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  • Yes Ito. - Rimister? TST - : Bir (Trdate Attainment Rtoffir) Horsc, Frmiiy)

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    This document provides a socioeconomic and health profile for a household. It collects information on family members' demographics, education, occupations, health histories, prenatal care, immunizations, sanitation facilities, water source, surroundings, smoking and drinking habits. Public health personnel will use this information to assess health risks and design appropriate interventions for the family.

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    FSUU_NP_Survey_Tool

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    This document provides a socioeconomic and health profile for a household. It collects information on family members' demographics, education, occupations, health histories, prenatal care, immunizations, sanitation facilities, water source, surroundings, smoking and drinking habits. Public health personnel will use this information to assess health risks and design appropriate interventions for the family.

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    © All Rights Reserved
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    5 views3 pages

    Yes Ito. - Rimister? TST - : Bir (Trdate Attainment Rtoffir) Horsc, Frmiiy)

    Uploaded by

    TikTok Trendz
    This document provides a socioeconomic and health profile for a household. It collects information on family members' demographics, education, occupations, health histories, prenatal care, immunizations, sanitation facilities, water source, surroundings, smoking and drinking habits. Public health personnel will use this information to assess health risks and design appropriate interventions for the family.

    Copyright:

    © All Rights Reserved
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    of 3

    r

    ' Fafiter Saturnino Urbs Unitersity


    Nursing Pro{1ram
    SOCTO.ECOHOMIC HEALTH PRCIFILE .

    l'louse # '
    . -.:

    Household:
    Family:

    I. FAMTLY PROFILE Bir{trdate AGE


    (Yrr5y"o, Above
    Educ-
    Attainment
    OccupaUon
    (Inconn pr
    ' Remarks
    (Hounetrold,
    1.16.:5y-o. betcw) rtoffir) Horsc, frmiiy)
    A. Head of the Family

    B. wife

    C. Children

    E. Rdligion
    Address

    L Prenatal
    ts tfrere u prugnant mosrer in the family? yes
    If ves, what Rimister? tst :_ Ito.-_. ,
    7d
    How often is the pr+natarvisnz -lE[ a mor,tto-
    ?,u
    "ti,vEilrrcnur
    - Weekly No pre-natal
    l$ Trimester
    . Z,d Trinrester
    3d Trimester
    76 - Bfr nrc.
    gh mo.
    YES NO ----a:-- -"--=-_--
    TII Risk of Pregnancy
    TT2 Age at first pregnanry
    TT3
    TI4

    None*-__
    Ngrre'
    oru3
    .1 DPTz
    DPT 3
    : HEP Bl
    HEP,82
    HEP 83
    .
    ,,,IEASLES
    ' . B; t3-59 months
    FIC
    cIC .l
    4, Types of Feedtng
    0-6 nronths ,
    BotU€fieed-___r:;_ Mixed*",:---,___
    Age (month) tvt t{ofmal Be0ow Eelow i,lormal Above
    No-rnral

    6' Famitv_llulTlg MCRA (rs-4e y.o.)


    typqs of Fp rnethod
    User Noh:User
    1. pifls
    2" DMPA "

    4, Vasectoffiy
    '
    .
    5. BTL
    6. Condom
    , .7, NaturalFamily planning
    a. .Billing's ttethod _..: .
    b, BBT
    c. Symp&rottrennal ,. .

    other,s (SpeOfVI ... ,.


    ,

    ET{VIROf{FTENTAL5AT{ITATION'
    7. Tollet Facllity Shared: Owned : ;'- . None: ,"
    ]Ypes:
    Water Sealed A. pour-lype--_
    -
    B. Ftushed.fype_
    pn privy___;_
    $tipoto--
    Strucurre A. Sanitarvf
    6rrot SVrt m. Others:
    . ffi?oliJition
    B. Septic tank.

    Compost pit with mver


    (Biodegradabte) ---....--
    DuTplng Anlnrrhere.- fumino ,
    . Othens (paper, leaves)
    9. _-- - . r., '.
    Water Supply
    tutl!rie HsnEFqH-4Fle Wst€r
    tnsty-qls

    (5 pipes/I0oft)
    . every ? months
    Level III.A,WAS
    *-.rnandatory i
    1O. Surroundings
    VegetaUte garden
    f lthstu^lrl
    Hertalgarden ,,
    a

    11. (xgarctt€ srnoldng


    ..
    With srrrokers
    12. Alohot Drtnking:lT-- Wittrout srokers
    WiBr drinkers
    .--.. WiUnut drinkers
    ...,.,-
    ffl Other ltenrs

    piiraate Enftor -: Flealth.personnel .

    tD.
    Fru,d, used Duri4s ffi#:::-'"' :
    E. Dorhestrcatuo
    "-#flffiy- hrat!r_;*_ rer[ir concoqron_:_ or,eo____
    *ni*.t@ Rice
    :

    TVpeS of Animals - Number ,. None..


    - ,
    i.

    Cat , . ",
    ?F.,'. .. ,-. .-,'-: ,

    . Chrcken l-l . '-----:-


    -=-
    :. . Pig :-. - . :

    i Goat
    Carabao
    Birds
    Others (spectfy)

    Date Updated: Ocbober Zg,


    ABIVIN,
    2009
    0g
    ' '

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