MUNICIPAL HEALTH OFFICE

_____________
BARANGAY

SURVEY 20__

AGE GROUP Male Female TOTAL

0-11 months
1-4 y/o
6-5 y/o
7-10 y/o
11-14 y/o
15-19 y/o
20-29 y/o
30-39 y/o
40-49 y/o
50-59 y/o
60 and above
TOTAL

MCRA ( 15-45 y/o)

Total Population
No. of Houses
No. of Households

Prepared by: