Latest m1

FHSIS REPORT for the MONTH: ______ YEAR: ______
M1
Name of Barangay: ____________________
Name of BHS: ________________________
Name of Municipality/City: BARCELONA
BRGY
Name of Province: ______________________
Projected Population of the Year: _______________________
For submission to RHU/MHC
Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
1. No. of WRA with unmet need for modern FP - Total
0
A2. Use of FP Method Current Users Acceptors Drop-outs Current Users New Acceptors
(Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
Total Total Total Total Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 137 137 0 0 0 0 0 137 137 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 76 77 0 0 0 0 1 76 77 0
d. Pills - Total 0 8 721 729 0 0 0 0 0 0 0 0 0 0 0 0 0 8 721 729 0 0 0 0
d.1 Pills-POP - Total 0 1 15 16 0 0 0 0 1 15 16 0
d.2 Pills-COC - Total 0 7 706 713 0 0 0 0 7 706 713 0
e. Injectables (DMPA/POI)-Tot. 0 6 496 502 0 0 0 0 6 496 502 0
f. Implant - Total 0 0 23 23 0 0 0 0 0 23 23 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 16 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16 16 0 0 0 0
g.1 IUD-I- Total 0 0 16 16 0 0 0 0 0 16 16 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 4 101 105 0 1 1 2 0 0 0 5 102 107 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 14 14 0 0 0 0 0 14 14 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 144 144 0 0 0 0 0 144 144 0
m. Total Current Users 0 19 1728 1747 0 1 1 2 0 0 0 0 0 0 0 0 0 20 1729 1749 0 0 0 0
Section B. Maternal Care and Services
Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
6. No. of pregnant women who completed
1. No. of Women Who Gave Birth” with at least 4 0 0
doses of calcium carbonate
prenatal check-ups - Total
supplementation - Total
2. No. of pregnant women 7. No. of pregnant women given 0
assessed of their nutritional 0 0 0 0 iodine capsules – Total
status during the 1st tri. -Total 8. No. of pregnant women given one dose
0
a. Number of pregnant of deworming tablet - Total
women seen in the first 9. No. of pregnant women screened for
0 0
trimester who have normal syphilis - Total
BMI - Total 1
a. Number of pregnant
0 0
BMI - Total 10. No. of pregnant women tested positive
0
b. No. of pregnant women for syphilis - Total
seen in the first trimester 0 11. No. of pregnant women screened for
0
who have low BMI - Total Hepatitis B - Total
c. No. of pregnant women 12. No. of pregnant women tested positive
0
seen in the first trimester 0 for Hepatitis B - Total
who have high BMI-Total 13. No. of pregnant women screened for
0
3. No. of pregnant women for HIV - Total
the first time given at least 2 0 14. No. of pregnant women tested for
0
doses of Td vaccination-Total CBC or Hgb & Hct count - Total
15. No. of pregnant women tested for
4. No. of pregnant women for
CBC or Hgb & Hct count diagnosed 0
the 2nd or more times given 0 with anemia - Total
at least 3 doses of Td
vaccination (Td2 Plus) - Total 16. No. of pregnant women screened for
0
gestational diabetes – Total
5. No. of pregnant women who
completed the dose of iron 17. No. of pregnant women tested positive
0 0
with folic acid for gestational diabetes – Total
B2. Intrapartum Care and Delivery Outcome
18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled 0
19. No. of live births – Total 0 health professionals - Total
a. No. of live births with a. No. of deliveries attended by a
normal birth weight - Total doctor - Total
b. No. of live births with low b. No. of deliveries attended by a
birth weight - Total nurse – Total
c. No. of live births with c. No. of deliveries attended by
unknown birth weight-Total midwives - Total
10-14 15-19 20-49 10-14 15-19 20-49
21. No. of health facility-based 23a. No. of vaginal deliveries – Total 0
0
deliveries - Total 23b. No. of deliveries by cesarean
0
a. No. of deliveries in section – Total
public health facility-Total 24a. No. of full-term births – Total 0
b. No. of deliveries in 24b. No. of pre-term births – Total 0
private health facility-Tot. 24c. No. of fetal deaths - Total 0
22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0
deliveries - Total
B3. Postpartum and Newborn Care
25. No. of postpartum women 27. No. of postpartum women with
together with their newborn Vitamin A supplementation – Total
who completed at least 2 0 0
postpartum check-ups -
Total
26. No. of postpartum women
who completed iron with 0
folic acid supplementation -
Total
Section C. Child Care and Services
Indicators Male Female Total Remarks Indicators Male Female Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total 0 13. PCV 1 - Total 0
2
2. BCG - Total 0 14. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 15. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 16. MCV 1 - Total 0
6. DPT-HiB-HepB 3 - Total 0 18. FIC - Total 0
7. OPV 1 - Total 0 19. CIC - Total 0
8. OPV 2 - Total 0 20. Td, Grade 1 (November) - Total 0
9. OPV 3 - Total 0 21. MR, Grade 1 (November) - Total 0
10. IPV 1- Total 0 22. Td, Grade 7 (November) - Total 0
11. IPV 2 (routine)- Total 0 23. MR, Grade 7 (November) - Total 0
12. IPV 2 (catch-up)- Total 0
C2. Nutrition Services for Infants and Children
24. Newborns initiated on breastfeeding imme- 33. Stunted - Total 0
0
diately after birth lasting to 90 mins - Total 34. Wasted - Total 0 0 0
25. Preterm/LBW infants given iron 34.a. MAM - Total 0
0
supplementation - Total 34.a.1. MAM-admitted in SFP-Total 0
34.a.2. MAM-cured in SFP-Total
26. Infants exclusively breastfed until 5th month and 29 days (or 5th 0 0
months and 1 day before the child turns 6 months) - Total
27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

0
feeding with continued breastfeeding - Total 34.a.4. MAM-died in SFP-Total 0
28. Infants 6 mos. old initiated to complementary 34.b. SAM-Total 0
0
feeding but no longer or never been breastfed - Total 34.b.1. SAM-admitted to OTC-Total 0
29. Infants 6-11 mos. given 1 dose of Vitamin A 34.b.2. SAM-cured in OTC-Total 0
0
100,000 I.U. - Total 34.b.3. SAM-defaulted in OTC-Total 0
30. Children 12-59 mos. old given 2 doses of 34.b.4. SAM-died in OTC-Total 0
0
Vitamin A 200,000 I.U. - Total 35. Overweight and Obese-Total 0
31. Infant 6-11 months old who completed MNP 36. Normal-Total 0
0
32. Children 12-23 mos. who completed MNP
0
C3. Deworming Services for Infants, Children and Adolescents
37. 1-19 y/o given 2 doses of deworming drug - b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
0 0 0
Total c. Adolescents, 10-19 y/o dewormed (2
0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 doses) - Total
C4. Management of Sick Infants and Children
38. Sick Infants 6-11 mos. old seen - Total 0 42. Diarrhea cases 0-59 months old seen - Total 0
39. Sick Infants 6-11 mos. old received Vitamin 43. Diarrhea cases 0-59 months old received
0 0
A - Total ORS - Total
40. Sick Children 12-59 mos. old seen - Total 0 44 Diarrhea cases 0-59 mos. received ORS w/
0
41. Sick Children 12-59 mos. old received zinc - Total
0
Vitamin A - Total 45. Pneumonia cases 0-59 mos. old seen - Total 0
46. Pneumonia cases 0-59 mos. old completed
0
treatment - Total
Section D. Oral Care and Services
To be submitted Quarterly
1. Orally fit children 12-59 months old upon oral 6a. Adolescents 10-14 years old who received
0 0
exam plus orally fit after rehab - Total BOHC - Total
2.a. Clients 5 years old and above examined - Total 0 6b. Adolescents 15-19 years old who received 0
BOHC - Total
3
2.b. Clients 5 years old and above with cases 7. Adults 20-59 years old who received BOHC -
0 0
of DMFT - Total Total
3. Infants 0-11 months old who received BOHC - 8. Senior citizens 60 years old and above who
0 0
Total received BOHC - Total
4. Children 1-4 years old who received BOHC -
0
Total 10-14 15-19 20-49
Indicators Total Remarks
5. Children 5-9 years old who received BOHC - y/o y/o y/o
0
Total
9. Pregnant women who received BOHC - Total
Section E. Infectious Disease Prevention and Control Services
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
2. No. of suspected cases seen - Total 0 7. No. of confirmed cases (acute and chronic) -
0
3. No. of acute clinically diagnosed cases - Total 0 Total
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
5. No. of chronic clinically diagnosed cases - 0
9. No. of confirmed chronic cases referred to a 0
Total hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed
0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of Leprosy cases on treatment during 1. No. of animal bites - Total
0 0
reporting period - Total
2. No. of newly detected cases during 2.. No. of deaths due to Rabies - Total
0 0
Section F. Non-Communicable Disease Prevention and Control Services
1. No. of adults risk-assessed using PhilPEN - 5. No. of adult women screened for Cervical
0
Total Cancer using VIA/Pap Smear - Total
2. Current smokers - Total 0 6. No. of adult women found positive / suspect for
3. Alcohol binge drinkers - Total 0 Cervical Cancer using VIA or Pap Smear -
4. Overweight/Obese - Total 0 Total
7. No. of adult women screened for breast mass 11. No. of senior citizens screened for visual 0
- Total acuity - Total
8. No. of adult women with suspicious breast 12. No. of senior citizens diagnosed with eye
0
mass - Total disease/s - Total
9. No. of newly-identified hypertensive adults - 0
13. No. of senior citizens who received one (1) 0
Total dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM- 14. No. of senior citizens who received one (1)
0 0
Total dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 0 2. No of HHs with basic sanitation facility - Total 0
a. No. of HHs with Level I - Total a. No. of HH with pour/flush toilet connected to septic tank - Total
b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total
4
b. No. of HHs with pour/flush toilet connected to community
sewer/sewerage system or any other approved treatment
system - Total
c. No. of HHs with ventilated improved pit latrine (VIP) - Total
3a. No. of industrial establishments - Total
3b. No. of industrial establishments issued with sanitary permit - Total
Section H. Mortality Section I. Natality
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
2. Maternal Deaths - Total 2. Livebirths among 15-19 y/o women-Total. 0 ABR:
3. Under-five Deaths - Total 0 3. Live births with low birth weight- Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0 0 0
Dear FHSIS point-person,

In case of discrepancy/ies in the data, the cell will automatically turn red.
Error Notification:
1. Total number of Livebirths ≠ Livebirths by Weight
2. Total number of Livebirths ≠ Natality (Livebirths-Male or Female)
3. Facility Based Deliveries + Non- Facility Based Deliveries ≠ Total Deliveries
4. Facility Based Deliveries ≤ Delivered by Skilled Health Professionals
5. Total Deliveries ≠ Delivery by Type (Vaginal Deliveries + Cesarean Section)
6. Total Deliveries ≠ Delivery by Outcome (Fullterm + Preterm + Fetal Death)
7. Fetal Death in Delivery by outcome ≠ Fetal Death in Mortality
8. Livebirths with low birth weight in Sec. I (Natality) ≠ Livebirths with low birth weight in Sec. B2.19.b (Maternal Care Services)
9. Livebirths among 15-19y/o women Sec. I (Natality) ≠ Livebirths among 15-19y/o women in Sec. B2.19 (Maternal Care Services)
5
FHSIS REPORT for the MONTH: ________ YEAR: _______
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: BULAN
BRGY
Name of Province: SORSOGON
Projected Population of the Year: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 937 937 0 0 0 0 0 0 0 0 937 937 0
b. NSV - Total 0 0 3 3 0 0 0 0 0 0 0 0 3 3 0
c. Condom - Total 0 3 541 544 0 0 0 0 0 0 0 3 541 544 0
d. Pills - Total 0 39 3327 3366 0 0 0 0 0 0 0 0 0 0 0 0 0 39 3327 3366 0 0 0 0
d.1 Pills-POP - Total 0 18 496 514 0 0 0 0 0 0 0 18 496 514 0
d.2 Pills-COC - Total 0 21 2831 2852 0 0 0 0 0 0 0 21 2831 2852 0
e. Injectables (DMPA/POI)-Tot. 0 62 1711 1773 0 0 0 0 0 0 0 62 1711 1773 0
f. Implant - Total 0 27 553 580 0 0 0 0 0 0 0 27 553 580 0
g.1 IUD-I- Total 0 1 31 32 0 0 0 0 0 0 0 1 31 32 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 106 648 754 0 10 17 27 0 0 0 116 665 781 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 40 40 0 0 0 0 0 0 0 0 40 40 0
l. NFP-SDM - Total 0 0 83 83 0 0 0 0 0 0 0 0 83 83 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 6
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
7
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
8
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
1041 1095 2136 0 0
2. Current smokers - Total 213 32 245 6. No. of adult women found positive / suspect for
3. Alcohol binge drinkers - Total 295 93 388 Cervical Cancer using VIA or Pap Smear - 0 0
4. Overweight/Obese - Total 48 83 131 Total
7. No. of adult women screened for breast mass 87 11. No. of senior citizens screened for visual 13 12 25
0
0 0 2 2 4
13. No. of senior citizens who received one (1) 0 0 0
18 27
1 2 3 0 0 0
system - Total
9
system - Total

Error Notification:
10
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: BULUSAN
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 174 174 0 0 0 0 0 174 174 0
b. NSV - Total 0 0 5 5 0 0 0 0 0 5 5 0
c. Condom - Total 0 0 66 66 1 1 0 0 0 0 67 67 0
d. Pills - Total 0 8 458 466 0 0 0 0 0 0 0 0 0 0 0 0 0 8 458 466 0 0 0 0
d.1 Pills-POP - Total 0 2 3 5 0 0 0 0 2 3 5 0
d.2 Pills-COC - Total 0 6 455 461 0 0 0 0 6 455 461 0
f. Implant - Total 0 10 223 233 0 0 0 0 10 223 233 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 5 5 0 0 0 0 0 5 5 0
h. NFP-LAM - Total 0 5 79 84 7 7 0 0 0 5 86 91 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 268 268 0 0 0 0 0 268 268 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 11
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
12
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
13
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
14
system - Total

Error Notification:
15
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: CASIGURAN
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
1. No. of Women Who Gave Birth” with at least 4 6. No. of pregnant women who completed
prenatal check-ups - Total 0 doses of calcium carbonate 0
0
0 0
BMI - Total 16
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
17
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
18
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
19
system - Total

Error Notification:
20
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: CASTILLA
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 430 430 0 0 0 0 0 430 430 0
b. NSV - Total 0 0 1 1 0 0 0 0 0 1 1 0
c. Condom - Total 0 5 273 278 0 0 0 0 5 273 278 0
d. Pills - Total 0 69 3621 3690 0 0 0 0 0 0 0 0 0 0 0 0 0 69 3621 3690 0 0 0 0
d.1 Pills-POP - Total 0 3 20 23 0 0 0 0 3 20 23 0
d.2 Pills-COC - Total 0 66 3601 3667 0 0 0 0 66 3601 3667 0
f. Implant - Total 0 2 162 164 0 0 0 0 2 162 164 0
g.1 IUD-I- Total 0 1 35 36 0 0 0 0 1 35 36 0
g.2 IUD-PP - Total 0 1 5 6 0 0 0 0 1 5 6 0
h. NFP-LAM - Total 0 29 329 358 0 0 0 0 29 329 358 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 34 813 847 0 0 0 0 34 813 847 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 341 341 0 0 0 0 0 341 341 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 21
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
22
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
23
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
24
system - Total

Error Notification:
25
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: DONSOL
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 408 408 0 0 0 0 0 408 408 0
b. NSV - Total 0 0 18 18 0 0 0 0 0 18 18 0
c. Condom - Total 0 1 144 145 0 0 0 0 1 144 145 0
d. Pills - Total 0 27 2,005 2,032 0 0 0 0 0 0 0 0 0 0 0 0 0 27 2,005 2,032 0 0 0 0
d.1 Pills-POP - Total 0 13 103 116 0 0 0 0 13 103 116 0
d.2 Pills-COC - Total 0 14 1,902 1,916 0 0 0 0 14 1,902 1,916 0
f. Implant - Total 1 2 266 269 0 0 0 1 2 266 269 0
g.1 IUD-I- Total 0 0 28 28 0 0 0 0 0 28 28 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 6 386 392 0 0 0 0 6 386 392 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 25 2,199 2,224 0 0 0 0 25 2,199 2,224 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 7 7 0 0 0 0 0 7 7 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
women seen in the first 0
trimester who have normal
BMI - Total 26
0 0
0
for syphilis - Total
b. No. of pregnant women
0
11. No. of pregnant women screened for
seen in the first trimester
Hepatitis B - Total 0
who have low BMI - Total
12. No. of pregnant women tested positive

c. No. of pregnant women for Hepatitis B - Total 0
seen in the first trimester 0
HIV - Total 0
doses of Td vaccination-Total CBC or Hgb & Hct count - Total 0

4. No. of pregnant women for CBC or Hgb & Hct count diagnosed 0
the 2nd or more times given with anemia - Total
0
gestational diabetes – Total 0
completed the dose of iron 0 17. No. of pregnant women tested positive
with folic acid 0
for gestational diabetes – Total

10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
27
Total
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
28
0
treatment - Total
0 0
BOHC - Total
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
29
0 0
system - Total

Error Notification:
30
FHSIS REPORT for the MONTH: ____APRIL____ YEAR: ___2022____
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: GUBAT
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 390 390 0 0 0 0 0 390 390 0
b. NSV - Total 0 0 2 2 0 0 0 0 0 2 2 0
c. Condom - Total 0 4 123 127 0 0 1 1 0 3 123 126 0
d. Pills - Total 0 13 1354 1367 0 0 0 0 0 0 0 0 0 0 0 0 0 13 1354 1367 0 0 0 0
d.1 Pills-POP - Total 0 3 25 28 0 0 0 0 3 25 28 0
d.2 Pills-COC - Total 0 10 1329 1339 0 0 0 0 10 1329 1339 0
e. Injectables (DMPA/POI)-Tot. 0 21 864 885 0 1 1 0 0 22 864 886 0
f. Implant - Total 0 0 56 56 0 0 0 0 0 56 56 0
g.1 IUD-I- Total 0 0 24 24 0 0 0 0 0 24 24 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 35 399 434 2 2 2 2 1 1 0 35 402 437 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 1 212 213 0 0 0 0 1 212 213 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
1. No. of Women Who Gave Birth” with at least 4 1 1 0
0
1 1 0
BMI - Total 31
1 1 0
0
0
0
0
0
the 2nd or more times given 1 1 with anemia - Total
0
2 2 0
18. No. of deliveries – Total 2 2 20. No. of deliveries attended by skilled 2 2
19. No. of live births – Total 2 2 health professionals - Total
a. No. of live births with 2 2 a. No. of deliveries attended by a 2 2
10-14 15-19 20-49 10-14 15-19 20-49
21. No. of health facility-based 23a. No. of vaginal deliveries – Total 2 2
2 2
0 0
2 2
public health facility-Total 24a. No. of full-term births – Total 2 2
0
deliveries - Total
who completed at least 2 2 2 2 2
Total
Total
1. CPAB - Total 6 9 15 13. PCV 1 - Total 17 18 35
32
2. BCG - Total 8 12 20 14. PCV 2 - Total 16 19 35
3. HepB, within 24 hours. - Total 7 12 19 15. PCV 3 - Total 21 16 37
4. DPT-HiB-HepB 1 - Total 17 20 37 16. MCV 1 - Total 9 9 18
6. DPT-HiB-HepB 3 - Total 24 20 44 18. FIC - Total 11 10 21
7. OPV 1 - Total 22 23 45 19. CIC - Total 1 1 2
8. OPV 2 - Total 16 24 40 20. Td, Grade 1 (November) - Total 0 0 0
9. OPV 3 - Total 19 15 34 21. MR, Grade 1 (November) - Total 0 0 0
10. IPV 1- Total 30 17 47 22. Td, Grade 7 (November) - Total 0 0 0
11. IPV 2 (routine)- Total 10 7 17 23. MR, Grade 7 (November) - Total 0 0 0
12. IPV 2 (catch-up)- Total 36 29 65
6 9 15
0 0 0
26. Infants exclusively breastfed until 5th month and 29 days (or 5th 12 10 22 0

13 11 24
0 0 0
28 15 43
57 71 128
0 0 0
32. Children 12-23 mos. who completed MNP 0 0
0
0 0 0
0
38. Sick Infants 6-11 mos. old seen - Total 2 4 6 42. Diarrhea cases 0-59 months old seen - Total 2 0 2
0 0 0 2 0 2
40. Sick Children 12-59 mos. old seen - Total 12 12 24 44 Diarrhea cases 0-59 mos. received ORS w/
0 0 0
0 0 0
Vitamin A - Total 45. Pneumonia cases 0-59 mos. old seen - Total 0 0 0
0 0 0
treatment - Total
0 0
BOHC - Total
33
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
12 28 40
7. No. of adult women screened for breast mass 0 11. No. of senior citizens screened for visual 0
0 0
0 0
a. No. of HHs with Level I - Total 3117 a. No. of HH with pour/flush toilet connected to septic tank - Total 14567
b. No. of HHs with Level II - Total 1043 b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total 10857 sewer/sewerage system or any other approved treatment
system - Total 468
34
system - Total 468
c. No. of HHs with ventilated improved pit latrine (VIP) - Total 0
3a. No. of industrial establishments - Total 0
3b. No. of industrial establishments issued with sanitary permit - Total 0
1. Total Deaths 6 7 13 1. Livebirths - Total 1 1 2 CBR:

Error Notification:
35
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: IROSIN
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 393 393 0 0 0 0 0 393 393 0
b. NSV - Total 0 0 3 3 0 0 0 0 0 3 3 0
c. Condom - Total 0 3 184 187 4 1 5 0 0 0 7 185 192 0
d. Pills - Total 0 31 1478 1509 0 0 0 0 0 0 0 0 0 0 0 0 0 31 1478 1509 0 0 0 0
d.1 Pills-POP - Total 0 2 29 31 0 0 0 0 2 29 31 0
d.2 Pills-COC - Total 0 29 1449 1478 0 0 0 0 29 1449 1478 0
f. Implant - Total 0 1 25 26 0 0 0 0 1 25 26 0
g.1 IUD-I- Total 0 0 5 5 0 0 0 0 0 5 5 0
g.2 IUD-PP - Total 0 0 3 3 0 0 0 0 0 3 3 0
h. NFP-LAM - Total 0 62 397 459 7 17 24 0 0 0 69 414 483 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 154 154 0 0 0 0 0 154 154 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 23 921 944 0 0 0 0 23 921 944 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
1. No. of Women Who Gave Birth” with at least 4 8 74 82 5 51 56
0 doses of calcium carbonate
20 20
1 5 71 77 7 7
BMI - Total 36
1 5 71 77 7 7
0
seen in the first trimester 3 3 11. No. of pregnant women screened for
7 7
1 1
seen in the first trimester 14 14 for Hepatitis B - Total
5 5
the first time given at least 2 1 10 11 14. No. of pregnant women tested for
6 63 69
the 2nd or more times given 42 42 with anemia - Total
7 7
8 70 78 0
18. No. of deliveries – Total 7 75 82 20. No. of deliveries attended by skilled 82
19. No. of live births – Total 7 73 80 health professionals - Total
a. No. of live births with 6 68 74 a. No. of deliveries attended by a 7 40 47
b. No. of live births with low 1 5 6 b. No. of deliveries attended by a 0 0
c. No. of live births with 0 0 c. No. of deliveries attended by 35 35
10-14 15-19 20-49 10-14 15-19 20-49
21. No. of health facility-based 23a. No. of vaginal deliveries – Total 7 65 72
82
10 10
7 51 58
public health facility-Total 24a. No. of full-term births – Total 7 73 80
b. No. of deliveries in 24b. No. of pre-term births – Total 0 0
24 24
private health facility-Tot. 24c. No. of fetal deaths - Total 0 0
22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0
0 0
deliveries - Total
who completed at least 2 7 73 80 7 75 82
Total
who completed iron with 5 67 72
Total
37
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
38
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
164 177 341
3. Alcohol binge drinkers - Total 72 15 87 Cervical Cancer using VIA or Pap Smear -
7. No. of adult women screened for breast mass 11. No. of senior citizens screened for visual 3 6 9
1 5 6
11 11
2 2 4 0
1. No. of HHs with access to basic safe water supply - Total 14,837 2. No of HHs with basic sanitation facility - Total 13,356
a. No. of HHs with Level I - Total 659 a. No. of HH with pour/flush toilet connected to septic tank - Total 13,356
b. No. of HHs with Level II - Total 7,345 b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total 6,833 sewer/sewerage system or any other approved treatment 0
system - Total
39
sewer/sewerage system or any other approved treatment 0
system - Total
2. Maternal Deaths - Total 2. Livebirths among 15-19 y/o women-Total. 4 3 7 ABR:
3. Under-five Deaths - Total 0 3. Live births with low birth weight- Total 3 3 6

Error Notification:
40
FHSIS REPORT for the MONTH: YEAR: 2022
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: JUBAN
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total
b. NSV - Total
c. Condom - Total
d. Pills - Total
d.1 Pills-POP - Total
d.2 Pills-COC - Total
e. Injectables (DMPA/POI)- Tot.
f. Implant - Total
g. IUD (IUD-I and IUD-PP)-Tot.
g.1 IUD-I- Total
g.2 IUD-PP - Total
h. NFP-LAM - Total
i. NFP-BBT - Total
j. NFP-CMM - Total
k. NFP-STM - Total
l. NFP-SDM - Total
41
m. Total Current Users

10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care

1. No. of Women Who Gave Birth” with at least 4
7. No. of pregnant women given

2. No. of pregnant women iodine capsules – Total
assessed of their nutritional
of deworming tablet - Total
a. Number of pregnant 9. No. of pregnant women screened for

women seen in the first syphilis - Total
trimester who have normal
BMI - Total
for syphilis - Total
b. No. of pregnant women

seen in the first trimester 11. No. of pregnant women screened for

c. No. of pregnant women
for Hepatitis B - Total
seen in the first trimester
who have high BMI-Total
13. No. of pregnant women screened for
HIV - Total
the first time given at least 2 14. No. of pregnant women tested for
4. No. of pregnant women for CBC or Hgb & Hct count diagnosed
the 2nd or more times given
with anemia - Total
5. No. of pregnant women who 17. No. of pregnant women tested positive
completed the dose of iron for gestational diabetes – Total
with folic acid
18. No. of deliveries – Total 20. No. of deliveries attended by skilled

health professionals - Total
19. No. of live births – Total
42
unknown birth weight- Total midwives - Total
10-14 15-19 20-49 10-14 15-19 20-49
23a. No. of vaginal deliveries – Total
21. No. of health facility-based
deliveries - Total
23b. No. of deliveries by cesarean
section – Total
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total
24b. No. of pre-term births – Total

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total
22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total

deliveries - Total

who completed at least 2
Total
who completed iron with
Total

1. CPAB - Total
13. PCV 1 - Total
2. BCG - Total
14. PCV 2 - Total
3. HepB, within 24 hours. - Total
15. PCV 3 - Total
4. DPT-HiB-HepB 1 - Total
16. MCV 1 - Total
17. MCV 2 - Total
18. FIC - Total
7. OPV 1 - Total
19. CIC - Total
8. OPV 2 - Total
20. Td, Grade 1 (November) - Total
9. OPV 3 - Total
21. MR, Grade 1 (November) - Total
10. IPV 1- Total 22. Td, Grade 7 (November) - Total
11. IPV 2 (routine)- Total 23. MR, Grade 7 (November) - Total
43
12. IPV 2 (catch-up)- Total
33. Stunted - Total

24. Newborns initiated on breastfeeding imme-
diately after birth lasting to 90 mins - Total 34. Wasted - Total
34.a. MAM - Total

25. Preterm/LBW infants given iron 34.a.1. MAM-admitted in SFP-Total
26. Infants exclusively breastfed until 5th month and 29 days (or 5th
34.a.3. MAM-defaulted in SFP-Total
27. Infants 6 mos. old initiated to complementary 34.a.4. MAM-died in SFP-Total

feeding with continued breastfeeding - Total
28. Infants 6 mos. old initiated to complementary 34.b. SAM-Total
feeding but no longer or never been breastfed - Total
34.b.1. SAM-admitted to OTC-Total
29. Infants 6-11 mos. given 1 dose of Vitamin A 34.b.2. SAM-cured in OTC-Total
100,000 I.U. - Total
34.b.3. SAM-defaulted in OTC-Total
30. Children 12-59 mos. old given 2 doses of 34.b.4. SAM-died in OTC-Total
Vitamin A 200,000 I.U. - Total
35. Overweight and Obese-Total
31. Infant 6-11 months old who completed MNP 36. Normal-Total


37. 1-19 y/o given 2 doses of deworming drug - b. SAC, 5-9 y/o dewormed (2 doses) - Total
Total
c. Adolescents, 10-19 y/o dewormed (2
a. PSAC, 1-4 y/o dewormed (2 doses) - Total doses) - Total
38. Sick Infants 6-11 mos. old seen - Total

42. Diarrhea cases 0-59 months old seen - Total
40. Sick Children 12-59 mos. old seen - Total 44 Diarrhea cases 0-59 mos. received ORS w/
zinc - Total
41. Sick Children 12-59 mos. old received
Vitamin A - Total 45. Pneumonia cases 0-59 mos. old seen - Total

treatment - Total
44
2.a. Clients 5 years old and above examined - Total 6b. Adolescents 15-19 years old who received
BOHC - Total
Total 10-14 15-19 20-49
Total


1. No. of patients seen - Total 6. No. of confirmed chronic cases - Total
2. No. of suspected cases seen - Total 7. No. of confirmed cases (acute and chronic) -
Total
3. No. of acute clinically diagnosed cases - Total
4. No. of confirmed acute cases - Total 8. No. of cases treated - Total
5. No. of chronic clinically diagnosed cases - 9. No. of confirmed chronic cases referred to a

0
Cervical Cancer using VIA or Pap Smear -
Total
45
6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear -
3. Alcohol binge drinkers - Total Total
0
4. Overweight/Obese - Total 0
46
7. No. of adult women screened for breast mass 11. No. of senior citizens screened for visual
9. No. of newly-identified hypertensive adults - 13. No. of senior citizens who received one (1)

1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
a. No. of HH with pour/flush toilet connected to septic tank - Total

a. No. of HHs with Level I - Total
b. No. of HHs with Level II - Total
c. No. of HHs with Level III - Total system - Total

1. Livebirths - Total CBR:
1. Total Deaths
ABR:
2. Livebirths among 15-19 y/o women-Total.
2. Maternal Deaths - Total
3. Live births with low birth weight- Total
3. Under-five Deaths - Total
4. Infant Deaths - Total
5. Neonatal Deaths - Total
6. Fetal Deaths - Total
7. Early Neonatal Deaths - Total
8. Perinatal Deaths - Total

Error Notification:
47
48
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: MAGALLANES
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 49
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
50
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
51
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
52
system - Total

Error Notification:
53
FHSIS REPORT for the MONTH: MAY YEAR: 2022
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: MATNOG
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0 149 568 717
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 2 365 367 0 0 0 0 0 0 1 1 0 0 0 0 0 2 366 368 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 11 116 127 0 0 0 0 0 0 0 0 0 0 2 2 0 11 114 125 0 0 0 0
d. Pills - Total 0 13 1163 1176 0 0 0 0 0 0 19 19 0 1 10 11 0 12 1172 1184 0 0 0 0
d.1 Pills-POP - Total 0 4 115 119 0 0 0 0 0 0 6 6 0 1 0 1 0 3 121 124 0 0 0 0
d.2 Pills-COC - Total 0 9 1048 1057 0 0 0 0 0 0 13 13 0 0 10 10 0 9 1051 1060 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 29 665 694 0 0 0 0 0 0 15 15 0 1 11 12 0 28 669 697 0 0 1 1
f. Implant - Total 0 4 106 110 0 0 0 0 0 2 3 5 0 0 0 0 0 6 109 115 0 0 0 0
g.1 IUD-I- Total 0 0 13 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 13 0 0 0 0
g.2 IUD-PP - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
h. NFP-LAM - Total 0 18 251 269 0 5 5 10 0 1 24 25 0 4 47 51 0 20 233 253 0 1 3 4
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 1 949 950 0 0 0 0 0 0 0 0 0 0 0 0 0 1 949 950 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
1. No. of Women Who Gave Birth” with at least 4 5 22 27 0 3 15 18
2. No. of pregnant women 7. No. of pregnant women given 0 0 0 0
0 3 21 24
0 4 41 45 0 3 27 30
BMI - Total 54
0 4 41 45 0 3 27 30
0 0 0 0
seen in the first trimester 0 1 2 3 11. No. of pregnant women screened for
0 1 24 25
0 0 0 0
seen in the first trimester 0 1 7 8 for Hepatitis B - Total
0 0 15 15
the first time given at least 2 0 0 0 0 14. No. of pregnant women tested for
0 2 45 47
CBC or Hgb & Hct count diagnosed 0 0 1 1
0 0 9 9 with anemia - Total
0 0 5 5
0 6 29 35 0 0 0 0
18. No. of deliveries – Total 0 5 22 27 20. No. of deliveries attended by skilled 27
19. No. of live births – Total 0 5 22 27 health professionals - Total
a. No. of live births with 26 a. No. of deliveries attended by a 2
b. No. of live births with low 1 b. No. of deliveries attended by a 0
c. No. of live births with 0 c. No. of deliveries attended by 25
10-14 15-19 20-49 10-14 15-19 20-49
21. No. of health facility-based 23a. No. of vaginal deliveries – Total 0 5 22 27
27
0
27
public health facility-Total 24a. No. of full-term births – Total 0 5 22 27
b. No. of deliveries in 24b. No. of pre-term births – Total 0 0 0 0
0
private health facility-Tot. 24c. No. of fetal deaths - Total 0 0 0 0
22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0
0
deliveries - Total
who completed at least 2 0 5 22 27 10 5 22 37
Total
who completed iron with 0 4 22 26
Total
55
14 13 27
0 0 0

25 24 49
2 0 2
6 8 14
137 108 245
9 5 14
0
37. 1-19 y/o given 2 doses of deworming drug - b. SAC, 5-9 y/o dewormed (2 doses) - Total 3 8 11
89 126 215
26 38 64
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 60 80 140 doses) - Total
0 0 0 5 3 8
0 0 0
0 0 0
2 3 5
treatment - Total
0 0 0 0 0 0
exam plus orally fit after rehab - Total NO DENTIST BOHC - Total
2.a. Clients 5 years old and above examined - Total 0 0 0 6b. Adolescents 15-19 years old who received 0 0 0
BOHC - Total
56
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0
Total 10-14 15-19 20-49
0 0 0
Total
9. Pregnant women who received BOHC - Total 0 0 0
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
2. No. of suspected cases seen - Total 0 0 0 7. No. of confirmed cases (acute and chronic) -
0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0 Total
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
5. No. of chronic clinically diagnosed cases - 0 0 0
9. No. of confirmed chronic cases referred to a 0 0 0
0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
408 371 779
3. Alcohol binge drinkers - Total 251 153 404 Cervical Cancer using VIA or Pap Smear -
0 0 1 1
7 6
0 0 0 0 0 0
system - Total
57
system - Total
3. Under-five Deaths - Total 0 0 0 3. Live births with low birth weight- Total 0 1 1
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0

Error Notification:
58
FHSIS REPORT for the MONTH: YEAR:
M1
Name of Barangay: Marifosque
Name of BHS:
Name of Municipality/City: PILAR
BRGY
Name of Province: Sorsogon
Projected Population of the Year:
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 494 494 0 0 0 0 0 494 494 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 3 400 403 0 0 0 0 3 400 403 0
d. Pills - Total 0 13 3247 3260 0 0 2 2 0 0 0 0 0 0 0 0 0 13 3249 3262 0 0 0 0
d.1 Pills-POP - Total 0 2 20 22 1 1 0 0 0 2 21 23 0
d.2 Pills-COC - Total 0 11 3227 3238 1 1 0 0 0 11 3228 3239 0
e. Injectables (DMPA/POI)-Tot. 0 17 1007 1024 1 1 0 0 0 17 1008 1025 0
f. Implant - Total 0 2 112 114 0 0 0 0 2 112 114 0
g.1 IUD-I- Total 0 1 23 24 0 0 0 0 1 23 24 0
g.2 IUD-PP - Total 0 0 3 3 0 0 0 0 0 3 3 0
h. NFP-LAM - Total 0 34 417 451 4 5 9 0 0 0 38 422 460 0
i. NFP-BBT - Total 0 0 2 2 0 0 0 0 0 2 2 0
j. NFP-CMM - Total 0 0 357 357 0 0 0 0 0 357 357 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 26 26 0 0 0 0 0 26 26 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 59
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
60
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
61
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
62
system - Total

Error Notification:
63
FHSIS REPORT for the MONTH: __MAY YEAR: _2022
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: PTO. DIAZ
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 167 167 0 0 0 0 0 0 3 3 0 0 0 0 0 0 170 170 0 0 0 0
b. NSV - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
c. Condom - Total 0 0 59 59 0 0 0 0 0 0 4 4 0 0 1 1 0 0 62 62 0 0 0 0
d. Pills - Total 0 6 544 550 0 0 0 0 0 1 7 8 0 1 5 6 0 6 546 552 0 0 0 0
d.1 Pills-POP - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 1 1 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 6 538 544 0 0 0 0 0 1 7 8 0 1 4 5 0 6 541 547 0 0 0 0
f. Implant - Total 0 5 158 163 0 0 0 0 0 0 2 2 0 0 3 3 0 5 157 162 0 0 0 0
g.1 IUD-I- Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 8 133 141 0 2 3 5 0 0 16 16 0 1 27 28 0 9 125 134 0 2 1 3
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 28 28 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 28 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0 1 9 10
0 3 33 36 0 2 25 27
BMI - Total 64
0 3 33 36 0 2 25 27
0 0 0 0
0 2 25 27
0 0 1 1
0 0 0 0
0 2 14 16
0 1 7 8
0 0 20 20 0 0 0 0
18. No. of deliveries – Total 0 0 11 11 20. No. of deliveries attended by skilled 0 0 11 11
a. No. of live births with 0 11 11 a. No. of deliveries attended by a 0 0 11 11
0
b. No. of live births with low 11- OCCURRENCE 13 ORIGIN b. No. of deliveries attended by a
0 0 0 0 0 0 0 0
c. No. of live births with 0 0 0 c. No. of deliveries attended by 0 0 0 0
0
10-14 15-19 20-49 10-14 15-19 20-49
0 0 11 11
0 0 0 0
a. No. of deliveries in section – Total 3 CS 9 NSD (ALL ORIGIN)11OCCURENCE
0 0 11 11
0 0 0 0
22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 1 3 4 10 FT 1 PT(11 FT OCCURRENCE)
0 0 0 0
deliveries - Total
lahat po ba to naka complete ng 2ppv sa
who completed at least 2 0 2 24 26 Pto Diaz only? 0 3 20 23
Total
Total
65
24. Newborns initiated on breastfeeding imme- 33. Stunted - Total 26 17 43
14 9 23
25. Preterm/LBW infants given iron 34.a. MAM - Total 0 0 0
0 0 0
supplementation - Total 34.a.1. MAM-admitted in SFP-Total 0 0 0
26. Infants exclusively breastfed until 5th month and 29 days (or 5th 12 10 22 0 0 0
27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0 0 0

15 13 28
feeding with continued breastfeeding - Total 34.a.4. MAM-died in SFP-Total 0 0 0
28. Infants 6 mos. old initiated to complementary 34.b. SAM-Total 0 0 0
4 5 9
feeding but no longer or never been breastfed - Total 34.b.1. SAM-admitted to OTC-Total 0 0 0
29. Infants 6-11 mos. given 1 dose of Vitamin A 34.b.2. SAM-cured in OTC-Total 0 0 0
14 23 37
100,000 I.U. - Total 34.b.3. SAM-defaulted in OTC-Total 0 0 0
30. Children 12-59 mos. old given 2 doses of 34.b.4. SAM-died in OTC-Total 0 0 0
51 64 115
Vitamin A 200,000 I.U. - Total 35. Overweight and Obese-Total 11 4 15
31. Infant 6-11 months old who completed MNP 36. Normal-Total 130 132 262
7 8 15
30
0 0 0
0 0 0
0 0 0 3 0 3
0 0 0
2 0 2
0 0 0
treatment - Total
4 2 6 2 2 4
2.a. Clients 5 years old and above examined - Total 0 0 0 6b. Adolescents 15-19 years old who received 3 1 4
BOHC - Total
66
0 0 0 8 27 35
1 1 2 3 3 6
8 3 11
Total 10-14 15-19 20-49
2 6 8
Total
9. Pregnant women who received BOHC - Total 0 6 35 41
2. No. of suspected cases seen - Total 0 0 0 7. No. of confirmed cases (acute and chronic) - 0 0
0
3. No. of acute clinically diagnosed cases - Total 0 0 0 Total 0 0
5. No. of chronic clinically diagnosed cases - 0 0 9. No. of confirmed chronic cases referred to a 0 0
0 0
Total 0 0 hospital facility - Total 0 0
0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
25 80 105 0
3. Alcohol binge drinkers - Total 7 42 49 Cervical Cancer using VIA or Pap Smear - 0
0 0 0 0
1 2
0 0 0 0 0 0
a. No. of HHs with Level I - Total 2488 a. No. of HH with pour/flush toilet connected to septic tank - Total 5218
b. No. of HHs with Level II - Total 2501 b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total 1052 sewer/sewerage system or any other approved treatment 31
system - Total
67
system - Total
1. Total Deaths 0 1. Livebirths - Total 10 1 11 CBR:

Error Notification:
68
FHSIS REPORT for the MONTH: MAY YEAR: 2022
M1
Name of Barangay: ALL BARANGAYS
Name of BHS: _______________________________
Name of Municipality/City: STA. MAGDALENA
BRGY
Name of Province: SORSOGON
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 147 147 0 0 0 1 1 0 0 0 0 0 0 148 148 0
b. NSV - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0
c. Condom - Total 0 0 29 29 0 0 0 3 3 0 0 0 0 0 0 32 32 0
d. Pills - Total 0 5 364 369 0 0 0 0 0 1 11 12 0 0 0 0 0 6 375 381 0 0 0 0
d.1 Pills-POP - Total 0 3 3 6 0 0 0 4 4 0 0 0 0 0 3 7 10 0
d.2 Pills-COC - Total 0 2 361 363 0 0 1 7 8 0 0 0 0 0 3 368 371 0
e. Injectables (DMPA/POI)-Tot. 0 2 193 195 0 0 0 3 3 0 0 5 5 0 2 191 193 0
f. Implant - Total 0 4 208 212 0 0 0 8 8 0 0 5 5 0 4 211 215 0
g.1 IUD-I- Total 0 0 33 33 0 0 0 0 0 0 0 0 0 0 0 33 33 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 1 80 81 0 0 1 1 0 0 12 12 0 0 20 20 0 1 73 74 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0 0 0 0
0 1 9 10 0 0 1 1
BMI - Total 69
0 1 9 10 0 0 1 1
0 0 0 0
0 0 2 2
0 0 1 1
0 0 0 0
0 6 0 6
0 1 0 1
0 1 9 10 0 0 0 0
18. No. of deliveries – Total 0 1 9 10 20. No. of deliveries attended by skilled 0 1 9 10
a. No. of live births with 1 9 10 a. No. of deliveries attended by a 0 0 0 0
0
b. No. of live births with low 0 0 0 b. No. of deliveries attended by a 0 0 0 0
0
c. No. of live births with 0 0 0 c. No. of deliveries attended by 0 1 9 10
0
10-14 15-19 20-49 10-14 15-19 20-49
0 1 9 10
0 0 0 0
0 1 9 10
0 0 0 0
0 0 0 0
deliveries - Total
Total
Total
70
3 7 10
0 0 0

1 3 4
0 0 0
0 0 0
0 0 0
0 0 0
0
0 0 0
0 0 0
0 0 0 0 0 0
0 0 0
0 0 0
0 0 0
treatment - Total
0 0
BOHC - Total
71
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
72
system - Total
2. Maternal Deaths - Total 0 2. Livebirths among 15-19 y/o women-Total. 1 0 1 ABR:

Error Notification:
73
FHSIS REPORT for the MONTH: YEAR:
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: SORSOGON CITY
BRGY
Name of Province: _______________________________
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
0
0 0
BMI - Total 74
0 0
0
0
0
0
0
0
0 0
10-14 15-19 20-49 10-14 15-19 20-49
0
0
deliveries - Total
Total
Total
75
0
0

0
0
0
0
0
0
0 0 0
0
0 0
0
0
0
treatment - Total
0 0
BOHC - Total
76
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
0
0
0 0
0 0
0
0
0 0
system - Total
77
system - Total

Error Notification:
78
M1
Name of Barangay: _______________________________
Name of BHS: _______________________________
Name of Municipality/City: _______________________________
Name of Province:
Projected Population of the Year:
SORSOGON
_______________________________
BRGY
Total for WRA
15-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)
10-14 y/o 15-19 y/o 20-49 y/o
0 149 568 717
10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49 10-14 15-19 20-49
a. BTL - Total 0 2 4042 4044 0 0 0 0 0 0 5 5 0 0 0 0 0 2 4047 4049 0 0 0 0
b. NSV - Total 0 0 34 34 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34 34 0 0 0 0
c. Condom - Total 0 31 2011 2042 0 4 2 6 0 0 7 7 0 1 3 4 0 34 2017 2051 0 0 0 0
d. Pills - Total 0 232 18,282 18,514 0 0 2 2 0 2 37 39 0 2 15 17 0 232 18,306 18,538 0 0 0 0
d.1 Pills-POP - Total 0 51 835 886 0 0 1 1 0 0 10 10 0 1 1 2 0 50 845 895 0 0 0 0
d.2 Pills-COC - Total 0 181 17,447 17,628 0 0 1 1 0 2 27 29 0 1 14 15 0 182 17,461 17,643 0 0 0 0
f. Implant - Total 1 57 1892 1950 0 0 0 0 0 2 13 15 0 0 8 8 1 59 1897 1957 0 0 0 0
g.1 IUD-I- Total 0 3 212 215 0 0 0 0 0 0 0 0 0 0 0 0 0 3 212 215 0 0 0 0
g.2 IUD-PP - Total 0 1 17 18 0 0 0 0 0 0 0 0 0 0 0 0 0 1 17 18 0 0 0 0
h. NFP-LAM - Total 0 308 3220 3528 0 29 58 87 0 1 54 55 0 5 95 100 0 333 3237 3570 0 3 4 7
i. NFP-BBT - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
j. NFP-CMM - Total 0 59 3,537 3,596 0 0 0 0 0 0 0 0 0 0 0 0 0 59 3,537 3,596 0 0 0 0
k. NFP-STM - Total 0 0 40 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 40 0 0 0 0
l. NFP-SDM - Total 0 25 2979 3004 0 0 0 0 0 0 0 0 0 0 0 0 0 25 2979 3004 0 0 0 0
10-14 15-19 20-49 10-14 15-19 20-49
B1. Prenatal Care
1. No. of Women Who Gave Birth with at least 4 131 0 9 81 90
0 14 117 doses of calcium carbonate
0 4 50 54
1 13 155 169 0 5 60 65
BMI - Total 79
1 13 155 169 0 5 60 65
0 0 0 0
0 3 58 61
0 0 3 3
0 0 20 20
0 16 122 138
0 1 74
0 2 19 21
0 15 130 145 0 0 0 0
18. No. of deliveries – Total 0 13 119 132 20. No. of deliveries attended by skilled 132
a. No. of live births with 123 a. No. of deliveries attended by a 62
b. No. of live births with low 7 b. No. of deliveries attended by a 0
c. No. of live births with 0 c. No. of deliveries attended by 70
10-14 15-19 20-49 10-14 15-19 20-49
132
0 0 10 10
108
24
0
deliveries - Total
Total
Total
80
24. Newborns initiated on breastfeeding imme- 33. Stunted - Total 26 17 43
37 38 75
25. Preterm/LBW infants given iron 34.a. MAM - Total 0 0 0
0 0 0
supplementation - Total 34.a.1. MAM-admitted in SFP-Total 0 0 0
26. Infants exclusively breastfed until 5th month and 29 days (or 5th 56 44 100 0 0 0
27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0 0 0

54 51 105
feeding with continued breastfeeding - Total 34.a.4. MAM-died in SFP-Total 0 0 0
28. Infants 6 mos. old initiated to complementary 34.b. SAM-Total 0 0 0
6 5 11
feeding but no longer or never been breastfed - Total 34.b.1. SAM-admitted to OTC-Total 0 0 0
29. Infants 6-11 mos. given 1 dose of Vitamin A 34.b.2. SAM-cured in OTC-Total 0 0 0
48 46 94
100,000 I.U. - Total 34.b.3. SAM-defaulted in OTC-Total 0 0 0
30. Children 12-59 mos. old given 2 doses of 34.b.4. SAM-died in OTC-Total 0 0 0
245 243 488
Vitamin A 200,000 I.U. - Total 35. Overweight and Obese-Total 11 4 15
31. Infant 6-11 months old who completed MNP 36. Normal-Total 130 132 262
16 13 29
15 15 30
89 126 215
26 38 64
0 0 0 10 3 13
0 0 0
2 0 2
2 3 5
treatment - Total
0 0
BOHC - Total
81
0 0
0 0
0
Total 10-14 15-19 20-49
0
Total
2. No. of suspected cases seen - Total 0 0 0 7. No. of confirmed cases (acute and chronic) -
0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0 Total
5. No. of chronic clinically diagnosed cases - 0 0 0
9. No. of confirmed chronic cases referred to a 0 0 0
0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1650 1751 3401 0
3. Alcohol binge drinkers - Total 625 303 928 Cervical Cancer using VIA or Pap Smear - 0
0 3 8 11
37 46
3 4 7 0 0 0
system - Total
82
system - Total
2. Maternal Deaths - Total 0 2. Livebirths among 15-19 y/o women-Total. 7 6 13 ABR:

Error Notification:
83

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FHSIS REPORT for the MONTH: ______ YEAR: ______

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

12. No. of pregnant women tested positive

15. No. of pregnant women tested for

B2. Intrapartum Care and Delivery Outcome

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

27. Infants 6 mos. old initiated to complementary 34.a.3. MAM-defaulted in SFP-Total 0

Dear FHSIS point-person,

d.1 Pills-POP - Total

d.2 Pills-COC - Total

e. Injectables (DMPA/POI)- Tot.

g. IUD (IUD-I and IUD-PP)-Tot.

g.1 IUD-I- Total

g.2 IUD-PP - Total

Section B. Maternal Care and Services

10-14 15-19 20-49 10-14 15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who completed

7. No. of pregnant women given

a. Number of pregnant 9. No. of pregnant women screened for

b. No. of pregnant women

12. No. of pregnant women tested positive

18. No. of deliveries – Total 20. No. of deliveries attended by skilled

24b. No. of pre-term births – Total

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total

B3. Postpartum and Newborn Care

25. No. of postpartum women 27. No. of postpartum women with

Section C. Child Care and Services

10. IPV 1- Total 22. Td, Grade 7 (November) - Total

11. IPV 2 (routine)- Total 23. MR, Grade 7 (November) - Total

33. Stunted - Total

34.a. MAM - Total

34.a.3. MAM-defaulted in SFP-Total

27. Infants 6 mos. old initiated to complementary 34.a.4. MAM-died in SFP-Total

32. Children 12-23 mos. who completed MNP

C3. Deworming Services for Infants, Children and Adolescents

38. Sick Infants 6-11 mos. old seen - Total

46. Pneumonia cases 0-59 mos. old completed

Section E. Infectious Disease Prevention and Control Services

E2. Schistosomiasis Prevention and Control

4. No. of confirmed acute cases - Total 8. No. of cases treated - Total

E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)

Section F. Non-Communicable Disease Prevention and Control Services

Section G. Environmental Health and Sanitation Services

a. No. of HH with pour/flush toilet connected to septic tank - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3a. No. of industrial establishments - Total

3b. No. of industrial establishments issued with sanitary permit - Total

Section H. Mortality Section I. Natality

4. Infant Deaths - Total

5. Neonatal Deaths - Total

FHSIS REPORT for the MONTH: YEAR: