Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD

)
Name of Municipality: ________________________
Name of MHO: ______________________________
Name of PHN: _______________________________

No.

REP Code

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011

Name of Child

(Surname, First,
MI.)

Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Sto. Domingo, Rebecca
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Francisco, Jim Andrei
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl

*Use Fill Color to identify reported children within the reporting month
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
JUNE

Summary:

Yellow
Blue

Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
MARIA JESUSA A. MARZAN, RN
NDP

No. of Vaccinated Neonate/Infant f
MALE

Sex (M/F)

Date of Birth*

Age in
Months

Age Group

M
F
F
F
M
M
F
M
M
M
F

8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015

27
22
22
19
15
6
6
6
4
3
2

24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos

eporting month

1380
1380
1380
1380
1380
0

24
24
24
24
24

mos
mos
mos
mos
mos

above
above
above
above
above

inated Neonate/Infant from Month 1-30, 2015
FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0

Birthplace
(Mun., Name of Mother (Surname, First,
Prov.)
MI.)

San
San
San
San
San
San
San
San
San
San
San

Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,

Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora

Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Sto. Domingo, Leslie
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Abragon, Regine Rose
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen

Date of Completion: __________________

Detailed Address in Purok
including Landmarks

Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone

1
1
1
1
1
1
1
1
1
1
1

Purok

Barangay

zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1

Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut

Noted by:
ROGELYNE P. TAMAYO, RN
PHN

pletion: ____________________________ Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 none none none none none none NHTS (Yes/No) yes No yes No No yes yes No No No No PhilHealth (YesNBS write the PHIC done* number/No) (Yes/No) 0720-0320-3183 No 0720-1046-1295 No No Yes Yes No No No No No No No No No No No .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

MD MHO . TANGSON.ROSALILIA C.

IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 een given* FIC* 1 1 CIC* 1 1 1 .

.

Immunized Immunized Immunized Immunized Immunized TT5 Partially Partially Partially Partially Partially TT4 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT3 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

Name (Yes/No) Visitor P(Date) mos 2: of Pediatrician.Vitamin A* Status Age TI-Trans In TOGroup Location (Brgy. Private Pedia 12-23 Reason for refusal R-Refused mos . CPAB* Trans Out VGiven 1: 6-11 Mun.). Prov.

.

Remarks adopted by Vilma Ritual Date of Completion 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 .

.

Queen Althea Joy Sindac. Nadiajan. Lea Mae S. Princess Banalee Abragon. Jayven Roy Bernabe. Jake Lee 10 11 12 13 14 *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . First. Janelle Mila. Orena.) Lopez. Rhianne Alojado. Eduardo jr. MI. Irish Jade Sindac.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: ________________________ Name of MHO: ______________________________ Name of PHN: _______________________________ No. REP Code 1 2 3 4 5 6 7 8 9 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 Name of Child (Surname.

MARZAN. of Vaccinated Neonate/Infant f MALE . RN NDP No.Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A.

Sex (M/F) Date of Birth* Age in Months Age Group F F F F F F M M M 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 24 24 21 18 15 17 10 9 7 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos eporting month 1380 1380 1380 1380 1380 0 24 24 24 24 24 mos mos mos mos mos above above above above above .

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 .inated Neonate/Infant from Month 1-30.

) San Luis. Aurora San Luis.Birthplace (Mun. Aurora Baler. Aurora San Luis. Orena. Michelle Bernabe. Jaycel . Fatima Mila. Marjorie Abragon.) MI. First.. Aurora Lopez. Jemelie Sindac. Aurora San Luis. Aurora San Luis. Normelyn Alojado. Aurora Baler. Marmelyn S. Prov. Name of Mother (Surname. Ginalyn Nadiahan. Aurora Baler. Aurora San Luis. Kwinie Trinidad.

.

Date of Completion: __________________ Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone 3 3 2 3 3 3 2 2 2 Purok Zone Zone Zone Zone Zone Zone Zone Zone Zone 3 3 2 3 3 3 2 2 2 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

Noted by: ROGELYNE P. RN PHN . TAMAYO.

pletion: ____________________________ Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) No yes no no yes No No No No PhilHealth (YesNBS write the PHIC done* number/No) (Yes/No) No No no no yes No No No Yes No Yes No No No No No Yes Yes .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 Place 1 if vaccine has been 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

MD MHO . TANGSON.ROSALILIA C.

MMR 1 1 1 1 1 1 1 1 1 1 1 1 IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 AMV vaccine has been given* .

.

1 1 1 1 1 1 Card Check Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized TT3 CIC* TT2 FIC* TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

TT5 Vitamin A* TT4 her recall TT doses* 1 1 1 Status Age TI-Trans In TOGroup CPAB* Trans Out VGiven 1: 6-11 (Yes/No) Visitor P(Date) mos 2: Private Pedia 12-23 R-Refused mos .

.

Mun.). Name of Pediatrician.Status Location (Brgy. Reason for refusal Remarks Date of Completion 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 . Prov.

.

Micaela Salinel. GINMAR *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . Lance Aeron Tanael. James Marky Loberiano.) Abragon. Mark Angel Salinel.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: ________________________ Name of MHO: ______________________________ Name of PHN: _______________________________ No. Jean Aira Lopez. REP Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115083011 Name of Child (Surname. MI. Clarisse Udarbe. Lea Mae OLIT. First. Lovelyn Mae Andrada. Yodi Gonzales. Jhon Carl Aldama.

RN NDP No.Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. of Vaccinated Neonate/Infant f MALE . MARZAN.

Sex (M/F) Date of Birth* Age in Months Age Group M M F M F F M F M F M 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 7/25/2015 12/14/2014 31 27 20 19 12 14 18 10 10 4 11 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos eporting month 1380 1380 1380 1380 1380 0 24 24 24 24 24 mos mos mos mos mos above above above above above .

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 .inated Neonate/Infant from Month 1-30.

DALIA .) San Luis. Name of Mother (Surname. Josephine Loberiano. Aurora San Luis. Aurora San Luis.) MI.. LAILA OLIT. Aurora San Luis. Aurora Lumbaga. Carmen Salinel. Prov. Aurora San Luis. Aurora San Luis. Luz Andrada. Aurora San Luis. Aurora San Luis. First. Aurora Baler. Ronalyn Tanael. Aurora Baler.Birthplace (Mun. Aurora San Luis. Aurora Abragon. April Gonzales. Mary Rose Salinel. Jonalyn Aldama. Maria Udarbe.

.

Date of Completion: __________________ Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 4 4 4 4 4 4 4 4 4 4 4 Purok zone zone zone zone zone zone zone zone zone zone zone 4 4 4 4 4 4 4 4 4 4 4 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

RN PHN . TAMAYO.Noted by: ROGELYNE P.

pletion: ____________________________ Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) no No No No No yes no yes No yes NO PhilHealth (YesNBS write the PHIC done* number/No) (Yes/No) no No No No No yes No 07-2009137042 No no NO No No No No No No No Yes No No YES .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 Place 1 if vaccine has been 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

MD MHO .ROSALILIA C. TANGSON.

MMR 1 1 1 1 1 1 1 1 1 IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 AMV vaccine has been given* .

.

1 1 1 1 1 Card Check Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT3 CIC* TT2 FIC* TT1 Place 1 if mother recall TT do 1 1 1 1 1 .

.

Vitamin A* TT5 TT4 her recall TT doses* Status Age TI-Trans In TOGroup CPAB* Trans Out VGiven 1: 6-11 (Yes/No) Visitor P(Date) mos 2: Private Pedia 12-23 R-Refused mos TO 1 1 1 1 1 .

.

Mun. Name of Pediatrician.Status Location (Brgy. Reason for refusal REAL Remarks Date of Completion 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 .). Prov.

.

REP Code 1 2 3 4 5 6 7 8 9 SANL0115084001 SANL0115084002 SANL0115084003 SANL0115084004 Name of Child (Surname. Clifford 10 11 12 13 14 *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . Nadine Novicio. MI. Marvin Magdato. Raico Jay Pradillada.) Alling.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: ________________________ Name of MHO: ______________________________ Name of PHN: _______________________________ No. First.

MARZAN. RN NDP No. of Vaccinated Neonate/Infant f MALE .Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A.

Sex (M/F) M F M M eporting month Date of Birth* Age in Months Age Group 5/7/2014 6/3/2014 4/15/2015 8/22/2015 19 18 8 4 12-23 mos 12-23 mos 0-11 mos 0-11 mos 1380 1380 1380 1380 1380 0 24 24 24 24 24 mos mos mos mos mos above above above above above .

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 .inated Neonate/Infant from Month 1-30.

Birthplace
(Mun., Name of Mother (Surname, First,
Prov.)
MI.)

San
San
San
San

Luis,
Luis,
Luis,
Luis,

Aurora
Aurora
Aurora
Aurora

Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Pradillada, Reena

Date of Completion: __________________

Detailed Address in Purok
including Landmarks

Zone
Zone
Zone
Zone

5
5
5
5

Purok

zone
zone
zone
zone

5
5
5
5

Barangay

Dibut
Dibut
Dibut
Dibut

Noted by:
ROGELYNE P. TAMAYO, RN
PHN

pletion: ____________________________

Contact No.

9068948109
9068948109

NHTS (Yes/No)

yes
no
No
No

PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
yes
No
No
No
No

No
Yes
No
No

BCG

HepB BD

Penta 1

Penta 2

Penta 3

OPV 1

OPV 2

OPV 3

Place 1 if vaccine has been

1
1
1
1

1
1
1
1

1
1

1
1

1
1

1
1

1
1

1
1

ROSALILIA C. TANGSON, MD
MHO

MMR 1 1 1 1 IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 AMV vaccine has been given* .

.

1 1 Card Check Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized TT3 CIC* TT2 FIC* TT1 Place 1 if mother recall TT dos 1 1 1 1 1 1 1 1 1 1 .

.

TT5 Vitamin A* TT4 her recall TT doses* 1 1 1 CPAB* (Yes/No) Age Group 1: 6-11 Given mos 2: 12-23 mos (Date) .

.

Private Pedia Reason for refusal R-Refused Remarks . Name Visitor Pof Pediatrician. Prov.).Status TI-Trans In TOLocation (Brgy. Trans Out VMun.

Date of
Completion

12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)
Name of Municipality: ________________________
Name of MHO: ______________________________
Name of PHN: _______________________________

No.

REP Code

1
2
3
4
5
6
7
8
9
10
11
12
13

SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115085013

Name of Child

(Surname, First,
MI.)

Natividad, Robin Jan
Natividad, Rappah Jan
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Del Monte, Bea Grace
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Novicio, Bb. Boy

*Use Fill Color to identify reported children within the reporting month
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue

Summary:

Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
MARIA JESUSA A. MARZAN, RN
NDP

No. of Vaccinated Neonate/Infant f
MALE

Sex (M/F)

Date of Birth*

Age in
Months

Age Group

M
M
M
F
F
F
F
F
M
F
F
F
M

4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/15/2015

32
19
29
28
28
27
22
21
20
34
23
19
8

24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos

eporting month

1380
1380
1380
1380
1380
0

24
24
24
24
24

mos
mos
mos
mos
mos

above
above
above
above
above

inated Neonate/Infant from Month 1-30, 2015
FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0

Birthplace
(Mun., Name of Mother (Surname, First,
Prov.)
MI.)

San
San
San
San
San
San
San
San
San
San
San
San
San

Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,

Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora

Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Loberiano, Evangeline
Del Monte, Bernadette
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Novicio, Daisy Rose

.

