Philippine Malaria Information System (PhilMIS)

F2

Monthly Malaria Report Form (MMRF)

REPORT NO. (To be filled-up by Data Encoder)

MONTH AND YEAR

NAME OF FACILITY
PROVINCE
MUNICIPALITY
BARANGAY
DATE SUBMITTED
SUBMITTED TO

NAME OF PATIENT

SLIDE /RDT NO.

DIAGNOSIS

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
NO. OF POSITIVE SLIDE:

NO. OF PATIENT TESTED

NEGATIVE FOR MALARIA

NO. OF RDT DONE :

WITHIN 24 HOURS:

NO. OF SLIDES EXAMINED :

NO. OF POSITIVE RDT:

NO. OF CLINICAL DIAGNOSIS:
TOTAL NO. OF POSITIVE CASES:
PREPARED BY:
DESIGNATION:
RECEIVED IN THE RHU BY :

REVIEWED IN THE RHU BY :

POSITION:

POSITION:

DATE RECEIVED:

DATE REVIEWED:

RECEIVED IN THE PHO BY:

(IF APPLICABLE)

REVIEWED IN THE PHO BY:

(IF APPLICABLE)

POSITION:
DATE RECEIVED:

POSITION:
DATE REVIEWED:

REMARK(S)