GENERAL INTAKE SHEET
DATE: September 24, 2021
I.PERSONAL INFORMATION:
Name : ALMA CRISTINA B. DU-OT
Date of Birth : DECEMBER 29, 2021
Age : 34 Years Old
Address : Eleazar, Calanasan, Apayao
Sex : Female
Civil Status : Single
Educ’l Attainment : College Graduate
Occupation : Day Care Worker, Self-Employed
Monthly Income : 6,000.00
Qualified Beneficiaries : Damiana B. Du-ot, Janaira Yvonne D. Lawat
Contact No. : 095536795418
Type of Assistance : Medical Assistance
II.FAMILY COMPOSITION:
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
Agra-am P. Du-ot 10/23/1943 M M Father Barangay HS Graduate 4,000.00
Captain
Damiana B. Duot 3/2/ 1944 F M Mother None Elem Level -
Axl Gan Inovejas 2/6/2005 M S Nephew Student HS Level -
Janaira Yvonne D. Lawat 1/3/2008 F S Daughter Student HS Level -
Yzhanne Avery B. Du-ot 6/23/2013 F S Niece Pupil Elem Level -
III.CASE HISTORY/PROBLEM PRESENTED:
Client’s child, nephew, niece and her mother went positive of Corona Virus last August 18, 2021 and they underwent home isolation for 14
days hindering the bread earner to provide the needs of the family. She works as a Day Care Worker during the children’s vacation (August)
she did not received her honorarium and only relied her income from her vending activity of which during their home isolation her sales
halted and that most of her perishable goods available were consumed by the family.
This compelled the family to ask the assistance of this office for possible augmentation considering their economic status to this date.
IV. SOCIO ECONOMIC BACKGROUND:
Client is a solo parent and is presently living with her biological family with two of her father’s grandchildren. The family is
living in their owned house that is predominantly made of wood located at Barangay Eleazar, this municipality. The family’s
source of electricityis from Solar Energy.
Client family’s source of income derive much from client’s income as a Day Care Worker which is augmented by selling
grocery items and perishable goods in the barangay where they live in of which is very minimal considering the escalating
cost of basic necessities and educational support to three children enrolled in school.
V. ACTION TAKEN:
- Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Based on the information gathered, client’s family is in need of financial assistance to support their needs because the family
is economically distressed as a result of COVID -19, hence, undersigned recommends the provision of Three Thousand
Pesos (3,000.00)
Conforme: Interviewed by: Approved by:
Alma Cristina B. Du-ot LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 25, 2021
I.PERSONAL INFORMATION:
Name : MABELYN D. DAGON
Date of Birth : 12/19/1993
Age : 27
Address : ELEAZAR, CALANASAN, APAYAO
Sex : FEMALE
Civil Status : MARRIED
Educ’l Attainment : HIGH SCHOOL LEVEL
Occupation : Barangay Health Worker
Monthly Income : 399.00
Qualified Beneficiaries : Herself, Aliven B. Du-ot
Contact No. :
Type of Assistance : Medical Assistance
II.FAMILY COMPOSITION:
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
ALIVEN B. DU-OT 8/30/1979 M M HUSBAND GOVT. EMP. College Grad 7,000.00
HYACINE D. DU-OT 6/17/2012 M S SON N/A Elem Level
DAKE JEEVAN D. DU-OT 2/4/2018 M S SON N/A - N/A
III.CASE HISTORY/PROBLEM PRESENTED:
Client’s family underwent home isolation after the result of NCOV19 RTPCR declared them positive of NCOV-19. The
family is still tormented of the effect of Pandemic considering that client’s husband was not able do some part-time job
which could augment his meager income as an administrative aid.
This forced client to ask for financial assistance from this office.
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family is presently living in their owned house that is made out of strong materials mixed with light materials
located at Barangay Eleazar, Clanasan, Apayao. Client’s source of electricity is from Solar Energy.
Client’s family subsistence depends on client’s income as a government employee and a part-time labourer during weekends
to augment the family’s present resources. Client’s family income is just enough to sustain their daily basic necessities.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Per presented information, client is in dire need of financial assistance, hence; undersigned recommends the provision of
Three Thousand Pesos as financial assistance.
Conforme: Interviewed by: Approved by:
Mabelyn D. Du-ot LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 25, 2021
I.PERSONAL INFORMATION:
Name : MARICAR DAGON
Date of Birth : FEBRUARY 1, 1997
Age : 24
Address : ELEAZAR, CALANASAN, APAYAO
Sex : FEMALE
Civil Status : LIVING-IN-WITH PARTNER
Educ’l Attainment : HS LEVEL
Occupation : HOUSEKEEPER
Monthly Income : N/A
Qualified Beneficiaries : FREDDIE DAMIAN JR., HERSELF, SON
Contact No. :
Type of Assistance : COVID
II.FAMILY COMPOSITION:
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
FREDDIE DAMIAN JR. 10/25/19 M S Live-In Partner LABOURER ELEM. LEVEL 4,500/
mo
LEANDRIE CYRUS D. 4/3/2021 M S - - - -
DAMIAN
III.CASE HISTORY/PROBLEM PRESENTED:
Client and her family got sick with COVID-19 since August 19, 2021 and they were held in isolation for fourteen days.
During the family’s isolation, client’s live-in partner was no allowed to find job leaving their economic vulnerable after their
isolation period. The kind of job of client’s live-in partner pays them on 15-days basis of which really pressures the family.
This compelled the family to ask for financial assistance.
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family lives in Barangay Eleazar, this locality in their owned 1-storey house with one bedroom. The family’s dirty
kitchen is separated from the house and the family use firewood to prepare their food. Their source of illumination is from
Solar Energy.
Client’s family relies their existence from the meager income of client’s husband who works as a labourer which is being
augmented by upland farming, however, client’s family income is very limited considering that they have to buy milk
formula for their baby since the mother could not produce enough breastmilk for her child’s consumption.
Nevertheless, client’s family has a good standing in the community where they live-in.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Client’s family is in dire need of financial assistance to sustain their daily basic necessities while under recovery from the
effect of COVID-19, hence; undersigned recommends the provision of Three Thousand Pesos (3,000.00).
Conforme: Interviewed by: Approved by:
MARICAR S. DAGON LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 25, 2021
I.PERSONAL INFORMATION:
Name : MYLENE S. DAGON
Date of Birth : APRIL 25, 1991
Age : 30
Address : ELEAZAR, CALANASAN, APAYAO
Sex : FEMALE
Civil Status : MARRIED
Educ’l Attainment : ELEM LEVEL
Occupation : HOUSEKEEPER
Monthly Income : N/A
Qualified Beneficiaries : HERSELF, HONEY LEE, STEPHANY
Contact No. : NONE
Type of Assistance : COVID
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
FELIX DALIWAG 5/21/1995 M M HUSBAND LABOURER COLL. LEVEL 4,500
HONEY LEE DALIWAG 6/17/2018 F S DAUGHTER - - -
STEPHANY JANE DALIWAG 11/4/2016 F S DAUGHTER - - -
III.CASE HISTORY/PROBLEM PRESENTED:
Client and her two daughter got sick of COVID-19 and were held in isolation for 14 days. Client’s husband was not able to
pursue his job because he was subjected to home isolation since he became Covid-19 Positive’s level to his family and after
five days, he was suspected again of COVID-19 after the result of the RTPCR of his mother-in-law and
stepdaughter became positive.
To date, client’s family is economically tormented considering the fact that they had just settled in their new house and that
he had just started working as a labourer one week ago. This compelled client to ask the assistance of this office for any
possible augmentation that could be extended.
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family is living in their newly built house that is made of strong but predominatly light materials locacated at
Barangay Eleazar, this locality.
Client’s depends their food sustenance from the limited income of client’s husband who works as a labourer and part-timer
to any carpentry works. Client’s family is presently under financial difficulties considering that they had just settled in their
owned house which is not yet fully furnished and incomplete utensils.
V. ACTION TAKEN:
Provided Family Food Pack.
VI. ASSESSMENT AND RECOMMENDATION
Client is in dire need of financial assistance to sustain their daily basic needs as the family recovers from the
disadvantage effect of COVID-19, hence; undersigned recommends the provision of financial assistance in the
amount of Three Thousand Pesos.
Conforme: Interviewed by: Approved by:
MYLENE S. DAGON LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 25, 2021
I.PERSONAL INFORMATION
Name : MELANDRO S. DAGON
Date of Birth : 10/24/1987
Age : 32
Address : ELEAZAR, CALANASAN, APAYAO
Sex :M
Civil Status :S
Educ’l Attainment : ELEM. LEVEL
Occupation : LABOURER
Monthly Income : 3,500.00
Qualified Beneficiaries : NENA DAGON, JOELYN TAYAWA, MARVIN ALCANTARA
Kind of Assistance :
II.FAMILY COMPOSITION
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
DIONICIO DAGON 2/21/1955 M M SON NONE ELEM LEVEL NONE
NENA S. DAGON 2/24/1954 F M SON NONE ELEM LEVEL NONE
JOELYN D. TAYAWA 3/15/2010 F S UNCLE - - -
MARVIN D. ALCANTARA 7/10/2015 M S UNCLE - - -
III.CASE HISTORY/PROBLEM PRESENTED
Client and two members of his family got sick of COVID 19 and were held in isolation for fourteen days. Client’s family is
now experiencing economic difficulties since client had just resumed to his laboring work and the family doesn’t have
enough food resources compelling the family to ask for financial augmentation.
