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    Jay Bulan
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    This document appears to be a household survey collecting demographic information about family members such as name, age, education level, health status, lifestyle, and more. The survey includes sections for collecting information on immunization status, reproductive health, lifestyle factors like smoking, and ownership of household items. Respondents are asked whether family members have received COVID vaccines. Fields are provided to list all household members and collect details for each.

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    This document appears to be a household survey collecting demographic information about family members such as name, age, education level, health status, lifestyle, and more. The survey includes sections for collecting information on immunization status, reproductive health, lifestyle factors like smoking, and ownership of household items. Respondents are asked whether family members have received COVID vaccines. Fields are provided to list all household members and collect details for each.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    1 views135 pages

    1 Master Profile

    Uploaded by

    Jay Bulan
    This document appears to be a household survey collecting demographic information about family members such as name, age, education level, health status, lifestyle, and more. The survey includes sections for collecting information on immunization status, reproductive health, lifestyle factors like smoking, and ownership of household items. Respondents are asked whether family members have received COVID vaccines. Fields are provided to list all household members and collect details for each.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    of 135

    Barangay Household No. Date of Interview 4PS Member?

    NHTS Household Number Name of


    Respondent
    Please Input Input Household (mm/dd/yyyy) 1. Yes Input if applicable NHTS Input Name of
    Barangay Number 2. No Household Number respondent
    HOUSEHOLD PROFILE
    11. Name 12. Relationship Relationship of 13. Sex 14. Educ. 15. Age
    of member to member to Attainment
    Write: Input here if others Write: Write: encircle 10-15 y. o.
    1-Head M -Male 1. Elementary Grad.
    16. Birthdate 17. Immunization 18. MARPS 19. Women at 20. Family 21. With cough 21. PhilHealth
    Status Reproductive Age Planning for more than 2 Membership
    mm/dd/y y Write: Put check (/) Write: Write: Put check (/) Write Philhealth
    1- FIC 1- Pregnant 1. SDM Number
    23. Received Vaccines against COVID-19? 24. Lifestyle 25. PWD Comorbity 26. Maintenance
    Status Medication
    1st dose 2nd dose 3rd dose Write: PWD-Psychosocial, Commorbidities- 1. Losartan
    (mm/dd/yy) (mm/dd/yy) (mm/dd/yy) 1. Smoker learning, mental, DM, HPN, 2. Amlodipine
    Specifiy here if Using Iodized Salt?Using Fortified Ric Do You Have Pet? If yes, what kind? Is it Vaccinated? Type of Toilet
    you choose others
    1. Yes 1. Yes 1. Yes 1. Yes
    2. No 2. No 2. No 2. No
    Source of Drinking Water
    Relationship Sex Write: Write: Write: Write: Losartan
    Head Male Elementary Grad. FIC SDM Smoker Amlodipine
    Spouse Female High school Grad.CIC LAM Alcoholic Metformin
    Son College Grad. Condom Simvastatin
    Daughter Post Grad. Pills others (Pls. specify in the nex
    Others; Specify relation Vocational Implanon
    Injectable
    IUD
    Vasectomy
    BTL
    Write: Alang-alang
    Yes Pregnant Amantacop
    No Post partum (6 weeks) Ando
    Not pregnant Balacdas
    ers (Pls. specify in the next row) Balud
    Banuyo
    Baras
    Bato
    Bayobay
    Benowangan
    Bugas
    Cabalagnan
    Cabong
    Cagbonga
    Calico-an
    Calingatngan
    Camada
    Campesao
    Can-abong
    Can-aga
    Canjaway
    Canlaray
    Canyopay
    Divinubo
    Hebacong
    Hindang
    Lalawigan
    Libuton
    Locso-on
    Maybacong
    Maypangdan
    Pepelitan
    Pinanag-an
    Punta Maria
    A
    B
    C
    D1
    D2
    E
    F
    G
    H
    Sabang North
    Sabang South
    San Andres
    San Gabriel
    San Gregorio
    San Jose
    San Mateo
    San Pablo
    San Saturnino
    Santa Fe
    Siha
    Sohutan
    Songco
    Suribao
    Surok
    Taboc
    Tabunan
    Tamoso

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