiveformicrofilariaexpressedaspermLof
capillaryblood
100X50/10=50
Numerator:Totalcountof
microfilariaintheslides
foundpositivex50
(presuming20microliter
perslide)
slidesfoundpositive
Reduce
Filariasis
microfilaria
Registry
densityinendemic
municipalitiesto0
Annual
3.MassDrug
Administration
Coverageamong
eligiblepopulation
MDAcoverageusingeligiblepopulation/target
populationinendemicprovincesProportionof
targetpopulationcoveredbyMDAduringthe
reportingyear
givenMDA
Denominator:Total
Populationaged2yrsand
aboveinimplementingunits
forMDA
(eligiblepopulation)
85%coveragefor
eligiblepopulation
Filariasis
Registry
Annual
givenMDA
Denominator:Total
Population
65%coveragefor
totalpopulation
Filariasis
Registry
Annual
Indicator
Definition
4.MassDrug
MDAcoverageamongtotalpopulation.
Administration
Coverageamong
totalpopulation
Frequency
ofReporting
Annual
UseandLimitation
Baselineis9.7casesper1,000
population(DOHNCDPC1998)
Baselineshows0provincehas
<1%
Baselineof82%masstarget
coveragein30endemicareas
(DOHNCDPC)
Indicator
5.ClinicalRateof
Filariasis
Definition
Proportionofpeopleexamined showingthe
chronicmanifestationofLFex.(Hydrocele,
Lymphedema,Elephantiasis(lowerandupper
extremities,breast,penisandscrotum)and
Chyluria
Formula
Numerator:No.ofpatients
withLymphedemaor
HydroceleorElephantiasisor
Chyluria
Denominator:Total
Numberofpeopleexamined
Target
Sourceof
Data
Filariasis
Reduce
adenolymphangitis Registry
attackstooneper
year
Frequency
ofReporting
Annual
UseandLimitation
3.10 L E P R O S Y
_____________________________________________________________________________________________________________________________________________________________
Indicator
1.Leprosy
PrevalenceRate
Definition
Prevalenceisthenumberofleprosycases
registeredatagivenpointintimeandthe
prevalencerateisper10,000totalpopulation.
Acaseofleprosyisapersonpresentingclinical
signsofleprosy(withorwithoutbacteriological
examination)whohasyettocompleteafullcourse
oftreatment.Apatientwhohascompletedafull
courseoffixeddurationMDT(6dosesforPBand12
dosesforMB)iscured.
AnMBpatientwhohasnotcollectedtreatmentfor
6consecutivemonthsandaPBpatientwhohasnot
collectedtreatmentfor3consecutivemonthsare
considereddefaulterandshouldstartretreatment
butnotremovedfromtheprevalence.
Includes:
1) stillneedingtreatment(includingreturnafter
default)
2) transin
3) Newcases
4) defaulted
Excludes:
1) Treatmentcompleted
2) Casescured
3) Transout
4) Died
Formula
Numerator:No.ofLeprosy
Cases
Denominator:Total
Population
Target
Lessthanone
caseper10,000
Population
Sourceof
Data
Leprosy
Registry
Frequency
ofReporting
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
UseandLimitation
Prevalencerate.Ifthe
prevalencerateishigh
(prevalencerate>1per10000
population),thiscanindicate
severalpossibilities:(1)high
transmissioninthedistrict(2)
resultofleprosyelimination
campaigns(3)resultofover
diagnosis(4)resultofrecycling
ofoldpatients,or(5)standard
MDTregimenisnotfollowedor
lowcurerate(accumulationof
patients)(6)shouldincrease
becauseofthepopulation
factor.
Italsosignifiesmagnitudeof
thecaseloadsparticularly
hiddencasesinthecommunity
Indicator
2.Casedetection
rate
Definition
Detectionanddetectionrate.Numberofcases
newlydetectedduringthereportingperiodand
nevertreatedbefore.Thedetectionrateisper
100,000totalpopulation.
Formula
Numerator:No.ofNewly
Detectedcasesduring
reportingperiod
Denominator:Total
Population
Target
Sourceof
Data
Leprosy
Benchmark:
Lessthan5%from Registry
previousyear
Frequency
ofReporting
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
UseandLimitation
Detectionrate.Ifthedetection
rateishigh,thepossibilitiesare
thesameasthefirstfourabove
pluscommunityawareness
maybeincreasing.Ifthetrend
isdecreasing,thefollowing
possibilitiesshouldbe
considered:1)transmissionis
decreasing,2)MDTservicesare
becominglessactive,or3)
imageofleprosyhasbeen
damaged.
Regarding(2)MDTservicesare
becominglessactive,itis
naturaltosomeextentthatthe
detectiondecreasesafter
intensifiedcasefinding
activitieslikeleprosy
eliminationcampaigns.Review
iftherestoftheservicesare
notdeteriorating.Regarding(3)
imageofleprosyhasbeen
damaged,IECactivitiescould
haveanegativeimpactonthe
imageofleprosy.ReviewIEC
materialsandinterview
patientsandthecommunity.
Themostusefulindicatorsfor
estimatingthemagnitudeof
theproblemandthelevelof
ongoingtransmission.Case
detectionisalsoessentialon
calculatingdrugneeds.
Frequency
ofReporting
Definition
Formula
3.Proportionof
newlydetected
leprosycases
below15years
ofage
Thenumberofnewlydiagnosedpatientsbelowthe
ageof15dividedbythenumberofnewlydetected
patientsforwhomageisrecorded.
casesbelow15yearsof
age
Denominator:No.ofnewly
detectedLeprosycases
Benchmark:
Leprosy
previousyear
Monthly
Givesanindicationofongoing
(BHSto
transmission
RHU)
Quarterly
(RHUto
nexthigher
level)
Benchmark:
Leprosy
previousyear
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Givesanindicationofthedelay
betweenonsetofsymptoms
andthestartoftreatmentand
theseverityofthediseasein
newcases
Monthly
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
Curerate,defaulterrate.Cure
rateshouldbeascloseto100%
aspossibleitshouldbe
ensuredthatallpatients
registeredfortreatmentare
cured.Lowcurerates,high
defaulterratesandhigh
proportionofpatientsstillon
treatmentafterhaving
completedthestandard
regimencanindicatefollowing
problems:(1)MDTservicenot
flexible.Improveservice
deliverytobemorepatient
friendly(2)Patientfollowupis
notsatisfactory.Should
improvefollowupofirregular
patientswhereverpossible(3)
patientisnotwellinformedof
importanceofcontinuingMDT.
Conductproperpatient
4.Proportionof
newlydetected
caseswith
gradetwo
disability
MethodofcalculationofpercentagewithGrade2
disabilityinleprosyiscausedbydamageofthe
peripheralnerves
caseswithGrade2
disability
Denominator:No.ofnewly
detectedLeprosycases
5.Curerate
(treatment
completion)
Curerate.Numberofpatientswhohavereceiveda
completetreatment(6blistersforPBpatientsand
12blistersforMBpatients)inagroupofpatients
detectedduringagivenperiod69monthsforPB
patientsand1218monthsfortheMBpatientsfor
thecohortanalysis).
Tofacilitatethecalculationoftheaveragecure
rate,itisrecommendedtotakethesameperiodof
oneyearbeforethereportperiod,aswellasforPB
andMBpatients,dividedbythenumberofpatients
detectedintheselectedperiod.
casesgotcured
Leprosycases
Target
Sourceof
Data
Indicator
100%
Leprosy
Registry
UseandLimitation
Indicator
Definition
Formula
Sourceof
Data
Target
Frequency
ofReporting
UseandLimitation
educationandcounseling(see
GuideforHealthProfessionals
toEliminateLeprosyasaPublic
HealthProblem)and(4)MDT
wasnotalwaysavailable.Keep
sufficientMDTstockand
improvestockmanagement.
Importantforassessingthe
qualityofpatientmanagement
aswellasprogram
performance
3.11 M A L A R I A
____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Formula
Target
Sourceof
Data
Frequency
ofReporting
UseandLimitation
1.Morbidityrateof
ConfirmedMalaria(per
100,000pop)
Numberofconfirmedmalariacasesovertotal
populationx100,000disaggregatedbysexand
age(>5and<5yearsofage)
Typesoftransmission(define):
Stable
Unstable
Sporadic
Numerator:No.of
confirmedmalariacases
Denominator:
TotalPopulationx
100,000
15casesper
100,000
populationin
stablerisk
provinces
2.6casesper
100,000in
unstableand
sporadicrisk
provinces
Malaria
Registry
Annual
2.AnnualParasite
Incidence
Numberofconfirmedmalariacasesover
populationatriskx1,000disaggregatedbysex
andage
Populationatriskreferstothepopulationof
endemicareaswithahighriskofMalariacases.
Numerator:No.of
confirmedmalariacases
Denominator:Atrisk
Populationx1,000
<0.1/1,000
Malaria
Registry
Annual
Toknowwhichprovincesare
atpreeliminationphase.
Malaria
Registry
Quarterly
Inmanycountriestheonly
datapresentlyreported
routinely
arethenumberofmalaria
cases(severeand
uncomplicated),themajority
ofwhicharebasedon
presumptivediagnosisrather
thanparasitologic
confirmation.Whilethese
dataarelimitedand
frequentlyrepresentonlya
smallproportionofmalaria
cases.Iftherearenomajor
changesinthereporting
3.Laboratory
confirmed
malariacases
Disaggregatedby:
age
sex
pregnancy
species
Laboratoryconfirmedmalariacases denote,for
areasperforminglaboratoryconfirmationof
malariadiagnosis,allpatientswithsignsand/or
symptomsofmalariaandlaboratoryconfirmed
diagnosiswhoreceivedantimalarialtreatment.
Laboratorydiagnosisconsistsofeitherslide
microscopyorarapiddiagnostictest.
Numerator:TotalNo. of
ConfirmedMalariaCases
Denominator:No.of
Malaria
casesseen
Indicator
Definition
Formula
Target
Sourceof
Data
Frequency
ofReporting
UseandLimitation
system,anunderstandingof
theselimitationswillallowfor
useofthedatatogenerate
estimatesoftheoverall
burdenofdiseaseaffecting
communitiesandfortracking
trendsovertime.
4.Laboratory
confirmed
malariacases
bymethod
disaggregatedby:
Slidemicroscopy
Rapid
Diagnostic
Test(RDT)
Laboratoryconfirmedmalariacaseseitherby
slideorRDT
Numerator:No.of
confirmed
Malariacasesby
slide/RDT
Denominator:Total
ConfirmedMalariacases
5.Proportionof
PopulationgivenLLIN
NumberofPopulationatrisk(perbrgy)givenLLIN
Numerator:Numberof
personslivinginatriskarea
givenLLIN
Denominator:Populationat
risk
6.MalariaMortality
Rate
Totalnumberofmalariadeathsperyearamong
targetgroupdividedbymidyearpopulationof
thesametargetgroupdisaggregatedbysex.
Numerator:No.ofMalaria
Deaths
Denominator:Total
Populationx100,000
Malaria
Registry
Quarterly
1LLINper2
persons
Malaria
Registry
Annual
0.05deathsor
lessper100,000
pop.MTDP
(MediumTerm
Development
Plan)stable
0.04deathorless
per100,000pop
Malaria
Registry
Annual
Indicator
Definition
Formula
Target
Sourceof
Data
inunstableand
sporadic
7.MalariaCase
FatalityRatio
NumberofMalariadeathsovertotalnumberof
malariacasesdisaggregatedbysex.
Numerator:No.ofMalaria
Deaths
Denominator:TotalMalaria
Cases
Frequency
ofReporting
UseandLimitation
Malaria
Registry
Monthly
Determineseverityofdisease
(BHSto
RHU)
Quarterly
(RHUto
nexthigher
level)
3.12 SCHISTOSOMIASIS
____________________________________________________________________________________________________________________________________________________________
Indicator
Definition
Frequency
ofReporting
Formula
Target
SourceofData
UseandLimitation
50%reductionin
28endemic
provinces
Schistosomiasis
Registry
Annual
Todeterminethe
status/magnitudeof
schistosomiasisproblem
Toevaluateiftherateofold
andnewinfectionsare
decreasingorincreasing
Toquantifytheindividuals
sufferingofsevere
consequences
Todecideonappropriate
interventionmeasures
Tomonitortheresultsand
impactofprogram(%fallin
arithmeticorgeometricmean
epgpergram(epg)counts)
1.Prevalenceof
infection
Prevalenceofinfectiongivesthenumberof
infectedpeopleinthepopulationper100,000
population
Numerator:No.of
individuals
PositiveSchistosomiasis
Denominator:No.examined
X100,000
2.Proportionof
intensityof
infection
Canbeexpressedthroughmeanepg.
No.ofepg=Numberofovax24
Theintensityofinfectiongivesinformationonthe
severity(wormburden)ofaninfection.
Numerator:No.of
low/medium/high
infected
Denominator:No.ofcases
Examined
Schistosomiasis
Registry
Annual
3.Proportionof
Schistosomiasis
withclinical
signsand
symptoms
CRASSgivestheinformationinthenumberof
personsinfectedbasedontheclinicalsignsand
symptomswithorwithouthepatomegaly.
Sjcasedefinition=1majorand2minorS/Swith
orwithouthepatomegaly
withS/S
personsinthe
area/school
ofintervention
Schistosomiasis
Registry
Annual
4.Proportionof
schistosomiasis
cases
treated
Treatmentofcasesistheadministrationof
Praziquantel,600mggivenjustonedayin23
divideddosesat4060mg/kg
Numerator:No.ofcases
treated
PositiveCases
Schistosomiasis
Registry
Annual
Todetermineifallcases
foundweretreated
Toaddressethicalissuesof
nontreatment
Toevaluatedrugutilization
andconsumption
5.Proportionof
complicated
Schistosomiasis
casesreferred
tohospital
PercentageofcomplicatedSchistosomiasiscases
referredtohospitalfacility.
Numerator:No.of
complicatedcasesreferred
tohospitalfacility
Schistosomiasis
Registry
Annual
Referredcasestohospitalsare
complicatedcaseswithhigh
indexofsuspicionwhichthe
primaryhealthfacilitiescannot
manage,ex.(1)Neurologic
Indicator
facility
Definition
Formula
Schistosomiasis
casesdetected
Target
SourceofData
Frequency
ofReporting
UseandLimitation
cases(2)Spinal
(3)Cardiovascular(cor
pulmonate)(4)Hepaticor
renalcomplications(5)Pipe
Systemfibrosis(6)
Hypertensive
3.13 TUBERCULOSIS
_____________________________________________________________________________________________________________________________________________________________
Target
SourceofData
Frequency
ofReporting
Indicator
Definition
Formula
UseandLimitation
1.NumberofTB
symptomatics
whounderwent
DirectSputum
Smear
Microscopy
(DSSM)
ThisreferstoallTBSymptomaticswhounderwent
DSSM.
Definitionofterms:
TBSymptomaticsrefertoapatientwithcough
oftwoweeksormorewithorwithoutthe
followingsignsandsymptoms:fever,chestor
backpains,hemoptysisorbloodstreakedsputum,
significantweightlossorothersymptomssuchas
sweating,fatigue,bodymalaiseandshortnessof
breath.
NumberofTBSymptomatics
whounderwentDSSM
NTPLaboratory
Register
Quarterly
(RHUto
next
higher
level)
Toassessthecasefinding
activitiesofaDOTSfacility.
Thiswillalsobeusedto
estimatesforthelogistics
neededinthelaboratory
activitiesoftheDOTSfacility.
2.Numberof
smearpositive
discovered/
identified
ThisreferstoTBsymptomaticswithsmear
positiveresultsintheNTPLaboratoryRegistry.
Smearpositivepatientsarethosepatientswithat
least2sputumsmearspositiveforAFB.
Numberofsmearpositive
discovered/identified
NTPLaboratory
Register
Quarterly
Todeterminethepositivity
ratewhichmeasuresthe
qualityofscreeningofTB
Symptomaticsandmicroscopy
workinaDOTSfacility.
3.Numberofnew
smearpositive
casesinitiated
treatmentand
registered
Thisreferstothenumberofnewsmearpositive
casesgiventreatmentandregisteredinaDOTS
facility.
TBpatientswithpositiveDSSMresultthathave
nottakenantiTBdrugsbeforeoriftheyhave
takenantiTBdrugsitisforlessthan1month.
tocomputeCDRfornewsmearpositives:
CDR=newsmearpositives/{totalpopulationx
0.00131(IncidenceRatefornewsmearpositive)}x
100
Numberofnewsmear
positivecasesinitiated
treatment
TBCase
Registry
Quarterly
Toassess theCaseNotification
RateandCaseDetectionRate
ofnewsmearpositivecasesin
anarea
Frequency
ofReporting
Indicator
Definition
Formula
Target
SourceofData
UseandLimitation
4.TBCase
DetectionRate(All
formsofTB)
SummationofallformsofTBpertainingtonew
smearpositive,newsmearnegative,relapseand
extrapulmonaryTB
TocomputeforCDRallforms:
CDRallforms=totalnumberofallformsofTB/
{totalpopulationx0.00275(estimatedTBAll
Forms)}x100
Numerator: Numberofall
formsofTBCasesidentified
Denominator:estimated
numberofallformsofTB
casesfortheyear
Multiplier:X100
85%(NOH2016)
Quarterly
reports(All
formsreferto
newsmear
positive,new
smearnegative,
relapseand
extrapulmonary
TB)
5.Numberofall
formsofTB
casesinitiated
treatmentand
registered
ThisreferstothenumberofallformsofTBcases
(newsmearpositive,newsmearnegative,relapse,
extrapulmonaryTB)regardlessofagegiven
treatmentwhoareregisteredinTBCaseRegistry
oftheDOTSfacility.
AllformsofTBincludetheff:
Newsmearpositive
Newsmearnegative
Relapse
ExtrapulmonaryTB
NumberofNewSmear
positivecasesinitiated
treatmentandregistered
+NumberofsmearNegative
Casesinitiatedtreatment
andregistered
+Numberofrelapsecases
initiatedtreatmentand
registered
+Numberofextra
pulmonarycasesinitiated
treatmentandregistered
TBCase
Registry
Quarterly
(RHUto
next
higher
level)
ToassesstheCNRandCDRof
allformsofTBinanarea
5.Numberofnew
smearpositive
casescureda
yearago
Thisreferstothenumberofnewsmearpositive
caseswhohavecompletedtreatmentandis
smearnegativeinthelastmonthoftreatment
andonatleastonepreviousoccasioninthe
continuationphase.
TocomputeforNewSmearPositiveCureRate:
NewSmearPositiveCR=newsmearpositivecases
whogotcured/newsmearpositivecasesdetected
forthatquarter
Numberofnewsmear
positivecasesatstartof
treatmentwhohave
completedtreatmentand
smearnegativeinthelast
monthoftreatmentandon
atleast1previousoccasion
inthecontinuationphase
TBCase
Registry
Quarterly
ToassessthequalityofDOTS
servicesprovided.
6.Numberof
Thisreferstothenumberofsmearpositivere
TBCase
Quarterly
Toassessthetrendofre
Indicator
Definition
Formula
smearpositive
retreatment
casesinitiated
treatmentand
registered
treatmentcasesgiventreatmentandregisteredin
aDOTSfacility.
Retreatmentcasesrefersto:
Relapse,
ReturnafterDefault,
TreatmentFailure,and
OthertypeofTBcasesdoesnotfallin
anyofthementionedabovebutis
positive.
retreatmentcasesinitiated
treatment
Registry
7.Numberof
smearpositive
retreatment
caseswhogot
cured
Thisreferstothenumberofsmearpositivere
treatmentcases:
a. Relapsecasescuredarethosewhohave
completedtreatmentandaresmear
negativeinthelastmonthoftreatment
andonatleastonepreviousoccasionin
thecontinuationphase.
b. ReturnafterDefaultcuredarethose
whohavecompletedtreatmentandis
smearnegativeinthelastmonthof
treatmentandonatleastoneprevious
occasioninthecontinuationphase.
c. TreatmentFailurecuredarethosewho
havecompletedtreatmentandissmear
negativeinthelastmonthoftreatment
andonatleastonepreviousoccasionin
thecontinuationphase.
retreatmentcaseswhogot
cured
TBCase
Registry
Target
SourceofData
Frequency
ofReporting
UseandLimitation
treatmentcasesfortheyare
alreadysuspectsfordrug
resistance.
Quarterly
ToassessthequalityofDOTS
servicesprovidedandto
determineifDOTisbeing
done.
3.14 MORBIDITY RATES

_____________________________________________________________________________________________________________________________________________________________
Indicator
1.Toptenleading
causeofmorbidity
Definition
Formula
2.Morbidityrateof NOTE:
Notifiable
diseasesamongthe
elderly(per100,000
pop)bygender&
agegroup(6064
yrs;6569yrs&70
yrs&above)
Notifiablediseasesinclude:both
communicable&noncommunicable
diseases
Canwestartthecutoffoftheageof
elderlypersonsto60yrsoldinsteadof65
yrsoldtoharmonizewiththedefinitionin
RepublicAct9994(ExpandedSenior
CitizensActof2010).Anelderlyorsenior
citizenofthePhilippinesatleastsixty(60)
yearsold.
Fortheagegroupingsamongtheelderly,
canwefollowthedisaggregationusedin
thePhil.HealthStatistics:
- 6064yrsold
- 6569yrsold
- 70yrsold&above
Numerator:No.ofnotifiable
diseasecasesamongthe
elderly
- 6064yrsold
- 6569yrsold
- 70yrs&above
Denominator:Total
population(agegroup:6064
yrs;6569yrs&70yrs&
above)
Multiplier:X100,000
3.Influenza
NOTE:
MortalityRate
Cutofftheelderly&agegroupings
amongtheelderly
sameasabove
(per100,000pop)
bygender&age
group(6064yrs;
6569yrs&70yrs&
above)
Numerator:No.ofinfluenza
deathsamongtheelderly
- 6064yrsold
- 6569yrsold
- 70yrs&above
Denominator:Total
yrs;6569yrs&70yrs&
above)
Multiplier:X100,000
4.Pneumonia
MortalityRate
Numerator:No.of
pneumoniadeathsamong
Pneumoniadeathsamongelderly
Target
Sourceof
Data
Frequency
ofReporting
UseandLimitation
Indicator
Definition
amongtheelderly NOTE:
(per100,000pop)
bygender&age
group(6064yrs;
6569yrs&70yrs&
above)
Cutofftheelderly&agegroupings
sameasabove
(?)laboratoryconfirmed
Formula
Target
Sourceof
Data
Frequency
ofReporting
Monthly
theelderly
- 6064yrsold
- 6569yrsold
- 70yrs&above
Denominator:Total
yrs;6569yrs&70yrs&
above)
Multiplier:X100,000
5.Prevalenceof
>25y/oatriskfor
CVDeventin10
years
Disaggregatedby
levelofrisk
Level
<10%risk
<20%risk
<30%risk
<40%risk
>=40%risk
Proportionofthepopulation>25y/oatriskfor
CVDeventin10yrs
Numerator:>25y/oatrisk
forCVDevent(bylevelof
risk)in10yrs
Denominator:total
population>25y/oX100
Stilltobe
identified
Operations
Manualon
the
Philippine
Packageof
Essential
NCD
interventions
(PhilPen)on
the
Integrated
Management
of
Hypertension
andDiabetes
forPrimary
HealthCare
Facilities
(Annex4.
Patients
Record)
6. Numberofcases
withurethral
discharge
(Syndrome
Allindividualswithurethraldischargethatare
diagnosedbyinspection
Disaggregatebysex,andagegroup(<15yo,15to
Numberofindividualswith
urethraldischargethatare
SSESS
Manualof
Operations
(Appendix
Monthly
UseandLimitation
Indicator
Reporting)
Definition
Formula
Target
17yo,18to24yo,>24yo)
Sourceof
Data
Frequency
ofReporting
A.1ICR);
FHSISITR
7. Numberofcases
withgenital
ulcer(Syndrome
Reporting)
Allindividualswithgenitalulcersthatare
Numberofindividualswith
genitalulcersthatare
SSESS
Manualof
Operations
(Appendix
A.1ICR);
FHSISITR
Monthly
8. Percentageof
gonorrheacases
amongsmears
done(Etiologic
Reporting)
Allfemaleswhohaveacervicalsmearandare
foundtohavegramnegativeintracellular
diploccoci
Allmaleswhohaveaurethraloranalsmearand
arefoundtohavegramnegativeintracellular
diplococci
Numerator:Numberof
smearsthatarefoundto
havegramnegative
intracellulardiplococci
ofsmearsdone
SSESS
Manualof
Operations
(Appendix
A.1ICR);
FHSISITR
Monthly
9. Percentageof
syphiliscases
amongRPR
screeningdone
(Etiologic
Reporting)
Allindividualswhoarepositiveforsyphilis
Numerator:Numberoftests
thatarepositivefor
TreponemaPallidum
HemaglutinationAssayor
TPHA
ofRPRscreeningtestsdone
SSESS
Manualof
Operations
(Appendix
A.1ICR);
FHSISITR
Monthly
UseandLimitation
___________________
ANNEXES
Republic of the Philippines