IV. SOCIO ECONOMIC BACKGROUND
Client’s family lives in their family house that is predominantly built with wood mixed with light materials with three rooms located at
Barangay Eleazar, this locality.
Client as a breadwinner could not provide enough sustenance for his family, hence; the family augmented their limited resources through
upland farming but of which is still limited considering that client is the only bread earner in the family and that his mother and father could
only assist him in farming works because of their old age.
Nevertheless, client’s family has a harmonious relationship and good standing in the community where they live in.
V. ACTION TAKEN
Povided Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION
Client’s family is still recovering from the effect of COVID-19 but they really need assistance, hence;
undersigned recommends the provision of Three Thousand Pesos (3,000.00)
Conforme: Interviewed by: Approved by:
MARICAR S. DAGON LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 27, 2021
I.PERSONAL INFORMATION:
Name : ELINOR G. ANDRES
Date of Birth : AUGUST 15, 1986
Age : 35
Address : PULOT,BUTAO, CALANASAN, APAYAO
Sex : FEMALE
Civil Status : MARRIED
Educ’l Attainment : COLLEGE GRADUATE
Occupation : BARANGAY SECRETARY
Monthly Income : 5,000.00
Qualified Beneficiaries : HERSELF
Contact No. :
Type of Assistance : COVID
II.FAMILY COMPOSITION:
CIVIL
RELATIONSHI EDUC’L
NAME Birth date SEX STATU OCCUPATION Income
P TO CLIENT ATTAINMENT
S
ANGELO B. ANDRES 7/22/1993 M S Husband LABOURER ELEM. LEVEL 3,000.00
III.CASE HISTORY/PROBLEM PRESENTED:
Client got sick of Covid-19 last July 28, 2021 and she was isolated for14 days. During her isolation and her economic
activity was eventually affected.
To date, her family is under recovery but she disclosed that they are really in need of financial assistance to sustain their
daily needs.
IV. SOCIO ECONOMIC BACKGROUND:
Client and her husband lives in a Pastoral House in Barangay Butao, this locality since they are a new couple but their house
is under construction.
Client’s main subsistence derive much from her honorarium as a Barangay Secretary since her husband is a minister in their
church whose salary is not determined since the church members could only provide small donations. Client’s family income
is just enough to sustain their daily basic needs considering the escalating cost of basic necessities and the on-going
construction of their humble abode.
Nevertheless, client’s family has a good standing in the community where they live-in.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Client’s family is in dire need of financial assistance to sustain their daily basic necessities while under recovery from the
effect of COVID-19, hence; undersigned recommends the provision of Three Thousand Pesos (3,000.00).
Conforme: Interviewed by: Approved by:
Elinor Andres LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 27, 2021
I.PERSONAL INFORMATION:
Name : JESSABEL DARISAN
Date of Birth :
Age :
Address : PULOT, BUTAO, CALANASAN, APAYAO
Sex : FEM
Civil Status : MARRIED
Educ’l Attainment : COLLEGE GRADUATE
Occupation : BARANGAY SECRETARY
Monthly Income : 5,000.00
Qualified Beneficiaries : HERSELF
Contact No. :
Type of Assistance : COVID
II.FAMILY COMPOSITION:
CIVIL
SE RELATIONSHIP TO EDUC’L
NAME Birth date STAT OCCUPATION Income
X CLIENT ATTAINMENT
US
NORA SILING 7/22/1993 M S Husband LABOURER ELEM. 3,000.00
LEVEL
ALDEN SILING 1/22/1993 M S Live-In Farming HS Level
JANNELLA SILING 4/27/2017 F S Daughter - -
ALWIN SILING M S Brother-In-Law Farming
AJAY SILING M S Nephew - -
EMELYN LAYOHAN F M Sister-In-Law BHW
FELDEX LAYOHAN M S Nephew
FELJOE LAYOHAN M S Nephew
III.CASE HISTORY/PROBLEM PRESENTED:
Client got sick of COVID-19 with her brother-in-law and both of them underwent isolation impeding them to earn money for their family.
To date, client’s family is having difficulties in their food sustenance since they were not able to help other bread earners of the family.
This compelled the client’s family to ask for any assistance
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family lives in their owned house that is made out of light materials with only 1 room. One of the family use the kitchen area as
their sleeping room during night time while the other family sleep in the living room.