Date of Completion: __________________ Detailed Address in Purok including Landmarks zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 6 6 6 6 Purok zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 6 6 6 6 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

TAMAYO. RN PHN .Noted by: ROGELYNE P.

pletion: ____________________________ Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 none NHTS (Yes/No) No No No yes yes no no yes yes yes yes No No PhilHealth (YesNBS write the PHIC done* number/No) (Yes/No) No No No yes yes no no yes yes yes yes No No No No No No No No No No No No No No No .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 Place 1 if vaccine has been 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

ROSALILIA C. MD MHO . TANGSON.

IPV PCV 3 PCV 2 PCV 1 1 1 1 1 1 1 1 1 1 1 1 1 ROTA 2 MMR 1 1 1 1 1 1 1 1 1 1 1 1 ROTA 1 AMV vaccine has been given* .

.

1 1 1 1 1 1 1 1 1 1 1 Card Check Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT3 CIC* TT2 FIC* TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 .

.

TT5 Vitamin A* TT4 her recall TT doses* 1 1 1 1 1 1 1 Status Age TI-Trans In TOGroup CPAB* Trans Out VGiven 1: 6-11 (Yes/No) Visitor P(Date) mos 2: Private Pedia 12-23 R-Refused mos Yes .

.

Status Location (Brgy. Name of Pediatrician. Mun. Prov. Reason for refusal Remarks Date of Completion 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 .).

.

Arjie Sollegue. MI. First. Johnmarvin Bihasa. Jamaica *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . Fea Esplandor.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: ________________________ Name of MHO: ______________________________ Name of PHN: _______________________________ No.) Tindogan. Rafael Casamis. Yuki Orca. Princess Eslera. Elerie Salcedo. REP Code 1 2 3 4 5 6 7 8 9 10 11 12 13 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 SANL0115086007 SANL0115086008 Name of Child (Surname.

MARZAN.Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. RN NDP No. of Vaccinated Neonate/Infant f MALE .

Sex (M/F) Date of Birth* Age in Months Age Group F M M M F F M F 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 4/15/2015 4/24/2015 31 24 27 24 24 5 7 7 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above 0-11 mos 0-11 mos 0-11 mos eporting month 0 .

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 .inated Neonate/Infant from Month 1-30.

Elsie Salcedo. Rachelle Eslera. Luis. Luis. maricel Bihasa. Odette Casamis. Lyn Orca. Luis. Luis.Birthplace (Mun. Razell Esplandor.) MI. Luis. Name of Mother (Surname. Prov.) San San San San San San San San Luis. Luis.. Luis. Joy . First. Elena Sollegue. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Tindogan.

.

Date of Completion: __________________ Detailed Address in Purok including Landmarks zone zone zone zone zone zone zone zone 7 7 7 7 7 7 7 7 Purok zone zone zone zone zone zone zone zone 7 7 7 7 7 7 7 7 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

RN PHN . TAMAYO.Noted by: ROGELYNE P.

9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) No No no No No No No No PhilHealth (YesNBS write the PHIC done* number/No) (Yes/No) No No no No No No No No No No No No No No No No .pletion: ____________________________ Contact No.

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 Place 1 if vaccine has been 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

ROSALILIA C. TANGSON. MD MHO .

MMR 1 1 1 1 1 1 1 1 1 1 IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 AMV vaccine has been given* .

.

Card Check Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT3 1 1 1 1 1 CIC* TT2 FIC* TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

Vitamin A* TT5 TT4 her recall TT doses* CPAB* (Yes/No) 1 1 1 Yes Yes Given (Date) Age Group 1: 6-11 mos 2: 12-23 mos .

.

V-Visitor Mun. Name P-Private Pedia of Pediatrician.). Prov. RReason for refusal Refused Remarks .Status TI-Trans In TO-Trans Out Location (Brgy.

.

Date of Completion 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 .

.

Gilyn Del Monte. REP Code 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 26 27 28 29 30 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 Name of Child (Surname. Janelle Mila. Micaela Salinel. AURORA Name of MHO: _ROSALILIA C.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Queen Althea Joy Abragon. Rommel Angara. Yodi Gonzales. First. TAMAYO. Lovelyn Mae Andrada. Khayla Loberiano. Marvin Magdato. Jhonny Bihasa. Robin Jan Natividad. Lance Aeron Tanael. Rebecca Avenilla. Princess Banalee Abragon. Allyna Sto. Bea Grace Molina. Daiton Lopez. Rappah Jan Aldama. Benedict Sex (M/F) M F F F M F F F F F F M M F M F F M F M F M M M F F F F F M . Jean Aira Alling. Rhianne Alojado. Lea Mae S. TANGSON. MI. RN No. Nadine Natividad. Clarisse Udarbe. Glory Joy Baynosa. James Marky Loberiano. Fairy Mae Angara. MD Name of PHN: ROGELYNE P. Irish Jade Sindac. Orena. Lyca joyce Caldosa. Domingo. Jhon Carl Aldama.) Novicio.

31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Novicio. Jeralyn Manarpiis. Arjie Sollegue. Princess F F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC MALE 0 0 0 0 2 2 0 2 0 2 1 2 0 No. Jenny De Leon. Irish Tindogan. of Vaccinated Neonate/In FEMALE 1 1 0 2 5 9 1 3 5 5 3 3 4 . Fea Esplandor. Yuki Orca. Johnmarvin Bihasa.

MARZAN.Prepared by: MARIA JESUSA A. RN NDP .

Date of Birth* Age in Months Age Group 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 17 12 12 9 5 14 14 11 8 5 7 21 18 10 9 2 4 8 0 8 7 21 8 18 17 17 16 11 10 9 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos .

2015 FEMALE TOTAL 1 1 1 1 0 0 2 2 5 7 9 11 1 1 3 5 5 5 5 7 3 4 3 5 4 4 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos .2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 23 12 8 21 14 17 14 14 ng month ccinated Neonate/Infant from Month 1-30.

.

Aurora Baler. Aurora San Luis. Evangeline Del Monte. Rose May Angara. Aurora San Luis. Leslie Avenilla. Kwinie Abragon.Birthplace (Mun. Luz Andrada. Marvy . Aurora San Luis. Aurora San Luis. First. Aurora San Luis. Abigail Natividad. Orena. Aurora San Luis. MI.) Novicio. Aurora San Luis. Maria Udarbe. Aurora Name of Mother (Surname. Aurora San Luis.Irene Baynosa. Prov. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Gretchen Angara.. Josephine Loberiano. Wendra Natividad. Carmen Salinel. Normelyn Alojado. Ronalyn Tanael. Aurora San Luis. Fatima Mila. Aurora San Luis. Aurora San Luis. Abigail Aldama. Dolores Bihasa. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Marjorie Abragon. Aurora San Luis. Rachelle Loberiano. Maritess Magdato. Aurora San Luis. Jonalyn Aldama. Aurora San Luis. Jemelie Sindac. Bernadette Molina.) San Luis. Aurora San Luis. Aurora San Luis. Lerma Sto. Aurora Baler. Aurora San Luis. Domingo. Aurora Alling. Daisyrose Lopez. Marmelyn S. liezel Caldosa. April Gonzales.

Luis. Rachelle . Aileen Tindogan. Luis. Luis. Razell Esplandor. Elsie Manarpiis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Novicio. Luis.San San San San San San San San Luis. Luis. Lyn Orca. Elena Sollegue. Luis. maricel Bihasa. Mercy De Leon. Luis.

.

Date of Completion: _ Detailed Address in Purok including Landmarks Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

#83 DOH Street In front of the church At the back of Brgy. Hall zone zone zone zone zone zone zone zone 6 6 6 7 7 7 7 7 Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

Noted by: ROGELYNE P. RN PHN . TAMAYO.

NHTS (Yes/No) BCG Place 1 if v 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .pletion: _JANUARY 2015 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No yes No No No yes no no yes No no No No No No yes no yes yes no No No No yes yes no no yes yes PhilHealth (Yeswrite the PHIC number/No) NBS done* (Yes/No) 0720-0320-3183 No No No No No No Yes No No No No No No No No No No No Yes No Yes No No No No No No No No No No 0720-1046-1295 No No No No no no yes No no No No No No yes No 07-2009137042 yes No No No No yes yes no no yes yes HepB BD Contact No.

9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes yes No No No no No No yes yes No No No no No No No No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

TANGSON MHO .ROSALILIA C.

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 MMR 1 1 1 1 AMV 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 OPV 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 FIC* CIC* OPV 2 OPV 1 Penta 2 Penta 3 Penta 1 Place 1 if vaccine has been given* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

MD .SALILIA C. TANGSON.

TT3 TT4 TT5 Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/No) .

Completely Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

). Mun. Reason for refusal . Prov.Vitamin A* Age Group 1: 6-11 mos Given (Date) 2: 12-23 mos Status TI-Trans In TO-Trans Out V-Visitor P-Private Pedia R-Refused Location (Brgy. Name of Pediatrician.

.

.

Remarks Date of Completion 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 .

1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 .

.

Rappah Jan Aldama. Rommel Angara. Rhianne Alojado. Benedict Novicio. Allyna Sto. Princess Banalee Abragon. TANGSON. Jeralyn Manarpiis. RN No. MI. Robin Jan Natividad. James Marky Loberiano. Jhon Carl Aldama. Domingo.) Novicio. Janelle Mila. Lea Mae S. Lance Aeron Tanael. Fea Sex (M/F) M F F F M F F F F F F M M F M F F M F M F M M M F F F F F M F F F F . Jean Aira Alling. Rebecca Avenilla. TAMAYO. Lyca joyce Caldosa. Bea Grace Molina. Orena. First. Lovelyn Mae Andrada.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Daiton Lopez. Yodi Gonzales. Nadine Natividad. Irish Tindogan. Gilyn Del Monte. MD Name of PHN: ROGELYNE P. Jenny De Leon. Micaela Salinel. Glory Joy Baynosa. AURORA Name of MHO: _ROSALILIA C. Jhonny Bihasa. Irish Jade Sindac. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 Name of Child (Surname. Khayla Loberiano. Clarisse Udarbe. Fairy Mae Angara. Marvin Magdato. Queen Althea Joy Abragon.

Yuki Orca.35 36 37 38 39 40 41 42 43 44 45 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Esplandor. Arjie Sollegue. of Vaccinated Neonate/Infant fro MALE FEMALE 0 1 0 1 0 0 0 2 2 5 2 9 0 1 2 3 0 5 2 5 1 3 2 3 0 4 . RN NDP No. MARZAN. Johnmarvin Bihasa. Princess M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis.. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora . Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/5/2013 18 13 13 10 6 15 15 12 8 6 8 22 18 11 10 3 5 9 1 9 8 22 9 19 18 18 17 12 11 10 24 13 9 22 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 24 mos above 12-23 mos 0-11 mos 12-23 mos San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

Luis.11/9/2013 8/8/2013 11/23/2013 11/19/2013 15 18 15 15 12-23 12-23 12-23 12-23 porting month ed Neonate/Infant from Month 1-30. 2015 FEMALE TOTAL 1 1 1 1 0 0 2 2 5 7 9 11 1 1 3 5 5 5 5 7 3 4 3 5 4 4 mos mos mos mos San San San San Luis. Luis. Aurora Aurora Aurora Aurora . Luis.

Bernadette Molina. liezel Caldosa. Dolores Bihasa. Marmelyn S. Abigail Aldama. Normelyn Alojado. MI. Orena. Luz Andrada.) Landmarks Novicio. Marvy Novicio. Marjorie Abragon. Daisyrose Lopez. Rachelle Loberiano. Leslie Avenilla. Aurora Alling. Wendra Natividad. First. Kwinie Abragon. Razell Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 7 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut . Josephine Loberiano. Fatima Mila. Carmen Salinel. Evangeline Del Monte.Irene Baynosa. April Gonzales. Maria Udarbe. Rose May Angara. Domingo. Elsie Manarpiis. Gretchen Angara.Date of Completion: _ Detailed Address Name of Mother in Purok including (Surname. Ronalyn Tanael. Mercy De Leon. Aileen Tindogan. Lerma Sto. Jemelie Sindac. Maritess Magdato. Jonalyn Aldama. Abigail Natividad.

Rachelle zone zone zone zone 7 7 7 7 Noted by: ROGELYNE P. maricel Bihasa. Lyn Orca. Elena Sollegue. TAMAYO. RN PHN Dibut Dibut Dibut Dibut .Esplandor.

ompletion: _JANUARY 2015 yes No yes No No No yes no no yes No no No No No No yes no yes yes no No No No yes yes no no yes yes yes yes No No NBS done* (Yes/No) 0720-0320-3183 No No No No No No Yes No No No No No No No No No No No Yes No Yes No No No No No No No No No No No No No No 0720-1046-1295 No No No No no no yes No no No No No No yes No 07-2009137042 yes No No No No yes yes no no yes yes yes yes No No Penta 1 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 PhilHealth (Yeswrite the PHIC number/No) HepB BD Contact No. NHTS (Yes/No) BCG Place 1 if vaccine ha 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

MHO . TANGSON.9068948109 9068948109 9068948109 9068948109 No no No No No no No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 ROSALILIA C.

Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* FIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CIC * 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Card Check Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Completely Immunized .

TANGSON. MD 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized .1 1 1 1 1 1 1 1 1 1 1 1 LILIA C.

TT1 TT2 TT3 TT4 TT5 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Vitamin A* CPAB* (Yes/No) Given (Date) Age Group 1: 6-11 mos 2: 12-23 mos .

1 1 1 1 1 1 1 1 1 1 1 .

Status TI-Trans In TOLocation (Brgy. Mun. Name of Visitor PPediatrician. Trans Out VProv. Reason Private Pedia for refusal R-Refused Remarks .).

.

Date of Completion 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 .

2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 2/28/2015 .

Allyna Sto. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 Name of Child (Surname. Irish Jade Sindac. Lance Aeron Tanael. TANGSON. Jayven Roy Bernabe. Daiton Lopez. Mark Angel Alling. Lyca joyce Caldosa. Lovelyn Mae Andrada. Jhonny Bihasa. Lea Mae S. Orena. Jhon Carl Aldama. Clarisse Udarbe. Queen Althea Joy Sindac. MD Name of PHN: ROGELYNE P. Marvin Magdato. MI. Eduardo jr. Rappah Jan Aldama. Rhianne Alojado. AURORA Name of MHO: _ROSALILIA C. TAMAYO. Benedict Novicio. Yodi Gonzales. Glory Joy Baynosa.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Rommel Angara. Princess Banalee Abragon. Fairy Mae Angara. Abragon. Gilyn Del Monte. Rebecca Avenilla. Micaela Salinel. First. Jeralyn Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F F M F . Khayla Loberiano. Domingo.) Novicio. Jean Aira Lopez. James Marky Loberiano. Bea Grace Molina. RN No. Robin Jan Natividad. Nadine Natividad. Janelle Mila.

Fea Esplandor. MARZAN.35 36 37 38 39 40 41 42 43 44 45 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Manarpiis. Arjie Sollegue. Yuki Orca. Princess F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. of Vaccinated Neonate/Infant from MALE FEMALE 1 0 0 0 0 0 2 0 0 0 1 4 2 0 2 3 1 3 1 2 0 1 1 2 0 0 . Johnmarvin Bihasa. RN NDP No. Irish Tindogan. Jenny De Leon.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora .. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 17 12 12 9 5 14 14 11 8 5 7 0 Err:502 21 18 10 9 2 4 8 0 0 8 7 21 8 18 17 17 16 11 10 9 23 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos Err:502 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora .1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 12 8 21 14 17 14 14 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos eporting month d Neonate/Infant from Month 1-30. Luis. Luis. Luis. 2015 FEMALE TOTAL 0 1 0 0 0 0 0 2 0 0 4 5 0 2 3 5 3 4 2 3 1 1 2 3 0 0 San San San San San San San Luis. Luis.

Aurora Lumbaga. Maria Udarbe. Ronalyn Tanael. Luz Andrada. Rose May Angara. Fatima Mila.Name of Mother (Surname. Lerma Sto. liezel Caldosa. Marmelyn S. Gretchen Angara. April Gonzales. Leslie Avenilla. Marvy Novicio. Abigail Aldama. Maritess Magdato. Wendra Natividad. MI. First. Ginalyn Abragon. Josephine Loberiano. Elsie Detailed Address in Purok including Landmarks Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 . Mary Rose Alling. Daisyrose Lopez. Domingo. Kwinie Trinidad. Marjorie Abragon. Michelle Bernabe. Dolores Bihasa.) Novicio. Orena. Bernadette Molina. Evangeline Del Monte.Irene Baynosa. Carmen Salinel. Jemelie Sindac. Abigail Natividad. Rachelle Loberiano. Jonalyn Aldama. Normelyn Alojado.

RN PHN zone zone zone zone zone zone zone 6 6 7 7 7 7 7 . Elena Sollegue. maricel Bihasa. Razell Esplandor. Mercy De Leon. Lyn Orca. Aileen Tindogan.Manarpiis. Rachelle zone zone zone zone zone zone zone 6 6 7 7 7 7 7 Noted by: ROGELYNE P. TAMAYO.

NHTS (Yes/No) Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no yes yes yes PhilHealth (Yeswrite the PHIC number/No) 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no yes yes yes .Date of Completion: _JANUARY 2015 Barangay Contact No.

Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No No No no No No yes No No No no No No .

OPV 3 AMV MMR 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 PCV 2 OPV 2 1 1 1 1 1 1 1 1 1 1 1 PCV 1 OPV 1 1 1 1 1 1 1 1 1 1 1 1 1 ROTA 2 Penta 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ROTA 1 Penta 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Penta 1 No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No No No No HepB BD NBS done* (Yes/No) BCG Place 1 if vaccine has been given* .

TANGSON. MD MHO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ROSALILIA C.

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT5 1 1 Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized TT4 1 Card Check TT3 CIC * TT2 FIC* TT1 IPV PCV 3 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

mos Private Reason Pedia for R.refusal Refused TO Real . Vitamin A* Status Age Trans Mun. CPAB* Remark 1: 6-11 V-Visitor Name of (Yes/No) Given (Date) s mos 2: Pediatri 12-23 Pcian.TI-Trans In Location TO(Brgy. Group Out Prov.).

.

Date of Completion 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 .

1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 1/31/2015 .

MD Name of PHN: ROGELYNE P. Rebecca Avenilla. Princess Banalee Abragon. Jhon Carl Aldama. Gilyn Del Monte. Rommel Angara. Queen Althea Joy Sindac. Khayla Loberiano. TANGSON. Mark Angel Alling. Jeralyn Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F F M F . Nadine Natividad. Allyna Sto. Robin Jan Natividad. First. James Marky Loberiano. Marvin Magdato. Janelle Mila. Lovelyn Mae Andrada. AURORA Name of MHO: _ROSALILIA C. Yodi Gonzales. Rappah Jan Aldama.) Novicio. Lea Mae S. Domingo. Lance Aeron Tanael.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Irish Jade Sindac. Jean Aira Lopez. Daiton Lopez. Benedict Novicio. Jhonny Bihasa. Eduuardo jr. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 Name of Child (Surname. Abragon. RN No. Clarisse Udarbe. Fairy Mae Angara. Glory Joy Baynosa. MI. Micaela Salinel. TAMAYO. Rhianne Alojado. Bea Grace Molina. Lyca joyce Caldosa. Orena. Jayven Roy Bernabe.

of Vaccinated Neonate/Infant fro MALE FEMALE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . Irish Tindogan. RN NDP No. Yuki Orca. Arjie Sollegue. Princess F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. MARZAN. Fea Esplandor. Johnmarvin Bihasa. Jenny De Leon.35 36 37 38 39 40 41 42 43 44 45 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Manarpiis.

Date of Birth* Age in Months Age Group 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 20 15 15 12 8 17 17 14 11 8 10 3 2 24 20 13 12 5 7 11 3 3 11 10 24 11 21 20 20 19 14 13 12 26 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above .

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 15 11 24 17 20 17 17 12-23 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos eporting month nated Neonate/Infant from Month 1-30.

Orena. Marmelyn S. Aurora Baler. Aurora San Luis. Josephine Loberiano. Aurora San Luis. Aurora San Luis.Birthplace (Mun. Michelle Bernabe. MI. Aurora San Luis. Aurora San Luis.. Aurora San Luis. Evangeline Del Monte. Aurora Lumbaga. Aurora San Luis. Prov. Aurora San Luis. Ginalyn Abragon. Marvy Novicio.) San Luis. Aurora San Luis. Abigail Aldama. Aurora San Luis. Domingo. Aurora San Luis. liezel Caldosa. Normelyn Alojado. Aurora San Luis. Bernadette Molina. Rose May Angara.) Novicio. Aurora San Luis. Aurora San Luis. April Gonzales. Aurora San Luis. Lerma Sto. Maria Udarbe. Aurora San Luis. Aurora Baler. Carmen Salinel. Aurora San Luis. Aurora San Luis. Ronalyn Tanael. Kwinie Trinidad. Aurora San Luis. Fatima Mila. Daisyrose Lopez. Abigail Natividad. Aurora San Luis. Aurora Name of Mother (Surname. Wendra Natividad.Irene Baynosa. Maritess Magdato. Aurora San Luis. Aurora San Luis. Dolores Bihasa. Aurora San Luis. Jonalyn Aldama. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Mary Rose Alling. Aurora San Luis. Aurora San Luis. Aurora San Luis. Rachelle Loberiano. Elsie . Luz Andrada. Marjorie Abragon. First. Gretchen Angara. Jemelie Sindac. Aurora Baler. Leslie Avenilla.

San San San San San San San Luis. Lyn Orca. Razell Esplandor. Luis. Mercy De Leon. Aileen Tindogan. Rachelle . Luis. Luis. Luis. Elena Sollegue. Luis. Luis. maricel Bihasa. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Manarpiis.

Date of Completion: _ Detailed Address in Purok including Landmarks zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 5 Zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

zone zone zone zone zone zone zone 6 6 7 7 7 7 7 Noted by: ROGELYNE P. RN PHN zone zone zone zone zone zone zone 6 6 7 7 7 7 7 Dibut Dibut Dibut Dibut Dibut Dibut Dibut . TAMAYO.

mpletion: _JANUARY 2015 Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS PhilHealth (Yes-write (Yes/No) the PHIC number/No) yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no yes yes yes 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no yes yes yes NBS done* (Yes/No) BCG Place 1 if No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No No No no No No yes No No No no No No No No No No No No No 1 1 1 1 1 1 ROSALILIA C. TA MHO .

HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* FIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CIC * 1 1 1 1 1 1 1 1 1 .

TANGSON. MD 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ROSALILIA C.

TT4 TT5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT3 Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/No) .

Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Vitamin A* Given (Date) Status TI-Trans In TOAge Group 1: Trans Out V6-11 mos 2: Visitor P12-23 mos Private Pedia R-Refused .

.

Prov. Reason for refusal Remarks Date of Completion 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 .Status Location (Brgy.). Mun. Name of Pediatrician.

4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 .

James Marky Loberiano. Yodi Gonzales. Domingo. Abragon. Allyna Sto. Gilyn Del Monte. Lovelyn Mae Andrada. Micaela Salinel.) Novicio. Rappah Jan Aldama. Queen Althea Joy Sindac. Mark Angel Alling. Nadine Natividad.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Clarisse Udarbe. Marvin Magdato. Rebecca Avenilla. Khayla Loberiano. Glory Joy Baynosa. Orena. Benedict Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F F M . AURORA Name of MHO: _ROSALILIA C. Princess Banalee Abragon. MI. TAMAYO. Jayven Roy Bernabe. Fairy Mae Angara. TANGSON. First. Lance Aeron Tanael. MD Name of PHN: ROGELYNE P. Jean Aira Lopez. RN No. Bea Grace Molina. Rhianne Alojado. Jhon Carl Aldama. Lyca joyce Caldosa. Robin Jan Natividad. Irish Jade Sindac. REP Code 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 26 27 28 29 30 31 32 33 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 Name of Child (Surname. Janelle Mila. Lea Mae S. Rommel Angara. Eduuardo jr. Jhonny Bihasa. Daiton Lopez.

Arjie Sollegue. Johnmarvin Bihasa. Jeralyn Manarpiis. Princess F F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. of Vaccinated Neonate/Infant f MALE FEMALE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .34 35 36 37 38 39 40 41 42 43 44 45 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Novicio. Fea Esplandor. Jenny De Leon. RN NDP No. Irish Tindogan. MARZAN. Yuki Orca.

Date of Birth* Age in Months Age Group 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 20 15 15 12 8 17 17 14 11 8 10 3 2 24 20 13 12 5 7 11 3 3 11 10 24 11 21 20 20 19 14 13 12 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos .

2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 26 15 11 24 17 20 17 17 24 mos above 12-23 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos ing month ed Neonate/Infant from Month 1-30. 2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

Aurora San Luis. Marjorie Abragon.Irene Baynosa. Wendra Natividad. Kwinie Trinidad. Michelle Bernabe. Aurora Baler. Maritess Magdato. Carmen Salinel. Aurora San Luis. Luz Andrada. Ronalyn Tanael. Ginalyn Abragon. Abigail Aldama.. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.) San Luis. Aurora San Luis.Birthplace (Mun. Abigail Natividad. Mary Rose Alling. Aurora San Luis. Daisyrose Lopez. Rose May Angara. Maria Udarbe. Aurora San Luis. Aurora Baler. Dolores Bihasa. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Lumbaga. Aurora San Luis. Marvy . Aurora San Luis. Jonalyn Aldama. Aurora San Luis. Aurora San Luis. Aurora San Luis. Josephine Loberiano. Domingo. Aurora San Luis. Aurora Baler. Lerma Sto. Jemelie Sindac. liezel Caldosa. Bernadette Molina. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. MI. Aurora San Luis. Aurora San Luis. First. Prov. Orena. Aurora San Luis.) Novicio. Marmelyn S. Gretchen Angara. Rachelle Loberiano. Aurora Name of Mother (Surname. Normelyn Alojado. Aurora San Luis. Fatima Mila. Evangeline Del Monte. Aurora San Luis. April Gonzales. Leslie Avenilla.

Elena Sollegue. Lyn Orca. Luis. Luis. Razell Esplandor. Elsie Manarpiis. Aileen Tindogan. Luis. maricel Bihasa. Rachelle . Mercy De Leon. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Novicio.San San San San San San San San Luis. Luis. Luis. Luis. Luis.

Date of Completion: _ Detailed Address in Purok including Landmarks zone zone zone zone zone 1 1 1 1 1 Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 3 3 2 3 3 3 2 2 4 4 4 4 4 4 4 4 4 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut .

zone zone zone zone zone zone zone zone 6 6 6 7 7 7 7 7 zone zone zone zone zone zone zone zone Noted by: ROGELYNE P. RN PHN 6 6 6 7 7 7 7 7 Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut . TAMAYO.

mpletion: _JANUARY 2015 Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no yes yes PhilHealth (Yeswrite the PHIC number/No) 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no yes yes NBS done* (Yes/No ) No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No No No BCG Place 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes yes No No No no No No yes yes No No No no No No No No No No No No No No 1 1 1 1 1 1 1 ROSALILIA C. TANG MHO .

HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 FIC* CIC* 1 1 1 1 1 1 1 1 .

TANGSON. MD 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ROSALILIA C.

TT4 TT5 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT3 Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/No) .

Completely Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Age Group 1: Trans Out VProv. Mun.). Name of Given (Date) 6-11 mos 2: Visitor PPediatrician. Reason 12-23 mos Private Pedia for refusal R-Refused .Vitamin A* Status TI-Trans In TOLocation (Brgy.

.

Remarks Date of Completion 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 .

4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 4/30/2015 .

Lyca joyce Caldosa. Jean Aira Lopez. Domingo. Clarisse Udarbe. Jayven Roy Bernabe.) Novicio.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. First. Daiton Lopez. Jhonny Bihasa. Micaela Salinel. TANGSON. Janelle Mila. TAMAYO. MI. Lance Aeron Tanael. Rommel Angara. Nadine Natividad. James Marky Loberiano. Orena. Benedict Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F F M . Rebecca Avenilla. Irish Jade Sindac. Princess Banalee Abragon. Abragon. Queen Althea Joy Sindac. MD Name of PHN: ROGELYNE P. Khayla Loberiano. Rhianne Alojado. Mark Angel Alling. Bea Grace Molina. AURORA Name of MHO: _ROSALILIA C. Allyna Sto. RN No. REP Code 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 26 27 28 29 30 31 32 33 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 Name of Child (Surname. Glory Joy Baynosa. Rappah Jan Aldama. Eduardo jr. Fairy Mae Angara. Marvin Magdato. Yodi Gonzales. Gilyn Del Monte. Robin Jan Natividad. Lea Mae S. Jhon Carl Aldama. Lovelyn Mae Andrada.

MARZAN. Princess F F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC No. Irish Tindogan. Jenny De Leon.34 35 36 37 38 39 40 41 42 43 44 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Novicio. Johnmarvin Bihasa. RN NDP . Fea Esplandor. Yuki Orca. Arjie Sollegue. of Vaccinated Neonate/Infant from Mo MALE FEMALE 0 0 0 0 0 0 0 0 0 0 0 0 1 1 2 0 1 0 2 5 0 0 1 2 0 2 Prepared by: MARIA JESUSA A. Jeralyn Manarpiis.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora . Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 22 17 17 14 10 19 19 16 13 10 12 5 4 26 22 15 14 7 9 13 5 5 13 12 26 13 23 22 22 21 16 15 14 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 0-11 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos San Luis. Aurora Baler. Aurora San Luis. Aurora Baler. Aurora San Luis.

Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . 2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 2 0 1 5 7 0 0 2 3 2 2 San San San San San San San San Luis. Luis.2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 28 17 13 26 19 22 19 19 24 mos above 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos reporting month d Neonate/Infant from Month 1-30. Luis. Luis. Luis.

Lerma Sto. Evangeline Del Monte.Irene Baynosa. April Gonzales. MI. Maritess Magdato. Bernadette Molina. Orena. Fatima Mila. Normelyn Alojado.) Novicio. Rose May Angara. Ginalyn Abragon. Jonalyn Aldama. Gretchen Angara. Rachelle Loberiano. Josephine Loberiano.Date of Completion: Name of Mother (Surname. Carmen Salinel. Marvy Detailed Address in Purok including Landmarks zone zone zone zone zone 1 1 1 1 1 Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 3 3 2 3 3 3 2 2 4 4 4 4 4 4 4 4 4 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut . Jemelie Sindac. Abigail Natividad. Aurora Lumbaga. Domingo. Marjorie Abragon. Abigail Aldama. First. Daisyrose Lopez. Mary Rose Alling. liezel Caldosa. Luz Andrada. Wendra Natividad. Michelle Bernabe. Kwinie Trinidad. Dolores Bihasa. Leslie Avenilla. Ronalyn Tanael. Marmelyn S. Maria Udarbe.

Mercy De Leon. RN PHN Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut . TAMAYO. Elena Sollegue. Razell Esplandor. maricel Bihasa. Aileen Tindogan. Elsie Manarpiis. Lyn Orca. Rachelle zone zone zone zone zone zone zone zone 6 6 6 7 7 7 7 7 zone zone zone zone zone zone zone zone 6 6 6 7 7 7 7 7 Noted by: ROGELYNE P.Novicio.

done* (Yes/No) PHIC (Yes/No) number/No) BCG Place 1 if vaccine has 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .te of Completion: _JUNE 2015 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no yes yes No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No No No Penta 2 yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no yes yes Penta 1 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 HepB BD PhilHealth NBS NHTS (Yes-write the Contact No.

MD MHO . TANGSON.9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes yes No No No no No No yes yes No No No no No No No No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ROSALILIA C.

Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR ce 1 if vaccine has been given* FIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Card Check Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized .

NGSON. MD 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Completely Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized .

TT1 TT2 TT3 TT4 TT5 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Vitamin A* CPAB* (Yes/No) Given (Date) Age Group 1: 6-11 mos 2: 12-23 mos .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Reason for refusal Refused Remarks (D) TO REAL . Prov. Name P-Private of Pediatrician.Status TI-Trans In TO-Trans Out Location (Brgy. V-Visitor Mun. Pedia R.).

.

Date of Completion 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 .

6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 6/30/2015 .

Jhon Carl Aldama. Robin Jan Natividad. Jayven Roy Bernabe. Nadiahan. Princess Banalee Abragon. TAMAYO. Eduardo jr.) Novicio. Jake Lee Francisco. Nadine Natividad. Irish Jade Sindac. Rappah Jan Aldama. Domingo. Jayron Melencio. Queen Althea Joy Sindac. Micaela Salinel. Rebecca Avenilla. Mark Angel Salinel. Janelle Mila. jim Andrei A Abragon. Jean Aira Lopez. James Marky Loberiano. Lance Aeron Tanael.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. MD Name of PHN: ROGELYNE P. Rommel Sex (M/F) M F F F M M M M F F F F F F M M M M M M F M F F M F M F M F M M M . Yodi Gonzales. Jaymar Lopez. MI. Marvin Magdato. Lea Mae S. TANGSON. First. REP Code 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 26 27 28 29 30 31 32 33 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115081006 SANL0115081007 SANL0115081008 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 SANL0115082010 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 Name of Child (Surname. Orena. Daiton Novicio. Clarisse Udarbe. Lea Mae Alling. Allyna Sto. RN No. Rhianne Alojado. Jhonny Bihasa. Lovelyn Mae Andrada. Lyca joyce Caldosa. AURORA Name of MHO: _ROSALILIA C. Laurence Dela Torre.

Arjie Sollegue. Bea Grace Molina. of Vaccinated Neonate/Infant from M MALE FEMALE 4 3 2 1 0 0 0 0 0 0 0 0 0 0 . Jeralyn Manarpiis. Benedict Novicio. Gilyn Del Monte. Yuki Orca. Elerie F F F F F M F F F M F M M M F F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 No. Jenny De Leon. Irish Novicio.34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115085013 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 Angara. Princess Eslera. Johnmarvin Bihasa. Fairy Mae Angara. Glory Joy Baynosa. Rayco Tindogan. Khayla Loberiano. Fea Esplandor.

RN NDP 1 1 0 0 0 0 0 0 0 0 0 0 . MARZAN.OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A.

) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 5/11/2015 7/22/2015 8/3/2015 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 5/27/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 8/1/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 23 18 18 15 11 2 0 Err:502 20 20 17 14 11 13 6 5 3 2 27 24 16 15 8 10 14 6 6 Err:502 14 13 27 14 24 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 0-11 mos Err:502 12-23 mos 12-23 mos 24 mos above 12-23 mos 24 mos above San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora . Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov.