Departmentof Health
NATIONAL EPIDEMIOLOGY CENTER
Bldg. # g,SanLazaro Compound,Rizal Avenue,Sta.Cruz, 1003Manila
local1900-1907Directline:743'1937
loc.1900 Trunkline:743-8301
Telefax:rc32\743-8301
gov.ph
: nec@doh.gov.ph
E-mail
URL : http:iiwww.doh.
;
FOR
ALL CHD RegionalDirectors
ATTENTION: ALL FHSIS Regional/ProvinciaVCity Coordinators
nNNqtWt*{G,
FROM
cESovI
FPSMTD,
MD,PHSAE,
DirectorIV U
/
SUBJECT
FHSIS Family Planning Calculation Correction on Current

Users
DATE
September312010
The following is an updateon the Family PlanningCurrentUsersFormula and

Calculation.
GUIDE IN FILLING-UP THE FORMS:
1. FOR MONTHLY FORM for FAMILY PLAI\NING

Current UsersBeg. Month (ex. February)
Formula:Just carry over the CU data of previous month (January)
New Acceptors(ex. February)
Formula: Count Total No. of New Acceptorsfor the month of Februaryin the
TCl/Summary Tables
o
Other Acceptors(ex. February)

Formula: Count Total No. of OtherAcceptorsfor the Month of Februaryin
the TCl/Summarv Tables
Cc: NCDPC (Family PlanningProgram)
180
Current Users End. Month (ex. February)

