Master List of Women of Reproductive Age

dolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN, PUALAS L.D.S Name of BHS Midwife: NORMIDA M. TOCALO Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

(4)
(2) (3)
(1)
10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sedic, Norhedaya / 12/26/76
Abobacar
2 Sedic, Nor-ain / 7/15/76
Aloyodan
3 Abdulmajed, / 8/23/78
Norhaida Sedic
4 Sedic, Senai / 6/20/79
Aloyodan
5 Macabtas, Rahma / 6/7/82
Mikunug
6 Gampong, Hanifa / 1/22/86
Sedic
7 Gampong, Noraya / 1/17/88
Sedic
8 Sedic, Rohaida / 2/9/81
Pundali
9 Ponsalagan, Norsia / 3/1/92
Gampong
10 Gampong, Nahida / 2/18/80
Sedic
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Monte, Soraifa Sedic / 7/26/95
2 Mangoda, Haniya / 12/25/99
Saliling
3 Gampong, Mohmina / 8/9/79
Amen
4 Sedic, Aslea / 11/16/89
Balindong
5 Bonsalangan Aisha / 4/26/95
Saripada
6 Aliakbar, Mohmina / 3/1/94
Sedic
7 Alon, Junaima Sedic / 3/17/96
8 Sedic, Norhedaya / 9/12/89
Abobacar
9 Sedic, Aspia Andap / 10/12/92
10 Balindong, Hanifa / 10/7/92
Sedic
 TOTAL

Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Gampong, Sarabai / 7/12/89
Marohom
2 Gampong, Asnida / 9/26/91
Andap
3 Acmad, Ainie / 2/22/93
Macalindong
4 Ampaso, Muslema / 3/15/97
Marohom
5 Andap, Norcaya / 7/26/98
Amen
6 Basher, Rofaida / 12/25/89
Gampong
7 Usman, Monaya / 12/23/88
Sedic
8 Sedic, Rahma / 10/12/87
Balindong
9 Sedic, Bamera / 4/26/90
Mangondato
10 Sedic, Amera / 4/8/91
Macaanga
 TOTAL

Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sedic, Soraida / 7/9/89
Gampong
2 Sedic, Farida / 9/26/93
Gampong
3 Sedic, Saida Asane / 10/25/90
4 Gampong, Anida / 7/9/85
Sedic
5 Ampaso, Jonaisa / 9/17/86
Gampong
6 Balindong, Monisa / 6/15/84
Sedic
7 Sedic, Sapia / 5/20/82
Masiding
8 Abba, Anida Sedic / 6/18/81
9 Sedic, Ainie Magara / 1/19/86
10 Caris, Normia Sedic / 2/22/89
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sedic, Raila / 7/13/82
Gampong
2 Sedic, Namraida / 4/25/76
Saripah
3 Ampong, Nor-ain / 3/23/76
Sedic
4 Aliakbar, Hanira / 5/5/74
Sedic
5 Balindong, Aripa / 6/5/77
Sedic
6 Watamama, Omaya / 6/17/78
Sedic
7 Sedic, Mohmina / 7/8/78
Pagnongon
8 Datubero, Fayzah S. / 4/7/97
9 Aliakbar, Omaya / 3/8/88
10 Saliling, Monaya A. / 9/7/81
TOTAL

Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services
 For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Aloyodan Sinay S. / 2/6/87
2 Sedic, Asnida A. / 7/9/86
3 Gampong, Nahipa B. / 5/20/90
4 Sedic, Raima A. / 6/6/89
5 Sedic, Raihana A, / 8/9/83
6 Gampong, Cairon S. / 12/7/84
7 Ampong, Nor-ain / 11/15/88
8 Sedic, Anida / 4/7/86
9 Ampong, Nor-aina S. / 5/9/81
10 Batua, Montia S. / 9/9/92
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Balindong, Zenaida / 5/7/87
S.
2 Saliling, Rocaya / 9/9/88
3 Andap, Soraida M. / 11/22/90
4 Sedic, Sagipoon / 4/6/84
5 Gampong, Mohmina / 8/7/92
S.
6 Balindong, Amera M. / 5/17/96
7 Andap, Saira S. / 1/13/91
8 Balindong, Saliha / 3/7/89
Gampong
9 Bairone, Sedic G. / 12/13/94
10 Saripa, Andap P. / 12/29/95
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sidic, Cadidia M. / 11/7/98
2 Sedic, Sonaya M. / 7/9/97
3 Sedic, Farida G. / 12/7/81
4 Gampong, Mohmina / 6/9/93
S.
5 Sedic, Sagipoon S. / 9/7/85
6 Balindong, Amera M. / 3/9/97
7 Andap, Saira S. / 2/12/92
8 Aloyodan, Noronisa / 12/13/88
S.
9 Gampong, Saliha / 7/9/90
10 Sedic, Bairone G. / 5/14/95
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Anday, Saripa P. / 6/19/96
2 Sedic, Cadidia M. / 9/7/98
3 Sedic, Sonaya M. / 10/7/97
4 Morohom, Mina / 2/18/91
5 Sedic, Ampera / 11/5/88
Baidon
6 Makil, Nor-ain A. / 8/7/86
7 Casir, Asnifa Sedic / 9/7/88
8 Aloyodan, Noronisa / 4/1/88
S.
9 Gampong, Salima B. / 4/7/93
10 Datubero, Dayonin S. / 3/1/89
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Datubero, Fayeda / 6/7/96
2 Ampuan, Somaya / 4/7/94
3 Sedic, Mohmina P. / 3/7/79
4 Sedic, Farida G. / 8/9/81
5 Datubero, Fayzah S. / 11/18/97
6 Aliakbar, Omaya / 12/16/89
7 Saliling, Monaya / 12/15/82
8 Marohom, Mina / 12/6/91
9 Sedic, Raihana / 9/13/84
10 Gampong, Cairon / 1/2/85
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Ampong, Nor-ain / 6/9/89
2 Sedic. Anida / 3/16/87
3 Ampong, Noraina / 5/15/82
4 Batua, Mortia S. / 3/28/92
5 Balindong, Zenaida / 12/8/87
S.
6 Saliling, Rocaya M. / 2/8/89
7 Andap, Sonaida M. / 12/25/91
8 Caris, Asnifa Sedic / 12/10/90
9 Sedic, Norhedaya / 5/19/83
Abobacar
10 Sedic, Nor-ain / 4/23/87
Aloyodan
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Abdulmajid, Norhaida / 6/17/76
Sidic
2 Sedic, Senai / 2/2/79
Aloyodan
3 Macabtas, Rahina / 11/12/82
Mikunog
4 Gampong, Hanipa / 12/19/80
Sedic
5 Gampong, Noraya S. / 7/8/78
6 Sedic, Rohaida / 4/4/89
Pundali
7 Bonsalagan, Norsia / 6/18/90
G.
8 Gampong, Nahida / 7/5/89
Sedic
9 Monte, Soraifa S. / 4/20/92
10 Mangoda, Haniya / 9/23/90
Saliling
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Gampong, Mohmina / 9/6/84
Amen
2 Sidic, Aslia Balindong / 6/12/89
3 Bonsalagan Aisha / 12/11/87
Saripada
4 Aliakbar, Mohmina S. / 11/10/94
5 Alon, Juhaima / 7/30/87
Maruhom
6 Sedic, Aspia Andap / 5/13/89
7 Balindong, Hanifa / 8/13/95
Sedic
8 Gampong, Sarabai / 12/2/95
Maruhom
9 Gampong, Asnida / 4/9/98
Andap
10 Acmad, Ainie / 11/14/91
Macadindong
TOTAL

Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services
 For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Ampaso, Muslema / 2/8/89
Marohom
2 Andap, Norcaya / 12/7/90
Amer
3 Ampaso, Jonaisa / 11/29/89
4 Basher, Rafaida G. / 11/4/91
5 Usman, Monayah S. / 2/3/88
6 Sidic, Rahma B. / 7/29/87
7 Sidic, Bamera / 10/22/93
Magondato
8 Sedic, Amera / 6/11/98
Macasangga
9 Sedic, Sonaida / 4/23/81
Gampong
10 Sedic, Farida / 3/9/96
Gampong
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sidic, Saida Asane / 10/27/85
2 Gampong, Anida / 1/5/89
Sidic
3 Ampaso, Jonaisah G. / 12/14/90
4 Balindong, Monisam / 1/7/93
S.
5 Aliakbar, Honania S. / 7/27/99
6 Balindong, Anipa S. / 5/13/79
7 Watamama, Omaya / 3/10/78
S.
8 Sidic, Sapia Masidig / 3/9/78
9 Abba, Anida Sidic / 9/2/76
10 Sidic, Ainie Mangara / 12/5/80
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Caris, Nornia Sedic / 10/23/79
2 Sidic, Raila Gampong / 1/2/85
3 Sidic, Namraida / 12/16/89
Saripada
4 Ampong, Nor-ain / 8/24/93
Sidic
5 Ampong, Baida Sedic / 6/7/88
6 Makil, Nor-ain / 5/7/86
Ayodan
7 Caris, Asnifa Sedic / 12/9/88
8 Aloyodon, Noronisa / 12/26/88
Sedic
9 Gampong, Salima B. / 2/13/97
10 Datuboro, Dayonon / 3/1/78
Sedic
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Macadato, Norhaida / 4/15/90
A.
2 Aksoni, Nobaisa / 10/6/95
Sedic
3 Sedic, Nobaisa / 11/30/95
Pumudali
4 H, Casan, Momina / 11/21/92
5 H. Sobair, Saida / 12/14/90
Sedic
6 Sedic, Saliha / 12/29/92
Gampong
7 Sedic, Raihana / 1/12/88
Aloyodan
8 Sedic, Norhedya A. / 3/7/99
9 Sedic, Nor-ain / 3/7/83
Ampong
10 Sedic, Moajma B. / 4/7/91
TOTAL
 Master List of Women of Reproductive Age and Adolescent Women for Family Planning Services

For the Quarter/Year: ________________

Barangay: YARAN Name of BHS Midwife: Date prepared:

N HH Name of WRA Age in Years Birthday SE Civil Status Do you plan to have more Fecundity If col. Sb & 8c is / are you If col. 8b or 8c Does Based on TCL on FP did
o No. (FN, MI, LN) (MM/DD/YY) Status children? (Place a /) currently using any FP is / and using this WRA accept any modern
(Place a /) method? col. 10 b ot 10 WRA FP method?
c, would you has
like to shift to MFP
modern unmet
method? need?
(Place a /)

10- 15- 20- 1: 1 currently If Yes when? No Fecund Infecund If yes what Not Yes No Place a No Yes
14 19 49 NHTS married (9a) (9b) using / - if Yes (13a (13b)
2: Non-
type? any FP
(11a) (11b) X – if )
2 Non
NHTS method No (Put
married but (Place a /)
in a /)
relationship[ Now Spacin Limitin Moder Traditiona (10c) Specify Date
as if married (8a) g g n l Moder when FP
3 Non- (8b) (8c) (10a) (10b) n FP method
married and method accepted?
not in any
relationship
with a man.
1 Sedic, Saida / 4/7/84
Aloyodan
2 Datubero, Fayyeza S. / 5/11/97
3 Salilimg, Rocaya M. / 6/14/87
4 Gampong, Nahifa B. / 6/22/90
5 Sedic, Sonaya M. / 7/5/95
6 Andap, Sharifa P. / 8/17/94
7 Sedic, Baisane G. / 9/15/93
8 Caris, Nornia S. / 11/10/92
9
10
TOTAL