Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OF MASBATE

Region: V-Bicol
Division: SDO Masbate Province
SCHOOL: ________________________

ADOLESCENT REPRODUCTIVE HEALTH (ARH) REPORT

GRADE LEVEL NO. OF TRIMESTER OF QUARTER OF IMPREGNATOR

PREGNANT PREGNANCY AT CALENDAR REPORTED
LEARNERS 1ST FOR CLINIC
CONSULTATION CONSULTATION

1st 2nd 3rd 1st 2nd 3rd 4th Minor Adult Undetermined
ELEM
JHS
SHS
TOTAL
Month: ______________________

A. TEENAGE PREGNANCY DATA IN PUBLIC SCHOOLS:

Report Requested by POPCOM:

TRIMESTER OF QUARTER OF
DISAGGREGATED NO. OF PREGNANCY AT CALENDAR REPORTED IMPREGNATOR
BY AGE PREGNANT 1ST FOR CLINIC
LEARNERS CONSULTATION CONSULTATION
1st 2nd 3rd 1st 2nd 3rd 4th Minor Adult Undetermined
10-14 y/o
15-16 y/o
17-19 y/o
TOTAL

B. STATUS OF PREGNANT LEARNERS:

ACCESS TO EDUCATION ACCESS TO HEALTH SERVICES
GRADE LEVEL NO. IN NO. ON ADM NO. NO. TO RHU/ NO WITH NO. LOST TO
SCHOOL (Alternative DROPPED HEALTH PRIVATE OB FF UP
Delivery Mode)
CENTER
ELEM
JHS
SHS
TOTAL

C. ARH ACTIVITIES CONDUCTED/ATTENDED

NO. OF PARTICIPANTS
LEARNERS PERSONNEL
DATE TITLE OF ACTIVITY
ELEMENTARY SECONDARY TP NTP

Prepared by:

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