Calculation:
Current users from the previous month
+ New Acceptors (previous month)
+ Other Acceptor (current month)
- Drop-outs (current month)
= Current User of ending month
(Jan)
(Jan)
(Feb)
(Feb)
(Feb)
Example: Calculation for the Month of January to March

Given: New Acceptors for the month of December = 8
Month
CU
Beg Mo.
New
Acceptors
Other
Acceptors
Dropouts
CU
End Mon
January
15
29 = (15 + 8
+ 7 1)
February
29
March
37
37= (29 + 6
+ 4 2)
44 = (37 + 3
+ 9 5)
2. FOR QUARTERLY FORM (ex. for First Quarter)

Current Users Beg. Quarter (ex. First Quarter)
Formula: Just carry over the CU data at the start of the First Quarter
(January)
New Acceptors (ex. First Quarter)

Formula: Count Total No. of New Acceptors for the First Quarter (January to
March) from the TCL/Summary Tables
Other Acceptors (ex. February)

Formula: Count Total No. of Other Acceptors for the First Quarter (January to
March) in the TCL/Summary Tables
Dropouts (ex. February)

Formula: Count Total No. Of Dropouts for the First Quarter (January to
March) in the TCL/Summary Tables
Current Users End. Quarter (ex. First Quarter)

Formula: carry over the CU end of the month data from the last month of the
Quarter (March) for First Quarter
Cc: NCDPC (Family Planning Program)

181
Month
January
February
March
First Quarter
CU
Beg Mo.
New
Acceptors
Other
Acceptors
Dropouts
15
29
37
15
add
3
8
17
add
4
9
21
add
2
5
8
Month
CU
Beg Mo.
New
Acceptors
Other
Acceptors
Dropouts
April
May
June
Second Quarter
44
53
54
44
add
1
3
6
Cc: NCDPC (Family Planning Program)

182
add
3
7
16
add
4
9
18
CU
End Mon
29
37
44
44
CU
End Mon
53
54
53
53
Annex2.IndividualTreatmentRecords
2.1ManagementoftheSickYoungInfantAge1Weekupto2Months
2.2ManagementoftheSickChildAge2Monthsupto5Years
2.3ChildrenUnderFiveYearsofAgewithHealthProblemsotherthanIMCI
Classification/OtherChildren/Adults
2.4MaternalClientRecordforPrenatalCare
2.5MaternalClientRecordforPostpartumandNeonatalCare
2.6FamilyPlanningServiceRecord
2.7DentalHealthProgramForm1
2.8TBProgramIndividualTreatmentCard
2.9ITRforMalariaPreventionandControlProgram
2.10ITRfortheLeprosyPreventionandControlProgram
2.11ITRfortheSchistosomiasisPreventionandControlProgram
2.12ITRfortheFilariasisPreventionandControlProgram


Integrated Management of Childhood Illness Strategy
Annex 2.1
Family Serial No. __________
INDIVIDUAL TREATMENT RECORD (ITR)
MANAGEMENT OF THE SICK YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS

Date: ____________
Childs Name: _________________________ Age: ____ Sex: ____ Weight: _____ kg Temperature: ______C
Address: ________________________________________ Mothers Name: _______________________________
ASK: What are the childs problems? _______________________ Initial visit? __________ Follow-up visit? ________
ASSESS (Circle all signs present)
CLASSIFY
CHECK FOR POSSIBLE BACTERIAL INFECTION
Has the infant had convulsions?
Count the breaths in one minute. ____ breaths per minute.

Repeat if elevated _____. Fast breathing?
Look for severe chest indrawing.
Look for nasal flaring.
Look and listen for grunting.
Look and feel for bulging fontanelle.
Look for pus draining from the ear.
Look at the umbilicus. Is it red or draining pus? Does the
redness extend to the skin?
Fever (temperature 37.5C or above or feels hot) or low body
temperature (below 35.5C or feels cool)
Look for skin pustules. Are there many or severe pustule?
See if the young infant is abnormally sleepy or difficult to
awaken.
Look at young infants movements. Less than normal?
DOES THE YOUNG INFANT HAVE DIARRHEA?
Yes ___ NO ___
For how long? ___ Days

Is there blood in the stools?
Look at the young infants general condition. Is the infant:

Abnormally sleepy or difficult to awaken
Restless or irritable?
Look for sunken eyes.
Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT

Is there any difficulty feeding? Yes __ No__
Is the infant breastfed? Yes __ No __
If Yes, how many times in 24 hours? __ times
Does the infant usually receive any other foods or
drinks? Yes ___ No ___
If Yes, how often?
What do you use to feed the child?
Determine weight for age. Low ___
Not Low ___
If the infant has any difficulty feeding, is feeding less than 8 times in 24 hours, is taking any other food or drinks, or
is low weight for age AND has no indications to refer urgently to hospital:
ASSESS BREASTFEEDING:
Has the infant breastfed in the previous hour?
If infant has not fed in the previous hour, ask the mother to put her
infant to the breast. Observe the breastfeed for 4 minutes.
Is the infant able to attach? To check attachment, look for:
- Chin touching breast
Yes __ No __
- Mouth wide open
Yes __ No __
- Lowe lip turned outward
Yes __ No __
- More areola above than below the mouth Yes __ No __
no attachment at all
not well attached
good attachment
Is the infant suckling effectively (that is, slow deep sucks,

sometimes pausing)?
not suckling at all not suckling effectively suckling effectively
CHECK THE YOUNG INFANTS IMMUNIZATION STATUS

____
BCG
_____
DPT1
ASSESS OTHER PROBLEMS:
_____
OPV1
_____
HEP B1
Look for ulcers or white patches in the mouth (thrush)
Circle immunizations needed today.
Return for next

immunization on:
____________
(Date)
TREAT
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Return for follow-up in: ___________________________________
Give any immunization needed today: _______________________
Feeding Advice: _________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________
Name of Health Worker
____________________
Signature
Annex 2.2

Department of Health-ARMM
Integrated Management of Childhood Illness Strategy
Family Serial No. __________
MANAGEMENT OF THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS

Date: ____________
Childs Name: ____________________________ Age: _____ Sex: ______ Weight: _______ kg
Temperature:
_________C
Address: ____________________________________________ Mothers Name: ______________________________________
ASK: What are the childs problems? ___________________________ Initial visit? ______________ Follow-up visit? _________
ASSESS (Circle all signs present)
CLASSIFY
CHECK FOR GENERAL DANGER SIGNS
NOT ABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
CONVULSIONS
DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
Yes ___ No ___
For how long? ___ days
Count the breaths in one minute.
____ breaths per minute. Fast breathing?
Look for chest indrawing.
Look and listen for stridor.
DOES THE CHILD HAVE DIARRHEA
Yes ___ No ___
For how long? ___ days
Look at the childs general condition.
Abnormally sleepy or difficult to awaken?
Is there blood in the stools?
Restless or irritable?
Look for sunken eyes.
Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5C or above)
Yes ___ No ___
Decide Malaria Risk
Look or feel for stiff neck.
Does the child live in a malaria area?
Look for runny nose.
Has the child visited a malaria area in the past 4
weeks?
If malaria risk, obtain a blood smear.
Look for signs of MEASLES.
+
Pf
Pv - Not done
Generalized rash and
For how long has the child had fever? __ days.
One of these: cough, runny nose or red eyes.
If more than 7 days, has fever been present every
day?
Has the child had measles within the last 3 months?
If the child has measles now or
Look for mouth ulcers.
within the last 3 months
If yes, are they deep and extensive?
Look for pus draining from the eye.
Look for clouding of the cornea.
Dengue Risk:
Then ask:
Look for bleeding from nose or gums
Has the child had any bleeding from the nose or gums
or in the vomitus or stools?
Look for skin petechiae.
Has the child had black vomitus or black stool?
Feel for cold and clammy extremities.
Has the child had persistent abdominal pain?
Check capillary refill. _____ seconds.
Has the child been vomiting?
Perform tourniquet test if child is 6 months or older AND
has no other signs AND has fever for more than 3
days. (+) (-) (not done)
Yes ___ No ___
DOES THE CHILD HAVE AN EAR PROBLEM?
Look for pus draining from the ear
Is there ear pain?
Feel for tender swelling behind the ear.
Is there ear discharge?
If Yes, for how long? ______ days
THEN CHECK FOR MALNUTRITION AND
Look for visible severe wasting.
ANEMIA
Look for edema of both feet.
Look for palmar pallor.
Severe palmar pallor? Some palmar pallor?
Determine weight for age.
Very low?
CHECK THE CHILDS IMMUNIZATION STATUS
Circle immunizations needed today.
____
____
_____
______
BCG
DPT1
OPV1
HEP B1
____
_____
______
______
DPT2
OPV2
HEP B2
AMV 1
____
_____
______
_______
DPT3
OPV3
HEP B3
AMV 2
CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older
Is the child six months of age or older? Yes __ No ___
Has the child received Vitamin A in the past six months? Yes __ No ___
YES ___ NO ___
Return for next

immunization on:
___________
(Date)
Vitamin A needed
today
Yes ___ No ___
ASSESS CHILDS FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old.
Do you breastfeed your child? Yes ___ No ____
If Yes, how many times in 24 hours? __ times. Do you breastfeed during the night? Yes ___ No ___
Does the child take any other food or fluids?
Yes __ No ___
If Yes, what food or fluids? ________________________________________________________________
How many times per day? __ times. What do you use to feed the child? ____________________________
If very low weight for age: how large are servings? _____________________________________________
Does the child receive his/her own serving? ____ Who feeds the child and how? _____________________
During the illness, has the childs feeding changed?
Yes ___
No ___
If Yes, how?
ASSESS OTHER PROBLEMS:
Feeding
Problems:
TREAT
Remember to refer any child who has a danger
sign and no other severe classification.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Return for follow-up in: ___________________________________
Advise mother when to return immediately:
Give any immunizations needed today: _______________________
Give vitamin A if needed today: _____________________________
Feeding Advice: _________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
_______________________________
Name of Health Worker
____________________
Signature

Department of Health-ARMM
Annex 2.3

Children and Other Adults
A. Patients Personal Profile
Family Serial No. __________________
Patients Name: ______________________________________________________ Sex: _______

Family Name
First Name
Middle Name
Birthdate:______________________________________ Civil Status:___________
Occupation:________________________________ Agency/Company:_______________________
Parent/Guardian/Contact Person:______________________________________________________
Address: __________________________________________________________________________
Contact Number: ____________ Health Insurance Membership: ___________________________
B. Patients Case Summary
Date of Visit:____________________
age):______
Age (in months if under five years of
I. Subjective Complaints:
Chief Complaint: ___________________________________________________________
Present Illness: ____________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Past History:_______________________________________________________________
__________________________________________________________________________
II. Objective findings:
Vital signs: BP if needed:______ Heart Rate: _______ Respiratory Rate:_______
Temperature: _______ Weight:__________ Height:__________
Physical Examination:_______________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
III. Assessment/Classification:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
IV. Plan of Management: (Treat, Refer and Health Educate)
__________________________________________________________________________
__________________________________________________________________________
_____________________________________
Name and Signature of Service Provider
Annex 2.4
MNC Form I SIDE A
MATERNAL CLIENT RECORD for Prenatal Care
M.I.
DATE OF BIRTH (mo/day/year)
____/____/________
AGE :
______
Last NAME
NAME OF CLIENT: _____________________ __________________ ____
GIVEN NAME
HIGHESST EDUC
OCCUPATION
NO. STREET
PR
____________ ____
MUNICIPALIY
_____________ ______
_______________ ______________
HIGHEST EDUC
____/____/________ _______________
IMPRESSION/DIAGNOSIS
TT Status: _______________________
M.I.
EXTREMITIES
Edema
Varicosities
Pain on forced dorsiflexion
GIVEN NAME
VAGINAL EXAMINATION:
Bleeding
Discharges
Cyst/mass
Scars
Warts
Laceration
Others (Specify)________________________
BIRTH PLAN: Hospital RHU LIC Home IF AT HOME, WHO IS THE Birth Attendant: SBA Non-SBA
Nipple discharge
Skin orange peel or dimpling
Enlarged axillary lymph nodes
THORAX
Abnormal heart sounds/cardiac rate
Abnormal breath sounds/respiratory rate
ABDOMEN
Enlarged liver
Tenderness
Mass
Scar
LAST NAME
Left Breast
NAME OF SPOUSE: _____________________ __________________ ____
Right
Breast
AVERAGE MONTHLY Family INCOME ______________
PHYSICAL EXAMINATION
VITAL SIGNS
Blood Pressure: ___________ mm Hg
Weight: ___________ kg
Pulse Rate: ____________/ min
CONJUNCTIVA
Pale
Yellowish
NECK
Enlarged thyroid
Enlarged lymph nodes
BREAST
Mass
NO. OF LIVING CHILDREN: _____
MEDICAL HISTORY
REVIEW OF SYSTEMS
HEENT
Epilepsy/Convulsion/Seizure
Severe headache/dizziness
Visual disturbance/blurring of vision
Yellowish conjunctiva
Enlarged thyroid
CHEST/HEART
Severe chest pain
Shortness of breath and easy fatigability
Breast/axillary masses
Nipple discharges (specify if blood or pus)
ABDOMEN
Mass in the abdomen
History of gallbladder disease
History of liver disease
GENITAL
Vaginal discharge
Intermenstrual bleeding
Postcoital bleeding
Mass in the uterus
EXTREMITIES
Severe varicosities
Swelling or severe pain in the legs not related to
injuries
SKIN
Yellowish skin
FAMILY HISTORY
CVA (strokes)
Hypertension
Asthma
Heart disease
Diabetes
PAST HEALTH HISTORY
Allergies
Drug intake (anti-tuberculosis, anti-diabetic,
anticonvulsant)
Bleeding tendencies (nose, gums, etc.)
Anemia
Diabetes
Itching or sores in or around vagina
Pain or burning sensation on urination
SOCIAL HISTORY
Smoking Sticks per day ___________
Alcoholic beverage Amt. Per day ________
Obesity
History of domestic violence or VAW
Unpleasant relationship with partner
Treated for STIs in the past
OBSTERICAL HISTORY
Number of pregnancies:
______ Full Term
______ Premature
______ Abortions
______ Living Children
History of Ectopic pregnancy
Hydatidiform mole (within the last 12 months)
History of Previous Deliveries
Date of last delivery
___/__/_____
Type of last delivery
_______________
Birth Attendant in last delivery __________
Menstrual History
Last menstrual period
_______________
Family Serial NO.
Past menstrual period

_______________
Duration of Menstrual bleeding ________
Character of Menstrual bleeding (no. of pads)
_________________
FAMILY PLANNING HISTORY
Previously Used Method: ______________________
Reminder: Kindly refer to PHYSICIAN for any checked () findings for further evaluation.

DATE
COMPLAINTS/COMPLICA
TIONS
MEDICAL OBSERVATION
PE Findings including pelvic
examination
Laboratory
OTHER IMPORTANT
COMMENTS IF ANY
SIDE B
MCN SERVICES GIVEN

Tetanus Toxoid
Anti-Helminthic
Anti-Malaria
Iron/Folate
FP Counseling
Counseling for Danger Signs
Referral Made
NAME OF
PROVIDER
AND
SIGNATURE
NEXT
Follow-Up
Schedule
Abdominal Examination Findings

1st mo
1st Trimester
2nd mo
3rd mo
4th mo
2nd Trimester
5th mo
6th mo
7th mo
Date
Fundic Height (cm)
Fetal Heart Tones
AOG
Leopolds
L1
L2
L3
L4
Uterine Activity
USE ADDITIONAL SHEETS AS NECESSARY
Adapted from the DOH Family Planning Service Record; updated 02/09/06.
3rd Trimester
8th mo
9th mo
REMARKS
Family Serial NO.
Name of Client: ______________________

BIRTH AND EMERGENCY PLAN
I know that any complication can develop at any time in the course of this pregnancy, childbirth and after birth. I know
that the best place to deliver my baby is in a health facility.
I will be attended at delivery by _________________________________________________________________________
(Name of Doctor/Nurse/Midwife or others. If others, pls. specify)
I plan to deliver at _____________________________________________________________________________________

(Name and location of hospital/health center/clinic or others. If others, pls. specify)
This is a Philhealth accredited facility
Yes
No
Distance from Residence __________________________
The estimated cost of the maternity package in this facility is PhP _____________________ (Inclusive of newborn care)
The mode of payment is _____________________________.
The available transport is ____________________________.
I have contacted ______________________, residing at _______________________________________ and with contact
(Name of Companion)
(Address)
number at __________________________, to bring me to the hospital/maternity clinic/health center.

(Landline or Cellphone)
I will be accompanied by _____________________________________, who is my ______________________, residing at

(Name)
(Relationship to patient)
___________________________________________________, and with contact number ___________________________.