Luis. Luis. Luis.8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/15/2015 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 23 23 22 17 16 15 29 18 14 3 27 20 23 20 20 1 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 0-11 mos 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos nate/Infant from Month 1-30. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . Luis. Luis. Luis. Luis. 2015 FEMALE TOTAL 3 7 1 3 0 0 0 0 0 0 0 0 0 0 San San San San San San San San San San San San San San San San Luis.

0 0 0 0 0 0 1 1 0 0 0 0 .

Daisyrose Novicio. Michelle Bernabe. Dolores Bihasa. Carmen Salinel. Josephine Loberiano. Kwinie Trinidad. Aurora Lumbaga. Zepora Melencio. liezel Caldosa. Jaycel Abragon. Maritess Magdato. Gretchen Detailed Address in Purok including Landmarks ZONE 1 ZONE 1 ZONE 1 ZONE 1 ZONE 1 ZONE 1 ZONE 1 ZONE 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 Zone 2 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 ZONE 5 ZONE 5 zone 6 zone 6 zone 6 Purok zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 . Domingo. Marjorie Abragon. Normelyn Alojado. First. Mary Rose Salinel. Jemelie Sindac. Luz Andrada. Orena. MI. Regine Rose Abragon. Dolores Dela Torre. Marmelyn S. LAILA Alling. Ronalyn Tanael. Fatima Mila.) Novicio. Ginalyn Nadiahan. Leslie Avenilla. Wendra Natividad. April Gonzales. Maria Udarbe. Lerma Sto. Abigail Aldama. Mica Lopez. Jonalyn Aldama.Name of Mother (Surname. Abigail Natividad.

Razell Esplandor.Angara. Elsie Manarpiis. Marvy Novicio. Lyn Orca. maricel Bihasa. Elena Sollegue.Irene Baynosa. Rachelle Loberiano. Aileen Novicio. Evangeline Del Monte. Rose May Angara. Rachelle Eslera. Elsie zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 1 7 7 7 7 7 7 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 1 7 7 7 7 7 7 . Mercy De Leon. Daisyree Tindogan. Bernadette Molina.

Noted by: ROGELYNE P. TAMAYO. RN PHN .

Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 none none none 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) yes No yes No No yes yes No No yes no no yes No No No No No no No No No No yes no yes No yes yes no No No No PhilHealth (Yes-write the NBS done* PHIC (Yes/No) number/No) 0720-0320-3183 No 0720-1046-1295 No No Yes Yes No No No no no yes No No No Yes No no No No No No yes No 07-2009137042 No yes No No No No No No No No No No No No No Yes No No No No No Yes Yes No No No No No No No No Yes No No No Yes No No No BCG Date of Completion: JULY 2015 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 none 9068948109 9068948109 9068948109 9068948109 9068948109 yes yes no no yes yes yes yes No No No No no No No yes yes no no yes yes yes yes No No No No no No No No No No No No No No No No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

TANG MHO .ROSALILIA C.

HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* FIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

ROSALILIA C. MD . TANGSON.

Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Partially Immunized Completely Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT5 1 Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 TT4 1 Completely Immunized Completely Immunized Completely Immunized Partially Immunized Partially Immunized TT3 1 1 Card Check TT2 CIC* TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 Completely Immunized Completely Immunized Partially Immunized Partially Immunized Partially Immunized Partially Immunized Completely Immunized Completely Immunized Partially Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Completely Immunized Partially Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

Vitamin A* CPAB* (Yes/No) Given (Date) Age Group 1: 6-11 mos 2: 12-23 mos Status TI-Trans In TOTrans Out VVisitor PPrivate Pedia R-Refused TO TO .

Yes Yes .

.

Status Location (Brgy. Prov. Name of Pediatrician.). Mun. Reason for refusal Remarks Benguet (D) REAL Date of Completion 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 .

7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 7/31/2015 .

.

Yodi Gonzales.) Novicio. RN No.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Lyca joyce Caldosa. Rhianne Alojado. Irish Jade Sindac. MI. Jhonny Bihasa. Jhon Carl Aldama. TANGSON. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115081006 SANL0115081007 SANL0115081008 SANL0115081009 SANL0115081010 SANL0115081011 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115083011 SANL0115084001 SANL0115084002 SANL0115084003 Name of Child (Surname. Girl Lopez. Queen Althea Joy Sindac. Faith Francisco. Janelle Mila. Jaymar Aldama. Jayven Roy Bernabe. Laurence Gambito. Micaela Salinel. Princess Banalee Abragon. Lea Mae OLIT. Lovelyn Mae Andrada. MD Name of PHN: ROGELYNE P. Orena. Clarisse Udarbe. Lea Mae S. Domingo. Raico Jay Sex (M/F) M F F F M M F M M M F F F F F F F M M M M M F M F F M F M F M M F M . Allyna Sto. First. Lance Aeron Tanael. Marvin Magdato. Jayron Melencio. Bb. Daiton Novicio. Nadine Novicio. Jean Aira Lopez. Rebecca Avenilla. TAMAYO. Nadiajan. Eduardo jr. AURORA Name of MHO: _ROSALILIA C. Jake Lee Abragon. James Marky Loberiano. Jim Andrei Dela Torre. GINMAR Alling. Mark Angel Salinel.

Yuki Orca.35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 51 52 53 54 55 56 SANL0115084004 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 SANL0115086007 SANL0115086008 Pradillada. Irish Tindogan. Robin Jan Natividad. Fea Esplandor. Fairy Mae Angara. Jamaica M M M M F F F F F M F F F F M M M F F M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . Glory Joy Baynosa. Elerie Salcedo. Rommel Angara. Khayla Loberiano. Clifford Natividad. Jenny De Leon. Jeralyn Manarpiis. Rafael Casamis. Johnmarvin Bihasa. Arjie Sollegue. Bea Grace Molina. Benedict Novicio. Princess Eslera. Rappah Jan Aldama. Gilyn Del Monte.

RN NDP No.Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. MARZAN. of Vaccinated Neonate/Infant from M MALE FEMALE 0 0 0 0 2 0 0 0 0 0 0 0 2 2 2 1 0 0 0 0 3 8 0 0 0 0 .

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Prov. Aurora San Luis. Aurora San Luis..) San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 5/3/2015 5/11/2015 5/27/2015 7/22/2015 8/3/2015 9/1/2015 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 7/25/2015 12/14/2014 5/7/2014 6/3/2014 4/15/2015 24 19 19 16 12 3 3 3 1 0 Err:502 21 21 18 15 12 14 7 6 4 28 25 17 16 9 11 15 7 7 1 8 15 14 4 Age Group 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora . Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis.

Luis. Luis. Luis. Luis. Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . Luis. Luis. Luis. Luis. Luis. Luis.8/22/2015 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 4/15/2015 4/24/2015 0 28 15 25 24 24 23 18 17 16 30 19 15 28 21 24 21 21 2 4 4 0-11 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 24 mos above 12-23 mos 24 mos above 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos San San San San San San San San San San San San San San San San San San San San San Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis.

2015 FEMALE TOTAL 0 0 0 0 0 2 0 0 0 0 0 0 2 4 1 3 0 0 0 0 8 11 0 0 0 0 .ate/Infant from Month 1-30.

Aurora Lumbaga. Wendra Novicio. Luz Andrada. DALIA Alling. Domingo. Josephine Loberiano. Marjorie Abragon. Mica Abragon.Name of Mother (Surname. liezel Caldosa. Daisyrose Novicio. Regine Rose Dela Torre. April Gonzales. Jonalyn Aldama. Michelle Bernabe.) Novicio. Normelyn Alojado. Orena. Fatima Mila. Kwinie Trinidad. Ronalyn Tanael. Jemelie Sindac. Daisyree Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 1 1 1 1 1 1 1 1 1 1 1 3 3 2 3 3 3 2 2 2 4 4 4 4 4 4 4 4 4 4 4 5 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 1 Zone 1 Zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 5 . Mary Rose Salinel. Zepora Melencio. Maritess Magdato. LAILA OLIT. Dolores Bihasa. Leslie Avenilla. MI. Dolores Gambito. Marmelyn S. Ginalyn Nadiahan. Lerma Sto. Jaycel Abragon. Carmen Salinel. First. Maria Udarbe. Gretchen Lopez. Mica Aldama.

Odette Casamis. Joy Zone 5 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 zone 7 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 5 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 . Razell Esplandor. Mercy Tindogan.Pradillada.Irene Baynosa. Elsie Salcedo. Rachelle Loberiano. Evangeline Del Monte. Elena Sollegue. Bernadette Molina. Rachelle Eslera. Abigail Natividad. Abigail Aldama. Gretchen Angara. maricel Bihasa. Mercy Manarpiis. Elsie Manarpiis. Rose May Angara. Marvy Novicio. Reena Natividad. Lyn Orca.

RN PHN . TAMAYO.Noted by: ROGELYNE P.

Date of Completion: AUGUST 2015 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Contact No. 9068948109 9068948109 9068948109 9068948109 9068948109 none none none none none none 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) yes No yes No No yes yes No No No No No yes no no yes No No No No no No No No No yes no yes No yes NO yes no No PhilHealth (Yes-write the NBS done* PHIC (Yes/No) number/No) 0720-0320-3183 No 0720-1046-1295 No No Yes Yes No No No No no no yes No No No Yes no No No No No yes No 07-2009137042 No no NO yes No No No No No No No No No No No No Yes No No No No No Yes Yes No No No No No No No Yes No No YES No Yes No BCG Place 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut #VALUE! Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 No No No No yes yes no no yes yes yes yes yes No No no No No No No No No No No No yes yes no no yes yes yes yes yes No No no No No No No No No No No No No No No No No No No No No No No No No No No No No 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

ROSALILIA C. TANG
MHO

HepB BD

Penta 1

Penta 2

Penta 3

OPV 1

OPV 2

OPV 3

AMV

MMR

Place 1 if vaccine has been given*
FIC*

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1

1

1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1
1
1

1
1
1
1

1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1
1

1
1
1
1

1

1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1

1

1

1
1

1
1

1
1

1
1

1
1

1

1
1

1
1

1
1

1
1

CIC*

1
1
1
1

1

1

1
1
1
1
1

1
1

1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1

1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

ROSALILIA C. TANGSON, MD

TT4

TT5

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

TT3

Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Partially Immunized
Completely Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Completely Immunized
Completely Immunized
Partially Immunized

TT2

Card Check

TT1

Place 1 if mother recall TT
doses*

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1

1

1

1

1

1

1

1

1

1
1

1

1

1

1

1
1
1
1

1
1
1
1

1

1
1

1
1
1
1

1

1

1

CPAB*
(Yes/No)

Partially Immunized
Completely Immunized
Partially Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Partially Immunized
Completely Immunized
Partially Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Completely Immunized
Partially Immunized
Partially Immunized
Partially Immunized

Partially Immunized
Partially Immunized

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1

1
1
1
1

1
1
1

1
1

1
1
1

1

1

1

1

Yes
Yes

Vitamin A*

Given (Date)

Age Group
1: 6-11 mos
2: 12-23 mos

Status
TI-Trans In
TOLocation (Brgy, Mun,
Trans Out
VProv.), Name of
Visitor
PPediatrician, Reason
Private Pedia
for refusal
R-Refused

TO

REAL

TI Umiray .

.

Remarks adopted by Vilma Ritual DEAD Date of Completion 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 .

8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 8/31/2015 .

.

Jhon Carl Aldama. TANGSON. Nadiajan. Rebecca Avenilla. Bb. Irish Jade Sindac. Jim Andrei Dela Torre.) Novicio. Girl Lopez. Micaela Salinel. Eduardo jr. James Marky Loberiano. Mark Angel Salinel. First. Princess Banalee Abragon. Nadine Novicio. GINMAR Alling. Jayven Roy Bernabe. Faith Francisco. MD Name of PHN: ROGELYNE P. Domingo. Lance Aeron Tanael. Yodi Gonzales. Jayron Melencio. Lea Mae OLIT. Lovelyn Mae Andrada. Jake Lee Abragon. Jaymar Aldama. Laurence Gambito. Jhonny Bihasa. Clarisse Udarbe. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115081006 SANL0115081007 SANL0115081008 SANL0115081009 SANL0115081010 SANL0115081011 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115083011 SANL0115084001 SANL0115084002 SANL0115084003 Name of Child (Surname. Lyca joyce Caldosa. Rhianne Alojado. Allyna Sto. RN No. TAMAYO. Queen Althea Joy Sindac. Raico Jay Sex (M/F) M F F F M M F M M M F F F F F F F M M M M M F M F F M F M F M M F M . Lea Mae S.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: SAN LUIS. Janelle Mila. Jean Aira Lopez. Daiton Novicio. Marvin Magdato. Orena. MI. AURORA Name of MHO: ROSALILIA C.

Rafael Casamis. Yuki Orca. Fea Esplandor. Robin Jan Natividad. Jenny De Leon. Gilyn Del Monte. Bea Grace Molina. Jeralyn Manarpiis. Rappah Jan Aldama. Benedict Novicio. Clifford Natividad. Rommel Angara. Jamaica M M M M F F F F F M F F F F M M M F F M F . Johnmarvin Bihasa. Princess Eslera. Khayla Loberiano. Elerie Salcedo. Glory Joy Baynosa. Fairy Mae Angara.35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 SANL0115084004 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 SANL0115086007 SANL0115086008 Pradillada. Irish Tindogan. Arjie Sollegue.

MARZAN.84 85 *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. of Vaccinated Neonate/Infant from M MALE FEMALE 2 1 0 1 2 S 4 1 0 1 0 2 1 0 2 0 . RN NDP No.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 5/3/2015 5/11/2015 5/27/2015 7/22/2015 8/3/2015 9/1/2015 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 7/25/2015 12/14/2014 5/7/2014 6/3/2014 4/15/2015 25 20 20 17 13 4 4 4 2 1 0 22 22 19 16 13 15 8 7 5 29 25 18 17 10 12 16 8 8 2 9 16 15 5 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 0-11 mos San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.. Aurora Baler. Aurora Baler.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora . Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

8/22/2015 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 4/15/2015 4/24/2015 1 29 16 26 25 25 24 19 18 17 31 20 16 29 22 25 22 22 3 5 5 0-11 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 24 mos above 12-23 mos 24 mos above 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos San San San San San San San San San San San San San San San San San San San San San Luis. Luis. Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis.

2015 FEMALE TOTAL 1 3 1 1 0 2 1 0 2 0 0 0 0 0 2 3 5 1 2 1 0 .0 ate/Infant from Month 1-30.

Ginalyn Nadiahan. MI. Aurora Lumbaga. Carmen Salinel. Luz Andrada. Marmelyn S. Mica Aldama.) Novicio. Zepora Melencio. Dolores Bihasa. Josephine Loberiano. Leslie Avenilla. Mary Rose Salinel. Domingo. Gretchen Lopez. Jaycel Abragon. LAILA OLIT. DALIA Alling. Jonalyn Aldama. Marjorie Abragon. Michelle Bernabe. Maria Udarbe. First. Wendra Novicio. Daisyree Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 1 1 1 1 1 1 1 1 1 1 1 3 3 2 3 3 3 2 2 2 4 4 4 4 4 4 4 4 4 4 4 5 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 1 Zone 1 Zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 5 . Normelyn Alojado. Maritess Magdato. Fatima Mila. Regine Rose Dela Torre. Orena. Ronalyn Tanael. Dolores Gambito. liezel Caldosa. Jemelie Sindac. Lerma Sto. Daisyrose Novicio. Mica Abragon.Name of Mother (Surname. Kwinie Trinidad. April Gonzales.

Pradillada, Reena
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Loberiano, Evangeline
Del Monte, Bernadette
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
Manarpiis, Mercy
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy

Zone 5
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone

6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7

zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone

5
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7

Noted by:
_ROGELYNE P. TAMAYO, RN
PHN

Date of Completion: SEPTEMBER 2015

Barangay

Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut

Contact No.

9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109

9068948109
9068948109

NHTS
(Yes/No)

yes
No
yes
No
No
yes
yes
No
No
No
No
No
yes
no
no
yes
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
NO
yes
no
No

PhilHealth (Yeswrite the PHIC
number/No)

NBS
done*
(Yes/No)

0720-0320-3183

No
No
No
No
No
No
No
No
No

No
0720-1046-1295

No
No
Yes
Yes
No
No

No
No
no
no
yes
No
No
No
Yes
no
No
No
No
No
yes
No
07-2009137042

No
no
NO
yes
No
No

No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
Yes
No
No
YES
No
Yes
No

Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut

9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109

No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No

No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No

No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No

BCG

HepB
BD

Penta 1

Penta 2

Penta 3

OPV 1

OPV 2

OPV 3

AMV

MMR

Place 1 if vaccine has been given*

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1

1
1
1
1
1

1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1
1
1

1
1
1
1

1
1
1
1

1

1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1

1

1

1

1
1

1
1

1
1
1
1

1
1
1

1
1
1

1
1

1
1
1
1

1
1
1

1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1

1

1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1

1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1

ROSALILIA C. TANGSON, MD
MHO

CIC* IPV PCV 3 PCV 2 FIC* PCV 1 ROTA 2 ROTA 1 een given* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

Place 1 if mother recall TT doses* TT3 TT4 TT5 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT2 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT1 Card Check 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/N o) .

Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Yes Yes .

.

1: 6-11 mos Given (Date) V-Visitor Name of 2: 12-23 mos P-Private Pedia Pediatrician.).Vitamin A* Status TI-Trans In Location (Brgy. Prov. Age Group TO-Trans Out Mun. R-Refused Reason for refusal TO TI REAL .

TI .

.

Remarks adopted by Vilma Ritual Date of Completion 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 .

9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 9/30/2015 .

9/30/2015 .

Rebecca Avenilla. Girl Lopez. Jhonny Bihasa. Laurence Gambito. Jayron Melencio. Lea Mae S. Orena. Janelle Mila. First. Allyna Sto. Lance Aeron Tanael. Nadiajan. Lea Mae OLIT. Mark Angel Salinel. Jim Andrei Dela Torre. Daiton Novicio. James Marky Loberiano. TANGSON Name of PHN: ROGELYN P. Nadine Novicio.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: SAN LUIS. Jhon Carl Aldama. MI. Yodi Gonzales. AURORA Name of MHO: ROSALILIA C. Marvin Magdato. Raico Jay Sex (M/F) M F F F M M F M M M F F F F F F F M M M M M F M F F M F M F M M F M . Irish Jade Sindac. GINMAR Alling. Queen Althea Joy Sindac. Faith Francisco. Clarisse Udarbe.) Novicio. Eduardo jr. Domingo. Lyca joyce Caldosa. Jayven Roy Bernabe. Micaela Salinel. Lovelyn Mae Andrada. Jaymar Aldama. Jake Lee Abragon. Jean Aira Lopez. Bb. Princess Banalee Abragon. TAMAYO No. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115081006 SANL0115081007 SANL0115081008 SANL0115081009 SANL0115081010 SANL0115081011 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115083011 SANL0115084001 SANL0115084002 SANL0115084003 Name of Child (Surname. Rhianne Alojado.

Benedict Novicio. Rafael Casamis. Clifford Natividad. Jeralyn Manarpiis. Khayla Loberiano. Bea Grace Molina.35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 SANL0115084004 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115085013 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 SANL0115086007 SANL0115086008 Pradillada. Rappah Jan Aldama. Yuki Orca. Robin Jan Natividad. Johnmarvin Bihasa. Gilyn Del Monte. of Vaccinated Neonate/Infant from MALE FEMALE . Boy Tindogan. Arjie Sollegue. Fairy Mae Angara. Glory Joy Baynosa. Fea Esplandor. Jamaica M M M M F F F F F M F F F M F M M M F F M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 No. Rommel Angara. Elerie Salcedo. Jenny De Leon. Princess Eslera. Irish Novicio. Bb.

ERTO. RN NDP .OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: CATHERINE M.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora . Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 5/3/2015 5/11/2015 5/27/2015 7/22/2015 8/3/2015 9/1/2015 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 7/25/2015 12/14/2014 5/7/2014 6/3/2014 4/15/2015 29 24 24 21 17 8 8 8 6 5 4 26 26 23 20 17 19 12 11 9 33 30 22 21 14 16 20 12 12 6 13 20 19 9 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos San Luis. Aurora San Luis. Aurora Baler.. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis.

8/22/2015 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/15/2015 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 4/15/2015 4/24/2015 5 33 20 30 29 29 28 23 22 21 35 24 20 9 33 26 29 26 26 7 9 9 0-11 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 24 mos above 24 mos above 12-23 mos 0-11 mos 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above 0-11 mos 0-11 mos 0-11 mos onate/Infant from Month 1-30. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. 2015 FEMALE TOTAL 0 0 0 0 0 0 0 San San San San San San San San San San San San San San San San San San San San San San Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . Luis. Luis. Luis.

0 0 0 0 0 0 .

Fatima Mila. Luz Andrada. Michelle Bernabe. Daisyrose Novicio. Aurora Lumbaga. Leslie Avenilla. Marmelyn S. liezel Caldosa. Lerma Sto. Jonalyn Aldama. Dolores Bihasa. MI. Mica Aldama. Kwinie Trinidad. April Gonzales. Domingo. Wendra Novicio. Dolores Gambito. DALIA Alling. Normelyn Alojado. Mary Rose Salinel. Jaycel Abragon. Carmen Salinel. Ronalyn Tanael.) Novicio. Daisyree Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 1 1 1 1 1 1 1 1 1 1 1 3 3 2 3 3 3 2 2 2 4 4 4 4 4 4 4 4 4 4 4 5 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 1 Zone 1 Zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 5 . Maritess Magdato.Name of Mother (Surname. LAILA OLIT. Jemelie Sindac. Regine Rose Dela Torre. Josephine Loberiano. Maria Udarbe. Orena. Marjorie Abragon. Mica Abragon. Gretchen Lopez. Ginalyn Nadiahan. First. Zepora Melencio.

Odette Casamis. Daisy Rose Tindogan. Joy Zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 7 zone 7 zone 7 zone 7 zone 7 zone 7 zone 7 zone 7 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 5 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 . Elsie Manarpiis. Aileen Novicio. Elsie Salcedo. Elena Sollegue. Razell Esplandor. Gretchen Angara.Irene Baynosa. Rachelle Eslera. Rachelle Loberiano. Lyn Orca. Reena Natividad. Bernadette Molina.Pradillada. Evangeline Del Monte. maricel Bihasa. Abigail Natividad. Marvy Novicio. Rose May Angara. Mercy De Leon. Abigail Aldama.

TAMAYO.Noted by: ROGELYNE P. RN PHN .

9068948109 9068948109 9068948109 9068948109 9068948109 none none none none none none 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) yes No yes No No yes yes No No No No No yes no no yes No No No No no No No No No yes no yes No yes NO yes no No PhilHealth (Yeswrite the PHIC number/No) NBS done* (Yes/No) 0720-0320-3183 No No No No No No No No No No 0720-1046-1295 No No Yes Yes No No No No no no yes No No No Yes no No No No No yes No 07-2009137042 No no NO yes No No No Yes No No No No No Yes Yes No No No No No No No Yes No No YES No Yes No .Date of Completion: JANUARY 2016 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Contact No.

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 none 9068948109 9068948109 9068948109 9068948109 9068948109 No No No No yes yes no no yes yes yes yes No No No No no No No No No No No No No No yes yes no no yes yes yes yes No No No No no No No No No No No No No No No No No No No No No No No No No No No No No No No No .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

TANGSON. MD MHO .ROSALILIA C.

IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 een given* FIC* CIC* 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

.

TT4 TT5 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT3 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/N o) .

Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Yes 1 1 1 1 1 Yes Yes .

.

Age Group TO-Trans Out Mun.). R-Refused Reason for refusal TO REAL .Vitamin A* Status TI-Trans In Location (Brgy. 1: 6-11 mos Given (Date) V-Visitor Name of 2: 12-23 mos P-Private Pedia Pediatrician. Prov.

.

.

Remarks adopted by Vilma Ritual Date of Completion 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 .

1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 .

.

Queen Althea Joy 23 SANL0115083003 Loberiano. Allyna 4 SANL0115081004 Sto. Lovelyn Mae 27 SANL0115083007 Andrada. Yodi 25 SANL0115083005 Gonzales. Domingo.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) 2 SANL0115081002 Bihasa. Lyca joyce 3 SANL0115081003 Caldosa. Benedict 46 SANL0115085011 Manarpiis. Daiton 14 SANL0115082003 Mila. Nadine 37 SANL0115085002 Natividad. Marvin 33 SANL0115084002 Magdato. Irish Jade 15 SANL0115082004 Sindac. Micaela 26 SANL0115083006 Salinel. Rappah Jan 42 SANL0115085007 Molina. Clarisse 24 SANL0115083004 Udarbe. Irish F F F M F F F F F M F F M M F M F F M F F . 17 SANL0115082006 Orena. Princess Banalee 16 SANL0115082005 Abragon. Lea Mae S. Rebecca 5 SANL0115081005 Avenilla. Glory Joy 44 SANL0115085009 Baynosa. Fairy Mae 43 SANL0115085008 Angara. Lance Aeron 32 SANL0115084001 Alling. Jenny 47 SANL0115085012 De Leon.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis.1/6/2014 1/11/2014 4/11/2014 8/2/2014 2/19/2014 5/30/2014 8/14/2014 6/10/2014 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 5/7/2014 6/3/2014 5/14/2014 2/19/2014 3/2/2014 4/17/2014 1/8/2014 5/2/2014 22 22 19 15 21 18 15 17 20 19 12 14 18 18 17 18 21 20 19 22 18 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 12-23 mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos mos San Luis. Aurora . Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

Maritess Magdato. Kwinie Loberiano. Marvy Manarpiis. Carmen Salinel. Daisyrose Mila. Maria Udarbe. Marjorie Abragon. Ronalyn Alling. Domingo. liezel Caldosa. Orena.Irene Baynosa. Wendra Natividad. Lerma Sto. Luz Andrada. April Gonzales. Leslie Avenilla. Mercy De Leon. Rose May Angara. Jemelie Sindac. Abigail Molina. Marmelyn S. Aileen Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone zone zone zone zone zone zone 6 6 6 6 6 6 1 1 1 1 2 3 3 3 4 4 4 4 4 5 5 zone zone zone zone Zone 2 Zone 3 Zone 3 Zone 3 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 1 1 1 1 .Bihasa.

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 No yes No No no no yes No No No No yes no yes no No no yes yes yes No No 0720-1046-1295 No No no no yes No No No No yes No yes No No no yes yes yes No No No No No No No No No No No No No No No Yes No No No No No No .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

TO REAL .

11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 11/30/2015 .

First. James Marky Loberiano. Bb. Lovelyn Mae Andrada. Rebecca Avenilla. GINMAR Alling. Marvin Magdato.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality: ________________________ Name of MHO: ______________________________ Name of PHN: _______________________________ No. MI. Clarisse Udarbe. Nadine Novicio. Lance Aeron Tanael. Janelle Mila. Daiton Novicio. Faith Francisco. Raico Jay Sex (M/F) M F F F M M F M M M F F F F F F F M M M M M F M F F M F M F M M F M . Mark Angel Salinel. Jayven Roy Bernabe. Domingo. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115081006 SANL0115081007 SANL0115081008 SANL0115081009 SANL0115081010 SANL0115081011 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115082009 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115083010 SANL0115083011 SANL0115084001 SANL0115084002 SANL0115084003 Name of Child (Surname. Princess Banalee Abragon. Lea Mae S.) Novicio. Rhianne Alojado. Jean Aira Lopez. Lyca joyce Caldosa. Girl Lopez. Nadiajan. Jayron Melencio. Jake Lee Abragon. Laurence Gambito. Yodi Gonzales. Irish Jade Sindac. Jim Andrei Dela Torre. Orena. Queen Althea Joy Sindac. Jaymar Aldama. Micaela Salinel. Eduardo jr. Jhon Carl Aldama. Allyna Sto. Lea Mae OLIT. Jhonny Bihasa.

Boy Tindogan. Bb. Robin Jan Natividad. Khayla Loberiano. Gilyn Del Monte. Rappah Jan Aldama. Elerie Salcedo. Yuki Orca. Irish Novicio. Clifford Natividad. Rafael Casamis. Benedict Novicio. Fairy Mae Angara. Fea Esplandor. Princess Eslera. Glory Joy Baynosa.35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 SANL0115084004 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115085013 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 SANL0115086006 SANL0115086007 SANL0115086008 Pradillada. Arjie Sollegue. Johnmarvin Bihasa. Rommel Angara. Bea Grace Molina. Jamaica M M M M F F F F F M F F F M F M M M F F M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: . Jeralyn Manarpiis. Jenny De Leon.

MARZAN.Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. RN NDP No. of Vaccinated Neonate/Infant from M MALE FEMALE .

. Aurora San Luis. Aurora . Aurora Baler. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 5/3/2015 5/11/2015 5/27/2015 7/22/2015 8/3/2015 9/1/2015 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 7/25/2015 12/14/2014 5/7/2014 6/3/2014 4/15/2015 28 23 23 20 16 7 7 7 5 4 3 25 25 22 19 16 18 11 10 8 32 29 21 20 13 15 19 11 11 5 12 19 18 8 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 0-11 mos 0-11 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis.

8/22/2015 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/15/2015 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 6/2/2015 4/15/2015 4/24/2015 4 32 19 29 28 28 27 22 21 20 34 23 19 8 32 25 28 25 25 6 8 8 1380 1380 1380 1380 1380 0 0-11 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 12-23 mos 0-11 mos 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above 0-11 mos 0-11 mos 0-11 mos 24 24 24 24 24 mos mos mos mos mos above above above above above San San San San San San San San San San San San San San San San San San San San San San Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis. Luis.

2015 FEMALE TOTAL 0 0 0 0 0 0 0 0 0 0 0 0 0 .ate/Infant from Month 1-30.

Luz Andrada. Gretchen Lopez. Ronalyn Tanael. Daisyrose Novicio. Jemelie Sindac. Dolores Bihasa. Domingo. Wendra Novicio. Ginalyn Nadiahan. April Gonzales. Marmelyn S. Jaycel Abragon. Mary Rose Salinel. Daisyree Detailed Address in Purok including Landmarks Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone Zone 1 1 1 1 1 1 1 1 1 1 1 3 3 2 3 3 3 2 2 2 4 4 4 4 4 4 4 4 4 4 4 5 5 5 Purok zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 1 Zone 1 Zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 5 . Jonalyn Aldama. Dolores Gambito. liezel Caldosa. Josephine Loberiano. DALIA Alling. LAILA OLIT. Aurora Lumbaga. Leslie Avenilla. Maria Udarbe. Michelle Bernabe. Mica Aldama.) Novicio. First. Regine Rose Dela Torre. Marjorie Abragon. Zepora Melencio. Fatima Mila.Name of Mother (Surname. Kwinie Trinidad. MI. Orena. Normelyn Alojado. Mica Abragon. Carmen Salinel. Maritess Magdato. Lerma Sto.

Bernadette Molina. Razell Esplandor. Lyn Orca.Pradillada. Joy Zone 5 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone zone 5 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 . Rose May Angara. maricel Bihasa. Mercy De Leon. Marvy Novicio. Odette Casamis. Aileen Novicio. Rachelle Eslera. Evangeline Del Monte. Abigail Aldama. Elena Sollegue.Irene Baynosa. Elsie Manarpiis. Daisy Rose Tindogan. Elsie Salcedo. Gretchen Angara. Rachelle Loberiano. Abigail Natividad. Reena Natividad.

RN PHN . TAMAYO.Noted by: ROGELYNE P.

9068948109 9068948109 9068948109 9068948109 9068948109 none none none none none none 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 NHTS (Yes/No) yes No yes No No yes yes No No No No No yes no no yes No No No No no No No No No yes no yes No yes NO yes no No PhilHealth (Yeswrite the PHIC number/No) NBS done* (Yes/No) 0720-0320-3183 No No No No No No No No No No 0720-1046-1295 No No Yes Yes No No No No no no yes No No No Yes no No No No No yes No 07-2009137042 No no NO yes No No No Yes No No No No No Yes Yes No No No No No No No Yes No No YES No Yes No .Date of Completion: _DECEMBER 2015 Barangay Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Contact No.

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 none 9068948109 9068948109 9068948109 9068948109 9068948109 No No No No yes yes no no yes yes yes yes No No No No no No No No No No No Yes No No No No yes yes no no yes yes yes yes No No No No no No No No No No 364658 475765 No No No No No No No No No No No No No No No No No No No No No No No No .

.

BCG HepB BD Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 AMV MMR Place 1 if vaccine has been given* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

TANGSON. MD MHO .ROSALILIA C.

IPV PCV 3 PCV 2 PCV 1 ROTA 2 ROTA 1 een given* FIC* CIC* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

TT4 TT5 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT3 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT2 Card Check TT1 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 CPAB* (Yes/N o) .

Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Yes 1 1 1 1 1 Yes Yes 1 1 1 .

.

1: 6-11 mos Given (Date) V-Visitor Name of 2: 12-23 mos P-Private Pedia Pediatrician.Vitamin A* Status TI-Trans In Location (Brgy. R-Refused Reason for refusal TO REAL . Prov.). Age Group TO-Trans Out Mun.

Baler. Manila Religious belief Dr. Aurora Makati City.TO V R P Brgy. Mangaba . 1.

.

Remarks adopted by Vilma Ritual Date of Completion 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 .

12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 12/31/2015 .

.

Irish Jade Sindac. Fairy Mae Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F . James Marky Loberiano. Rhianne Alojado. Robin Jan Natividad. Micaela Salinel. Queen Althea Joy Sindac. Jayven Roy Bernabe. REP Code 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 26 27 28 29 30 31 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 Name of Child (Surname. MD Name of PHN: ROGELYNE P. Lyca joyce Caldosa. Marvin Magdato. TANGSON. Rommel Angara. Lance Aeron Tanael. Daiton Lopez. Eduardo jr. Princess Banalee Abragon. Rebecca Avenilla. First. Orena. Domingo. TAMAYO. Bea Grace Molina. Jean Aira Lopez. RN No. Gilyn Del Monte. AURORA Name of MHO: _ROSALILIA C. Lovelyn Mae Andrada. Yodi Gonzales. Lea Mae S. Nadine Natividad. Mark Angel Alling. Jhonny Bihasa. Allyna Sto.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Janelle Mila.) Novicio. Clarisse Udarbe. Jhon Carl Aldama. Khayla Loberiano. Rappah Jan Aldama. MI. Abragon.

Johnmarvin Bihasa. Princess F M F F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC No. Benedict Novicio. Glory Joy Baynosa. Fea Esplandor. Arjie Sollegue. Yuki Orca. Irish Tindogan. of Vaccinated Neonate/Infant from M MALE FEMALE 1 0 0 0 0 0 2 0 0 0 1 4 2 0 2 3 1 3 1 2 0 1 1 2 0 0 . Jeralyn Manarpiis. Jenny De Leon.32 33 34 35 36 37 38 39 40 41 42 43 44 45 SANL0115085008 SANL0115085009 SANL0115085010 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Angara.

MARZAN.Prepared by: MARIA JESUSA A. RN NDP .

Prov.. Aurora . Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 29 24 24 21 17 26 26 23 20 17 19 12 11 33 30 22 21 14 16 20 12 12 20 19 33 20 30 29 29 28 23 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 0-11 mos 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 12-23 mos San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

Luis. Luis. Luis. Luis. Luis. Luis. Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora Aurora . 2015 FEMALE TOTAL 0 1 0 0 0 0 0 2 0 0 4 5 0 2 3 5 3 4 2 3 1 1 2 3 0 0 San San San San San San San San San San Luis. Luis.3/2/2014 4/17/2014 2/2/2013 1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 22 21 35 24 20 33 26 29 26 26 12-23 mos 12-23 mos 24 mos above 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above porting month d Neonate/Infant from Month 1-30. Luis.

.

Lerma Sto. Bernadette Molina. Evangeline Del Monte. Luz Andrada. Marmelyn S. Orena. Rachelle Loberiano. Marjorie Abragon. April Gonzales. Daisyrose Lopez. Ronalyn Tanael. Domingo. Carmen Salinel.Name of Mother (Surname. First.) Novicio. Rose May Detailed Address in Purok including Landmarks Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 . Ginalyn Abragon. Gretchen Angara. Dolores Bihasa. liezel Caldosa. Abigail Aldama. Wendra Natividad. Kwinie Trinidad. Abigail Natividad. Maritess Magdato. Fatima Mila. MI. Normelyn Alojado. Josephine Loberiano. Leslie Avenilla. Michelle Bernabe. Mary Rose Alling. Jemelie Sindac. Maria Udarbe. Aurora Lumbaga. Jonalyn Aldama.

Lyn Orca.Angara. Elena Sollegue. Aileen Tindogan.Irene Baynosa. Marvy Novicio. Rachelle zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 7 7 7 7 7 zone zone zone zone zone zone zone zone zone zone 6 6 6 6 6 7 7 7 7 7 . maricel Bihasa. Razell Esplandor. Mercy De Leon. Elsie Manarpiis.

Noted by: ROGELYNE P. RN PHN . TAMAYO.

NHTS (Yes/No) Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no PhilHealth (Yeswrite the PHIC number/No) 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no .Date of Completion: _JANUARY 2015 Barangay Contact No.

Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes yes yes yes No No No no No No yes yes yes yes No No No no No No .

.

OPV 3 AMV MMR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PCV 2 OPV 2 0 0 0 0 0 0 0 0 0 0 0 PCV 1 OPV 1 0 0 0 0 0 0 0 0 0 0 0 0 ROTA 2 Penta 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROTA 1 Penta 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Penta 1 No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No HepB BD NBS done* (Yes/No) BCG Place 1 if vaccine has been given* .

No No No No No No No No No No 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .

MD MHO .ROSALILIA C. TANGSON.

0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT5 0 0 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT4 0 Card Check TT3 CIC * TT2 FIC* TT1 IPV PCV 3 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

0 0 0 0 0 0 0 0 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

.

).Pediatric 12-23 Private ian. mos Pedia Reason Rfor Refused refusal TO Real . Vitamin A* Age TO-Trans Mun. CPAB* 1: 6-11 V-Visitor Name of Remarks (Yes/No) Given (Date) mos 2: P.TI-Trans Location In Status (Brgy. Group Out Prov.

.

.

Date of Completion 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 .

1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 1/31/2016 .

.

Allyna Sto. Orena. Fairy Mae Angara.) Novicio. Eduardo jr. Jhonny Bihasa. Princess Banalee Abragon. Queen Althea Joy Sindac. Janelle Mila. Gilyn Del Monte. REP Code 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 26 27 28 29 30 31 32 33 34 SANL0115081001 SANL0115081002 SANL0115081003 SANL0115081004 SANL0115081005 SANL0115082001 SANL0115082002 SANL0115082003 SANL0115082004 SANL0115082005 SANL0115082006 SANL0115082007 SANL0115082008 SANL0115083001 SANL0115083002 SANL0115083003 SANL0115083004 SANL0115083005 SANL0115083006 SANL0115083007 SANL0115083008 SANL0115083009 SANL0115084001 SANL0115084002 SANL0115085001 SANL0115085002 SANL0115085003 SANL0115085004 SANL0115085005 SANL0115085006 SANL0115085007 SANL0115085008 SANL0115085009 SANL0115085010 Name of Child (Surname. AURORA Name of MHO: _ROSALILIA C. Rappah Jan Aldama. Bea Grace Molina. Lea Mae S. Clarisse Udarbe. TAMAYO. Lovelyn Mae Andrada. Jean Aira Lopez.Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD) Name of Municipality:SAN LUIS. Rebecca Avenilla. Mark Angel Alling. Lyca joyce Caldosa. Lance Aeron Tanael. Irish Jade Sindac. Jayven Roy Bernabe. TANGSON. Nadine Natividad. Robin Jan Natividad. RN No. Jhon Carl Aldama. Jeralyn Sex (M/F) M F F F M F F F F F F M M M M F M F F M F M M F M M M F F F F F M F . MI. Rommel Angara. Abragon. Rhianne Alojado. Daiton Lopez. Micaela Salinel. James Marky Loberiano. MD Name of PHN: ROGELYNE P. Domingo. Khayla Loberiano. Benedict Novicio. Yodi Gonzales. Marvin Magdato. Glory Joy Baynosa. First.

MARZAN. Arjie Sollegue. Johnmarvin Bihasa. Yuki Orca. Fea Esplandor. Princess F F F M M M F *Use Fill Color to identify reported children within the reporting month JANUARY Light Blue FEBRUARY Red MARCH Green APRIL Purple MAY Yellow JUNE Blue Summary: Antigen BCG Hep B (w/i 24 hrs) Hep B (> 24 hrs) Penta 1 Penta 2 Penta 3 OPV 1 OPV 2 OPV 3 MCV 1 MCV 2 FIC CIC Prepared by: MARIA JESUSA A. RN NDP No. of Vaccinated Neonate/Infant from MALE FEMALE 1 0 0 0 0 0 2 0 0 0 1 4 2 0 2 3 1 3 1 2 0 1 1 2 0 0 . Jenny De Leon. Irish Tindogan.35 36 37 38 39 40 41 42 43 44 45 SANL0115085011 SANL0115085012 SANL0115086001 SANL0115086002 SANL0115086003 SANL0115086004 SANL0115086005 Manarpiis.

Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Prov. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora .) 8/28/2013 1/6/2014 1/11/2014 4/11/2014 8/2/2014 11/6/2013 11/7/2013 2/19/2014 5/30/2014 8/14/2014 6/10/2014 1/25/2015 2/5/2015 4/12/2013 7/31/2013 3/15/2014 4/8/2014 11/13/2014 9/13/2014 5/16/2014 1/22/2015 1/3/2015 5/7/2014 6/3/2014 4/23/2013 5/14/2014 7/5/2013 8/9/2013 8/9/2013 9/27/2013 2/19/2014 3/2/2014 4/17/2014 2/2/2013 31 26 26 23 19 28 28 25 22 19 21 14 13 35 32 24 23 16 18 22 14 14 22 21 35 22 32 31 31 30 25 24 23 37 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above 24 mos above 24 mos above 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 12-23 mos 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above 12-23 mos 24 mos above San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.Date of Birth* Age in Months Age Group Birthplace (Mun. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis.. Aurora Baler. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis. Aurora San Luis.

Luis. Aurora Aurora Aurora Aurora Aurora Aurora Aurora . 2015 FEMALE TOTAL 0 1 0 0 0 0 0 2 0 0 4 5 0 2 3 5 3 4 2 3 1 1 2 3 0 0 San San San San San San San Luis.1/8/2014 5/2/2014 4/5/2013 11/9/2013 8/8/2013 11/23/2013 11/19/2013 26 22 35 28 31 28 28 24 mos above 12-23 mos 24 mos above 24 mos above 24 mos above 24 mos above 24 mos above porting month d Neonate/Infant from Month 1-30. Luis. Luis. Luis. Luis. Luis.

Jemelie Sindac. Marmelyn S. Normelyn Alojado. Marvy Novicio. First. Mary Rose Alling. Elsie Detailed Address in Purok including Landmarks Purok zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 Zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 1 zone 1 zone 1 zone 1 zone 1 Zone 3 Zone 3 Zone 2 Zone 3 Zone 3 Zone 3 Zone 2 Zone 2 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 4 zone 5 zone 5 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 zone 6 . Carmen Salinel. Wendra Natividad. Kwinie Trinidad. Orena. Jonalyn Aldama. Ginalyn Abragon.Name of Mother (Surname. MI. Evangeline Del Monte. Maritess Magdato.Irene Baynosa. Dolores Bihasa. Lerma Sto. Rose May Angara. Abigail Natividad. liezel Caldosa. Domingo. Marjorie Abragon. Rachelle Loberiano. Josephine Loberiano. April Gonzales. Bernadette Molina. Michelle Bernabe. Maria Udarbe. Leslie Avenilla. Luz Andrada. Daisyrose Lopez. Fatima Mila. Aurora Lumbaga. Ronalyn Tanael. Abigail Aldama. Gretchen Angara.) Novicio.

RN PHN zone zone zone zone zone zone zone 6 6 7 7 7 7 7 .Manarpiis. Lyn Orca. TAMAYO. Razell Esplandor. Mercy De Leon. maricel Bihasa. Rachelle zone zone zone zone zone zone zone 6 6 7 7 7 7 7 Noted by: ROGELYNE P. Elena Sollegue. Aileen Tindogan.

Date of Completion: _JANUARY 2015 Barangay Contact No. NHTS (Yes/No) Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No yes No No No yes no no yes No No No no No No No No yes no yes No yes no No No No yes yes no no yes yes yes PhilHealth (Yeswrite the PHIC number/No) 0720-0320-3183 No 0720-1046-1295 No No No No no no yes No No No no No No No No yes No 07-2009137042 No yes No No No No yes yes no no yes yes yes .

Dibut Dibut Dibut Dibut Dibut Dibut Dibut 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 9068948109 yes No No No no No No yes No No No no No No .

OPV 3 AMV MMR 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PCV 2 OPV 2 0 0 0 0 0 0 0 0 0 0 0 PCV 1 OPV 1 0 0 0 0 0 0 0 0 0 0 0 0 ROTA 2 Penta 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROTA 1 Penta 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Penta 1 No No No No No No Yes No No No No No Yes No No No No No No No Yes No No Yes No No No No No No No No No No HepB BD NBS done* (Yes/No) BCG Place 1 if vaccine has been given* .

MD MHO 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 . TANGSON.No No No No No No No 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ROSALILIA C.

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized TT5 0 0 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially TT4 0 Card Check TT3 CIC * TT2 FIC* TT1 IPV PCV 3 Place 1 if mother recall TT doses* 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

0 0 0 0 0 0 Partially Partially Partially Partially Partially Partially Partially Partially Partially Partially Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized Immunized 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 .

CPAB* 1: 6-11 V-Visitor Name of Remarks (Yes/No) Given (Date) mos 2: P. mos Pedia Reason Rfor Refused refusal TO Real . Vitamin A* Age TO-Trans Mun. Group Out Prov.Pediatric 12-23 Private ian.).TI-Trans Location In Status (Brgy.

.

Date of Completion 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 .

3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 .