Client’s family relies their existence from upland farming which is augmented by part-time laboring works and vending of vegetables in
their neighborhood, however, client’s family income is very limited considering the number of mouth to feed and the escalating cost of basic
necessities now a days.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Client’s family is in dire need of financial assistance to sustain their daily basic necessities while under recovery
from the effect of COVID-19, hence; undersigned recommends the provision of Three Thousand Pesos
(3,000.00).
Conforme: Interviewed by: Approved by:
JESSABEL DARISAN LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 27, 2021
I.PERSONAL INFORMATION:
Name : LYNORE B. GANO
Date of Birth : 10/27/1985
Age : 35
Address : ELEAZAR, CALANASAN, APAYAO
Sex : FEMALE
Civil Status : SINGLE
Educ’l Attainment : COLLEGE GRADUATE
Occupation : SWO II
Monthly Income : 15,000.00
Qualified Beneficiaries : HERSELF
Contact No. :
Type of Assistance : COVID
II.FAMILY COMPOSITION:
CIVIL
SE RELATIONSHIP TO EDUC’L
NAME Birth date STAT OCCUPATION Income
X CLIENT ATTAINMENT
US
III.CASE HISTORY/PROBLEM PRESENTED:
Client got sick of COVID-19 with her brother-in-law and both of them underwent isolation impeding them to earn money for their family.
To date, client’s family is having difficulties in their food sustenance since they were not able to help other bread earners of the family.
This compelled the client’s family to ask for any assistance
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family lives in their owned house that is made out of light materials with only 1 room. One of the family use the kitchen area as
their sleeping room during night time while the other family sleep in the living room.
Client’s family relies their existence from upland farming which is augmented by part-time laboring works and vending of vegetables in
their neighborhood, however, client’s family income is very limited considering the number of mouth to feed and the escalating cost of basic
necessities now a days.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Client’s family is in dire need of financial assistance to sustain their daily basic necessities while under recovery from the
effect of COVID-19, hence; undersigned recommends the provision of Three Thousand Pesos (3,000.00).
Conforme: Interviewed by: Approved by:
JESSABEL DARISAN LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
GENERAL INTAKE SHEET
DATE: September 27, 2021
I.PERSONAL INFORMATION:
Name : JESSABEL DARISAN
Date of Birth :
Age :
Address : PULOT, BUTAO, CALANASAN, APAYAO
Sex : FEM
Civil Status : MARRIED
Educ’l Attainment : COLLEGE GRADUATE
Occupation : BARANGAY SECRETARY
Monthly Income : 5,000.00
Qualified Beneficiaries : HERSELF
Contact No. :
Type of Assistance : COVID
II.FAMILY COMPOSITION:
CIVIL
SE RELATIONSHIP TO EDUC’L
NAME Birth date STAT OCCUPATION Income
X CLIENT ATTAINMENT
US
NORA SILING 7/22/1993 M S Husband LABOURER ELEM. 3,000.00
LEVEL
ALDEN SILING 1/22/1993 M S Live-In Farming HS Level
JANNELLA SILING 4/27/2017 F S Daughter - -
ALWIN SILING M S Brother-In-Law Farming
AJAY SILING M S Nephew - -
EMELYN LAYOHAN F M Sister-In-Law BHW
FELDEX LAYOHAN M S Nephew
FELJOE LAYOHAN M S Nephew
III.CASE HISTORY/PROBLEM PRESENTED:
Client got sick of COVID-19 with her brother-in-law and both of them underwent isolation impeding them to earn money for their family.
To date, client’s family is having difficulties in their food sustenance since they were not able to help other bread earners of the family.
This compelled the client’s family to ask for any assistance
IV. SOCIO ECONOMIC BACKGROUND:
Client’s family lives in their owned house that is made out of light materials with only 1 room. One of the family use the kitchen area as
their sleeping room during night time while the other family sleep in the living room.
Client’s family relies their existence from upland farming which is augmented by part-time laboring works and vending of vegetables in
their neighborhood, however, client’s family income is very limited considering the number of mouth to feed and the escalating cost of basic
necessities now a days.
V. ACTION TAKEN:
Provided 1 Family Food Pack
VI. ASSESSMENT AND RECOMMENDATION:
Client’s family is in dire need of financial assistance to sustain their daily basic necessities while under recovery from the
effect of COVID-19, hence; undersigned recommends the provision of Three Thousand Pesos (3,000.00).
Conforme: Interviewed by: Approved by:
JESSABEL DARISAN LYNORE B. GANO RAYMUNDO G. DANGGAN
Client Name and Signature Social Worker MSWDO