(Address)
(Landline or Cellphone)
_________________________________________, my ____________________, will take care of my children/home while

(Name of care taker)
(Relationship to patient)
I am in the health facility.
My blood type is: __________________

In case of a need for blood transfusion, my possible donors are:
_____________________________________ ______________________________________________________________
(Name)
_____________________________________
(Address)
______________________________________________________________
(Name)
(Address)
In case of complications, I should be referred right away to:

Contact Person: ___________________________________________________________________
Address: __________________________________________________________________________
Tel. No.: __________________________________________________________________________
The nearest maternal and newborn health facility to my residence are:
Maternal/Hospital: __________________________________
(Name of Hospital)
___________________________________________
Newborn Hospital: ___________________________________
(Address)
___________________________________________
(Name of Hospital)
(Address)
Conforme:
___________________________
Signature
__________
Date

Annex 2.5
MNC Form 2 SIDE A
MATERNAL CLIENT RECORD for Postpartum and NeonatalCare
Family Serial NO.
Still birth
Sex:
Male
Female
Type of Delivery:
NSD
Place of Delivery:
Home
abortion
Nurse
Midwife
CS
Others
TBA/Hilot
Others
Government Hospital
1. Oxytocin injected w/in 1 minute
Private Hospital
of delivery
Private Clinic/Birthing
done
BHS/Birthing Home
3. Uterine massage done
No
Yes
No
Postpartum Visits
w/in 5-10
Other
days
visits
2. Eye prophylaxis
3. Referred for
Newborn Screening
No
BARANGAY
Number
Date
Given
Newborn Screening Done:

Yes Date ______________
Result ____________
PROVINCE
Others
NO. STREET
Postnatal Visits
w/in 3-5
Other
days
visits
1. Vit. K injection
If CS, bleeding
and/or swelling
from the wound
No. of tablets given (60mcg
w/in 24
hrs
MUNICIPALIY
Other ENC Given
_____________ _______________
Breastfeeding:
After 90 minutes but w/in twenty-four (24) hrs
OCCUPATION
Early ENC given (check yes if all 4

components were provided)
Vaginal Laceration
1st Degree
2nd Degree
3rd Degree
If with laceration,
Sutured?
Yes or No
Supplementation:
1. Immediate & thorough drying

2. Early skin to skin contact
3. Timely cord clamping
4. Early initiation of breastfeeding w/in 90 minutes
OCCUPATION
Uterus
Contracted
Relaxed
Vaginal Bleeding :
Profuse
Moderate
Scanty
Vaginal Discharge:
Color
Odor
Immediate Essential Newborn

Care (ENC)
HIGHESST EDUC
w/in 24
hrs
_______________ ______________ ____________ ___________
Post partum
depression
AGE :
Severe difficulties of
breathing
______
Bleeding from umbilical

stump or cut
Umbilicus draining pus or
umbilical redness
extending to skin
More than 10 skin
pustules or swelling,
redness, or hardness of
skin
____/____/________
Severe headache
with visual
disturbance
HIGHEST EDUC
Temp.>37.5 or <35.5
No
Floppy or stiff extremities
Looks very ill
M.I.
Yes
Grunting
Convulsions
Severe abdominal
Pain
____/____/________ _______________ ________________
Other
visits
Severe chest indrawing
w/in
3-5days
M.I.
Vaginal Bleeding
w/in 24
hrs
GIVEN NAME
Postnatal Visits
Danger Signs (Baby)
If breathing is >60/min or
<30/min
No. of pads per day
GIVEN NAME
Postpartum Visits
w/in 24
w/in
Other
hrs
5-10 days
visits
No
NEWBORN ASSESSMENT
Unconscious
PelvicExam
Findings
Yes
Therefore, AMTSL provided: Yes

(Check yes if all the 3 steps were done)
ASSESSMENT OF THE POST PARTUM MOTHER
Danger Signs
(Mother)
No
2. Controlled cord contraction
Main Health Center

Others:
Yes
Last NAME
AMTSL Steps:
LAST NAME
Health Facility
NAME OF CLIENT: _____________________ __________________ ____
Livebirths
Doctor
NAME OF SPOUSE: _____________________ __________________ ____
Outcome:
Attendant:
AVERAGE MONTHLY Family INCOME ______________
Date of Delivery: ______________________
Date of visit: ______________________
Physical Examination
MATERNAL CLIENT RECORD for Postpartum and Neonatal Care
DATE
COMPLAINTS/COMPLICAT
IONS
MEDICAL OBSERVATION
Pertinent PE Findings
including pelvic examination
Laboratory
OTHER IMPORTANT
COMMENTS IF ANY
MCN SERVICES GIVEN

Tetanus Toxoid
Vitamin A
Anti-Malaria
Iron/Folate
FP Counseling
Counseling for Danger Signs
Referral Made
SIDE B
NAME OF
PROVIDER
AND
SIGNATURE
NEXT
Follow-Up
Schedule
Family Serial No.________
Annex 2.6

STI RISKS
With history of multiple partners
For Women:
ACKNOWLEDGEMENT:
Unusual discharge from vagina
This is to certify that the Physician/Nurse/ Midwife of the
Itching or sores in or around vagina
clinic has fully explained to me the different methods available in
Pain or burning sensation
family planning and I freely choose the
______________________ method.
For Men:
_______________________ ___________
Pain or burning sensation
Client Signature
Date
Open sores anywhere in genital area
Pus coming from penis
Swollen testicles or penis
Reminder: Kindly refer to PHYSICIAN for any checked () findings prior to provision of any method for further evaluation.
DATE/TIME ________________
History of domestic violence or VAW

Unpleasant relationship with partner
Partner does not approve of the visit to FP clinic
Partner disagrees to use FP
Referred to: DSWD WCPU NGOs
Others (specify: ______________)
PREVIOUSLY USED METHOD: ___________________
Soft
RISKS FOR VIOLENCE AGAINST WOMEN (VAW)
Continuing User
HISTORY OF ANY OF THE FOLLOWING

Hydatidiform mole (within the last 12 months)
Ectopic pregnancy
Consistency
Firm
New to the Program
OBSTERICAL HISTORY
Number of pregnancies:
______ Full Term
______ Premature
_______ Abortions
______ Living Children
________ Full Term
Date of last delivery
___/__/_____
Type of last delivery _______________
Past menstrual period _______________
Last menstrual period _______________
Duration and character
Menstrual bleeding ________________
REASON FOR PRACTICING FP: _______________________________________________
Yellowish skin
HISTORY OF ANY OF THE FOLLOWING
Smoking
Allergies
Drug intake (anti-tuberculosis, anti-diabetic, anticonvulsant)
Bleeding tendencies (nose, gums, etc.)
Anemia
Diabetes
TYPE OF ACCEPTOR:
SKIN
PELVIC EXAMINATION
Others (Please specify) __________________
PERINEUM
UTERUS
Scars
Position
Warts
Mid
Reddish
Anteflexed
Laceration
Retroflexed
VAGINA
Size
Congested
Normal
Bartholins cyst
Small
Warts
Large
Skenes Gland
Discharge
Mass
Rectocele
Uterine Depth: ___cms.
Cystocele
(for intended IUD users)
CERVIX
Congested
ADNEXA
Erosion
Mass
Discharge
Tenderness
Polyps/cysts
Laceration
CLIENT NO.: ____
EXTREMITIES
Severe varicosities
Swelling or severe pain in the legs not related to injuries
NAME OF CLIENT: _________________ ______________ ____ ____/____/________ _____ ______________ ______________ _________ _________ ___________ ___________
LAST NAME
GIVEN NAME
M.I.
AGE
HIGHEST EDUC
OCCUPATION NO. ST BGY MUNI PROV
Intermenstrual bleeding
Postcoital bleeding
NAME OF SPOUSE: _________________ ______________ ____ ____/____/________ _________________ _________________ AVERAGE MONTHLY INCOME : ___________
LAST NAME
GIVEN NAME
M.I.
HIGHEST EDUC
OCCUPATION
GENITAL
Mass in the uterus
Vaginal discharge
PLAN MORE CHILDREN : Yes No
ABDOMEN
Mass in the abdomen
History of gallbladder disease
History of liver disease
CONJUNCTIVA
Pale
Yellowish
NECK
Enlarged thyroid
Enlarged lymph nodes
BREAST
Right Breast
Left Breast
Mass
Nipple discharge
Skin orange peel or dimpling
Enlarged axillary lymph nodes
THORAX
Abnormal heart sounds/cardiac rate
Abnormal breath sounds/respiratory rate
ABDOMEN
Enlarged lever
Mass
Tenderness
EXTREMITIES
Edema
Varicosities
CHEST/HEART
Severe chest pain
Shortness of breath and easy fatigability
Breast/axillary masses
Nipple discharges (specify if blood or pus)
Systolic of 140 & above
Diastolic of 90 & above
Family history of CVA (strokes), hypertension asthma,
rheumatic hearth disease
SIDE A
PHYSICAL EXAMINATION
Blood Pressure: ___ mm Weight: ____ kg/lbs
Pulse Rate: _____/ min (N.V. = 70 to 80/min)
METHOD ACCEPTED: COC Contraceptive patch POP Injectable Condom IUD BTL VSC LAM SDM BBT Billings/Cervical Mucus/Ovulation Method
FAMILY PLANNING SERVICE RECORD*

MEDICAL HISTORY
HEENT
Epilepsy/Convulsion/Seizure
Enlarged thyroid
Severe headache/dizziness
Yellowish
Visual disturbance/
conjunctiva
blurring of vision
DATE
SERVICE
GIVEN
METHOD
TO BE
USED/SUPPLIES
GIVEN
METHOD/
NO. OF
BRAND
UNITS
FAMILY PLANNING SERVICE RECORD

REMARKS
MEDICAL OBSERVATION
COMPLAINTS/COMPLICATIONS
SERVICE RENDERED/PROCEDURES/
INTERVENTIONS DONE (laboratory examination,
treatment, FP referrals, FP counseling, contraceptive
dispensing, etc.)
REASONS FOR STOPPING OR CHANGING
METHOD/BRAND
OTHER IMPORTANT COMMENTS IF ANY
NAME OF
PROVIDER
AND
SIGNATURE
DONT LEAVE ANY BOXES BLANKS NOT FILLED-UP

* Adapted from the DOH Family Planning Service Record; updated 02/09/0
NEXT
SERVICE
DATE
Annex 2.7
SUMMARY OF SERVICES RENDERED
Date
Tooth
No.
Oral
Prophy
Temp.
Filling
Perm.
Filling
Sealant
Exo.
ConsulTation
Others
(Specify)
Remarks
Signature
Family Serial No. _______

Dental Health Program
Individual Treatment Record

Name
___________________________________________
__________
Surname
M.I.
Date of Birth
__________
Place of Birth
________________________
First Name
Age ______
Sex
___________________________________________
__________
Address
___________________________________________
__________
Occupation
___________________________________________
__________
Parent/Guardian
___________________________________________
__________
Medical History
___________________________________________
__________
___________________________________________
__________
A. Check ( / ) if present
Oral Health Status

( X ) if absent
Date of Oral Examination

Dental Caries
Gingivitis/Periodontal
Disease
Debris
Calculus
Abnormal Growth
Cleft Lip/Palate
Others (supernumerary/
mesiodens, etc)
B. Indicate Number
No. of Perm. Teeth Present
No. of Perm. Sound Teeth
No. of Decayed teeth (D)
No. of Missing Teeth (M)
No. of Filled Teeth (F)
Total DMF Teeth
No. of Temp. Teeth Present
No. of Temp. Sound Teeth
No. of decayed teeth (d)
No. of filled teeth (f)
Total of Teeth
A. Oral Health Condition
Pontic
Year I Date
Year IV Date
B. Services Monitoring Chart
55 54 53 52 51 61 62 63 64 65
55 54 53 52 51 61 62 63 64 65
Date
Sealant/PF/TF/Exo
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27
28
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
55 54 53 52 51 61 62 63 64 65
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37
85 84 83 82 81 71 72 73 74 75
38
85 84 83 82 81 71 72 73 74 75
Year II Date
55 54 53 52 51 61
62 63 64 65
Year V Date
18 17 16
15 14 13
12 11 21 22 23 24 25 26 27 28
85 84 83 82 81 71 72 73 74 75
55 54 53 52 51 61 62 63 64 65
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Date
Sealant/PF/TF/Exo
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27
28
85 84 83 82 81 71 72 73 74 75
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
38
Year III Date
85 84 83 82 81 71 72 73 74 75
55 54 53 52 51 61 62 63 64 65
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
Capital letters shall be used for recording the condition of

permanent dentition and small letters for the status of
temporary dentition
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Legend:
85 84 83 82 81 71 72 73 74 75
Permanent
D
F
M
Un
JC
Tooth Condition
Sound
Decayed
Filled
Missing
Unerupted
Jacket Crown
Temporary
D
F
M
Un
Jc
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Legend:
S
PF
TF
X
O
Sealant
Permanent Filling (composite, Am/ART)
Temporary Filling
Extraction
Others

Annex 1 TB
Tuberculosis Prevention and Control Program
Annex 2.8
Family Serial No.
INDIVIDUAL TREATMENT CARD (ITC)
________
TB Case Number
Date the Card is Opened

Month day
Region-Province/City
year
Name of Patient
Occupation
Age
Address:
Sputum Examination Results/Weight Record

Date
Examined
0
2
3
Treatment started:
Result
Weight (kg)
II. 2HRZES/1HRZE/5HRE
1. Relapse
2. Treatment Failure
3. Return After Default (RAD)
4. Other (smear+/-)
III. (2HRZE/4HR)
New Case
1. Smear (-) with minimal
parenchymal lesions as
assessed by the TBDC
month____ day____ year__________
Treatment Outcome:
[ ] Cured
Date:__/__/__
[ ] Failed
Date:__/__/__
[ ] Treatment Completed
Date:__/__/__
[ ] Defaulted
Date:__/__/__
Specify:___________________
[ ] Died
Date:__/__/__
Cause:_______________
[ ] Transferred out
Date:__/__/__
Specify: ___________________
4
5
6
>7
Chest X-ray result (If applicable):
No. of Household
contacts:
( ) < 10 yrs old
( ) 10 yrs old
Category (encircle):
I. 2HRZE/4HR
New Case
1. Smear (+)
2. Seriously ill
2.1. Smear (-) with extensive
parenchymal lesions as
assessed by the TBDC
3. Extra-pulmonary
Type of Patient:
[ ] New
[ ] Return After Default (RAD)
[ ] Relapse
[ ] Treatment failure
[ ] Transfer-in
[ ] Other
Due Date
Contact Number
History of Anti-TB Drug Intake: [ ] No [ ] Yes

Duration: [ ] < 1 mo. [ ] > 1 mo.
Specify drugs: ___________________
When:_________________ Where: __________________Smear Status _______________
Classification of TB:
[ ] Pulmonary
[ ] Extra-pulmonary, specify site: ____________________
Month
Sex
BCG Scar
[ ] Yes
[ ] No
[ ] Doubtful
Contact Number
Name/Relationship/Address of Contact Person

Source of Patient:
[ ] Public [ ] Private
Name of Referring Physician:
Name of DOTS Facility
TBDC findings and recommendations:
_______________________________________________________________
_______________________________________________________________
Name of treatment partner: ________________________________________
Designation of treatment partner:_____________________________
Drug Intake (Intensive phase)
Month
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Doses
given for
this
month
Cumulative
Doses
given
Doses
given for
this
month
Cumulative
Doses
given
Drug Intake (Continuation Phase)
Month
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
REMARKS: ___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Annex 2.9
Malaria Prevention and Control Program
Annex 3 Malaria
Family Serial No.
Laboratory Result
Slide Number __________
For the Health Worker

PLACE PATIENT CONSULTED
Microscopy
Hospital
RHU
BHS
Others
BMC
Month
Day
Year
DATE CONSULTED
RDT
Pf
Pf
Pv
Pv
Pm
Neg
NMPS
Clinical Diagnosis
NAME OF PATIENT
_______________________________________________________________________________________
Last Name
First Name
M.I.
AGE
Year
Month (if below 1 yr old)
SEX
Male
Female
PREGNANT
Yes
No
WEIGHT
________________ kilo/s
IP
Yes,
tribe _________________________
No
OCCUPATION (PATIENT)
ADDRESS
None
Farmer
Logger
Fisherman
Miner
Others ________________________
_______________________________________________________________________________________
Street
Brgy.
Mun.
Prov.
HOUSEHOLD HEAD
CHIEF COMPLAINT
______________________________________________________________________________________
Last Name
First Name
M.I.
______________________________________________________________________________________
Month
Day
Year
ONSET OF ILLNESS
MALARIA LABORATORY RESULT:
Name of the BMC/RHU/Hospital Staff __________________________________________________________________________
Last Name
First Name
M.I.
Name of Microscopist
__________________________________________________________________________
Last Name
First Name
M.I.
Month
Day
Year
DATE SLIDE EXAMINED
Month
Day
Year
DATE RESULT RELEASED
DRUGS GIVEN
1. Chloroquine
NUMBER
___ tabs
NUMBER
4. Coartem
___ tabs
NUMBER
7. Others ________
8. None
2. Sulfadoxine-pyrimethamine
___ tabs
5. Quinine
___ tabs
3. Primaquine
___ tabs
6. Antibiotics
___ tabs, specify ____________________________
Month
Day
Year
Date Given
SUPERVISED TREATMENT ON DAY 1
Yes
CLASSIFICATIONS: 1. Probable Uncomplicated
Severe
No
2. Confirmed -
Uncomplicated
Severe
Remark(s): ______________________________________________________________________________________________
NAME OF HEALTH WORKER/
DESIGNATION
______________________________________________________________________
Last Name
First Name
M.I.
_____
Annex 2.10
REFERRED TO
BHW
MALARIA VOLUNTEER
BM
MHO
RHM
MMC
FAW
PHN
Hospital Staff
_________________________________________________________
REASON FOR REFERRAL
________________________________________________
Month
Tear Here
Year
Day
DATE RESULT RELEASED
Laboratory Result
Slide Number ___________
WHO/WHERE RESULT WILL

BE SENT TO ______________________________________________________
STREET/BARANGAY
HOUSEHOLD HEAD
________________________________________________
________________________________________________
Last Name
NAME OF PATIENT
First Name
M.I.
_________________________________________________
Last Name
First Name
AGE
SEX
Year
Microscopy
Pf
Pf
Pv
Pv
Pm
Neg
NMPS
M.I.
Male
RDT
Clinical Diagnosis
Female
Month
Remark(s): ___________________________________________________________________________________________________
REFERRED TO: ______________________________________ REFERRED BY: _________________________________________
Annex 2 Leprosy

Leprosy Prevention and Control Program
Family Serial No.:_______

Name:
___________________________________
Sex: _________
Age: ________
Present Address: ______________________________
Civil Status: ______________________
Date of Birth:
Place of Birth: ____________________
_____________________________
Name & Address of Nearest Relative: _____________________________________________________

Occupation:
__________________________
Contact Number: __________________
Mode of Detection: Self Reporting ( ) Referral ( ) Household Contact Exam ( )
Special Project ( )
Signs: No. of patches with loss of sensation: _______________________________________________

Enlargement/tenderness of peripheral nerve/s: Yes ( ) How many? ____ No ( )
Positive smear (if done):
Yes ( )
No ( )
Classification: PB ( )
MB ( )
Type of Case: New ( )
Date Classified: __________
Relapse ( )
Return After Default ( )
Date Treatment Started: __________

Reclassified ( )
Trans in ( )
HOUSEHOLD CONTACT EXAMINATIONS:

NAME OF HOUSEHOLD
CONTACT
DATE OF EXAM/RESULT
AGE
RELATIONSHIP
SEX
Y1
Y2
Y3
Y4
Y5
REMARKS
DRUG COLLECTION CHART

DATE FOR THE
SUPERVISED DOSE
TREATMENT
PB
MB
GIVEN BY
(Initials)
REMARKS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Treatment Outcome:
Cured/Treatment Completed: Date: ________
Transferred Out: Date: __________________
Defaulted: Date: __________

Died: Date: _____________
Annex 2.11
Annex 4 Schistosomiasis

Schistosomiasis Prevention and Control Program
I.
Family Serial No.______
GENERAL DATA:
NAME: _____________________________________ AGE: ______ SEX: ______
STATUS: Married___ Single ____ Widow/er ____ Separated _____
ADDRESS: ___________________________________CONTACT NO. ___________
II.
SOCIO-ECONOMIC DATA:
1.
2.
3.
III.
PAST HISTORY OF EXPOSURE TO SCHISTOSOMIASIS ENDEMIC AREA?

Yes ____ No ____, If Yes pls. specify? ________________ How long? ________
1.
2.
IV.
Occupation: ________________________________________
Number of members in the household: ___________________
Sanitation & Hygiene Data:
3.1
With Sanitary toilet?
Yes: _____
No: ____
3.2
With Access to safe Water Supply?
Yes: ____
No: ____
History of past schisto infection?

Yes ____ No ____, if yes, When? _________________
Were you able to take the medication during that conclusive Schistosomiasis infection?
Yes ____ No ____, if yes, What meds? _________________________
Chief Complaints: (please check any)

Abdominal pain
Bloody mucoid stool
Fever
Headache
Seizure
Others:
V.
__________
__________
__________
__________
__________
__________
Vital signs & pertinent PE findings:

Wt:
____________ (kg)
BP:
____________ Pallor:
_____________ Ascites: ______________
Temp: ____________
Hepatomegaly _____________
Others ______________
RR:
____________ Splenomegaly _____________
VI.
Diagnosis:
_______________________________________________________________
VII.
Laboratory
Examination
Stool Exam
1st
nd
2
Blood Exam
Urinalysis
Others
VIII.
Action Taken
Date
Results
Remarks
_______________________________________________________________
Annex 5 Filariasis

Annex 2.12
Filariasis Prevention and Control Program

Family Serial No.______
PERSONAL DATA
NAME: ______________________________________ AGE: ____ SEX: ____ CIVIL
STATUS:____________
ADDRESS: _______________________________________________CONTACT NUMBER:
_______________
DURATION OF STAY AT ABOVE ADDRESS: _____ BIRTH PLACE:
_________________________________
OCCUPATION: ___________________________ PLACE OF WORK:
________________________________
CLINICAL DATA
CHIEF COMPLAINT:
________________________________________________________________________
HISTORY OF PRESENT ILLNESS:
Signs and Symptoms
Location
Frequency
Duration
FEVER
BODY MALAISE/
HEADACHE/ CHILLS:
LYMPHADENITIS
RETROGRADE/RECURRENT
LYMPHANGITIS
HISTORY OF PAST FILARIA INFECTION:
BLOOD EXAMINATION (If done: Results):
_________________________________________________
TREATMENT:
________________________________________________________________________
REACTION:
_________________________________________________________________________
FAMILY HISTORY: (Other similar case/cases in the same household)
NAME
1. ___________________________
AGE
SEX
OCCUPATION
____
____
______________________
____
____
______________________
____
____
______________________
______________________
2. ___________________________
______________________
3. . __________________________
______________________
SOCIAL HISTORY:
PREVIOUS PLACES OF RESIDENCE (Inclusive Dates)
ADDRESS
1.
_______________________________________________________________________________________
_
2.
_______________________________________________________________________________________
_
PREVIOUS OCCUPATION (Inclusive Dates)
1.
_______________________________________________________________________________________
_
2.
_______________________________________________________________________________________
_
PHYSICAL EXAMINATION FINDINGS:
Weight: ________ BP: ____________ Temp:______
Cardiac Rate: ______ Resp. Rate:
___________
LYMPHADENITIS (Specify/Location):
__________________________________________________________
LYMPHANGITIS (Specify/Location):
___________________________________________________________
LYMPHEDEMA (Specify/Location):
____________________________________________________________
ELEPHANTIASIS (Specify-Leg/Scrotum/Arm/Penis/Vulva/Breast)
____________________________________
_______________________________________________________________________________________
___
MANAGEMENT:
____________________________________________________________________________
_______________________________________________________________________________________
___
Service Provider: ________________________ Date Examined: __________________
Annex 2.13
INDIVIDUAL TREATMENT RECORD (ITR) FOLLOW-UP FORM
For All Children Under-Five Years of Age with Health Problems under IMCI or NonIMCI Classification/Other Children/Adults
(To be attached to the Initial ITR of the patient)
PATIENTS CASE SUMMARY

Patients Name__________________________________ Family Serial No:______
Date of Visit:_____________ Age (in months if under five years of age):________
I. Subjective Complaints(S/Sx):
Chief Complaint:
Present Illness:
Past History:
II. Objective Findings:

Vital signs:
BP (if
____
Needed):
Temp:
____
Heart
Rate:
Weight:
_____
Resp.
Rate:
____
Height: _____
_____
Physical Examination:
_________________________________________________________________________
___________________________________________________________________
______________________________________________________________________
Laboratory Results: ____________________________________________________
III. Assessment/Classification:
_________________________________________________________________________
___________________________________________________________________
______________________________________________________________________
IV. Follow-up Plan of Management: (Further Treat, Refer and Health Educate)
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________
_____________________________________
Name and Signature of Service Provider

Field Health Information System

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Field Health Information System

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Field Health Services

FHSIS VER. 2012

Public Health Surveillance and Informatics Division

Message from the Director

The Field Health Services Information System (FHSIS) continues to

ENRIQUE A. TAYAG, MD, FPSMID, PHSAE, CESO III

Enrique A. Tayag MD, PHSAE, FPSMID, CESO III

Vito G. Roque, Jr. RMT, MD, PHSAE

Vikki Carr D. de los Reyes, MD, PHSAE

Kristine Dianne T. Toledo, RN

Francis Raize Nicholas Bautista, RN

Mr. Edgardo Erce

Family Planning Program, NCDPC

Soil Transmitted Helminthiasis Control

Dr. Juanita Basilio

Dr. Francesca Gajete

Dr. Mario Baquilod

Dr. Leda Hernandez

Dr. Gerard Bellimac

Ms. Liberty Importa

Dr. Anthony Calibo

Ms. Ruth Martinez

Newborn Care, FHO, NCDPC

Schistosomiasis Program, IDO, NCDPC

Dr. Manuel Calonge

Engr. Joselito Riego de Dios

Dental Program, FHO, NCDPC

Environmental Program, NCDPC

Dr. Genesis Samonte

National TB Program, IDO, NCDPC

HIV Surveillance, NEC

Ms. Frances Precilla Cuevas

Engr. Roland Santiago

Non-Communicable Disease Program, DDO,

Environmental Program, NCDPC

Nutrition Program, FHO, NCDPC

Dr. Rosalind Vianzon

National TB Program, IDO, NCDPC

Maternal Care Program, FHO, NCDPC

Dr. Ernesto Eusebio S. Villalon

Leprosy Program, IDO, NCDPC

EPI Program, FHO, NCDPC

Regional FHSIS Coordinators

Ms. Myrna Gurtiza

Mr. James Valencia

Dr. Marian Lynn de Laza

Ms. Gloria Rodriguez

Medical Specialist III

Ms. Luz Campos

Engr. Ma. Elizabeth Baba

Mr. Mariano Selorio Jr.

Mr. Leonardo Bautista

Ms. Genoveva Vias

Ms. Maria Angeles de Guzman

Ms. Suenia Loria

Mr. Paulito Ofiasa, RN

Ms. Alma Dumasis

Ms. Maria Luz dela Cuadra

Ms. Hermela Tan

Ms. Delia Ramos

Ms. Lilia Mariano

FHSIS DIC 201201

FHSIS DIC 201201