Republic of the Philippines

Department of Health- Center for Health Development -I (LuPangIlocos)

Parian, San Fernando City, La Union

PEN REPORTING FORM

[ MUNICIPALITY ]

Reporting Period Covered:

1 Number of adults (25 years old and above provided NCD risk screening):
2 Number of adult with <30% risk:
3 Proportion of adults with <30% risk:

4 Number of adults with 20-30% risk:

5 Proportion of adults with 20-30% risk:
6 Number of current cases with hypertension:
7 Number of newly diagnosed hypertension:

8 Total number of cases of hypertension (current + new):

9 Total number of cases of hypertension provided lifestyle interventions:
10 Percent of diagnosed adult hypertension provided lifestyle interventions:

11 Total number of cases of hypertension provided anti-HPN medications and lifestyle interventions:
Percent of diagnosed adult hypertension provided anti-HPN medications and lifestyle
12 interventions:
13 Number of current cases with diabetes:
14 Number of newly diagnosed diabetes:
15 Total number of cases of diabetes (current + new):

16 Total number of cases of diabetes provided lifestyle interventions:

17 Total number of cases of diabetes provided anti-DM medications and lifestyle interventions:
19 Percent of diagnosed adult diabetes provided anti-DM medications and lifestyle interventions:
20 No. of Adult screened with 30% risk

Prepared by: ______________________ Noted by: _______________________

nt -I (LuPangIlocos)

___________
 Republic of the Philippines
Center for Health Development -I
Parian, San Fernando City, La Union

PEN REPORTING FORM

MONTHLY/QUARTERLY/ANNUAL REPORTING FORM

Reporting Period Covered: