HO Form 1A.

Deworming C

Barangay Municipality/City

Part 1. Master list of PSAC

No. Name of Client Address Birthday Age Sex
(HSN) M-Male
F-Female

1234 Dela Cruz, Juan S. #1 Panalo Street 12/25/2015 4 M

4321 Reyes, Maria Y. #56 Natalo Street 10/18/2015 4 F

Total M-
F-

Accomplished by NDP/BHW/Volunteer
Noted by BHS Midwife
Date Accomplished
 HO Form 1A. Deworming Coverage of PSAC Reached Through the Community by Barangay

Province/City

C Part 2. Deworming Status During Each R

In-School Out-of- SE Status July Round
Name of School Grade/ School 1-NHTS (P)-dewormed, (P)-w/ ADR, Remarks
Level 4Ps
Place 2-NHTS write date specify type
dewormed (x)-no ADR
check (P) Non4Ps (x)-not
3-Non
NHTS dewormed

Innoville Center Kinder 1 1 P 7/23/2020 P diarrhea

Innoville Center Kinder 1 3 x no consent

NHTS No. NHTS 4Ps w/ ADRs-

4Ps- dewormed-

NHTS No. NHTS

Non4Ps- Non4Ps
dewormed-
Non
NHTS- No. Non NHTS
dewormed-

Total-
 Region

orming Status During Each Round Part 3. Status of

January Round Deworming in a Year
Remarks (P)-received 2
(P)-dewormed, (P)-w/ ADR, doses/year
write date specify type (x)-received only 1
dewormed (x)-no ADR dose or no dose/year
(x)-not
dewormed

No. NHTS 4Ps w/ ADRs- No. NHTS 4Ps w/ 2

dewormed- doses-

No. NHTS No. NHTS Non4Ps w/

Non4Ps 2 doses-
dewormed-
No. Non NHTS w/ 2
No. Non NHTS doses-
dewormed-
Total-
Total-
 HO Form 1B. Deworming

Barangay Municipality/City

Part 1. Master list of SAC

No. Name of Client Address Birthday Age Sex
M-Male
F-Female

Total M-
F-

Accomplished by NDP/BHW/Volunteer
Noted by BHS Midwife
Date Accomplished
 HO Form 1B. Deworming Coverage of In-School and Out-of-School SAC by Barangay

Province/City

AC Part 2. Deworming Status During Each R

In-School Out-of- SE Status July Round
Name of School Grade/ School 1-NHTS (P)-dewormed, (P)-w/ ADR, Remarks
Level 4Ps
Place 2-NHTS write date specify type
dewormed (x)-no ADR
check (P) Non4Ps (x)-not
3-Non
NHTS dewormed

NHTS No. NHTS 4Ps w/ ADRs-

4Ps- dewormed-

NHTS No. NHTS

Non4Ps- Non4Ps
dewormed-
Non
NHTS- No. Non NHTS
dewormed-

Total-
 Region

orming Status During Each Round Part 3. Status of

January Round Deworming in a Year
Remarks (P)-received 2
(P)-dewormed, (P)-w/ ADR, doses/year
write date specify type (x)-received only 1
dewormed (x)-no ADR dose or no dose/year
(x)-not
dewormed

No. NHTS 4Ps w/ ADRs- No. NHTS 4Ps w/ 2

dewormed- doses-

No. NHTS No. NHTS Non4Ps w/

Non4Ps 2 doses-
dewormed-
No. Non NHTS w/ 2
No. Non NHTS doses-
dewormed-
Total-
Total-
 HO Form 1C. Deworming Cov

Barangay Municipality/City

Part 1. Master list of Adolescents

No. Name of Client Address Birthday Age Sex
M-Male
F-Female

Total M-
F-

Accomplished by NDP/BHW/Volunteer
Noted by BHS Midwife
Date Accomplished
 HO Form 1C. Deworming Coverage of In-School and Out-of-School Adolescents by Barangay

Province/City

scents Part 2. Deworming Status During Each R

In-School Out-of- SE Status July Round
Name of School Grade/ School 1-NHTS (P)-dewormed, (P)-w/ ADR, Remarks
Level 4Ps
Place 2-NHTS write date specify type
dewormed (x)-no ADR
check (P) Non4Ps (x)-not
3-Non
NHTS dewormed

NHTS No. NHTS 4Ps w/ ADRs-

4Ps- dewormed-

NHTS No. NHTS

Non4Ps- Non4Ps
dewormed-
Non
NHTS- No. Non NHTS
dewormed-

Total-
 Region

orming Status During Each Round Part 3. Status of

January Round Deworming in a Year
Remarks (P)-received 2
(P)-dewormed, (P)-w/ ADR, doses/year
write date specify type (x)-received only 1
dewormed (x)-no ADR dose or no dose/year
(x)-not
dewormed

No. NHTS 4Ps w/ ADRs- No. NHTS 4Ps w/ 2

dewormed- doses-

No. NHTS No. NHTS Non4Ps w/

Non4Ps 2 doses-
dewormed-
No. Non NHTS w/ 2
No. Non NHTS doses-
dewormed-
Total-
Total-
Municipality

1st Round (July)

No. of PSAC (1-4 y/o) dewormed No. of SAC (5-9 y/o) dewormed
From HO Form 1A From HO Form 1B
Barangay
NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

1
2
3
4
5
6
7
8
9
10
TOTAL 0 0 0 0 0 0 0 0 0
Round 1 Accomplished by M/CHO IHCP Point Person
Noted by Municipal/City Health Officer
Date Accomplished
 HO Form 2A. Consolidation of Deworming Coverage at the Municipal/City Level

Province

1st Round (July)

/o) dewormed No. of Adol. (10-19 y/o) dewormed No. of PSAC (1-4 y/o) dewormed
orm 1B From HO Form 1C From HO Form 1A
No. with Adverse
Reaction
No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

0 0 0 0 0 0 0 0 0 0 0
Round 2 Accomplished by M/CHO IHCP Poi
Noted by Municipal/City Health O
Date Accomplished
unicipal/City Level

Region

2 Round (January)
/o) dewormed No. of SAC (5-9 y/o) dewormed No. of Adol. (10-19 y/o) dewormed
orm 1A From HO Form 1B From HO Form 1C

No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total No. w/
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS ADR

0 0 0 0 0 0 0 0 0 0 0
mplished by M/CHO IHCP Point Person
d by Municipal/City Health Officer
Accomplished
 No. of children given
No. with Adverse 2 doses in a year
Reaction

0 0
Province

1st Round (July)

No. of PSAC (1-4 y/o) dewormed No. of SAC (5-9 y/o) dewormed
From HO Form 1A From HO Form 1B
Municipality/City
NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

1
2
3
4
5
6
7
8
9
10
TOTAL 0 0 0 0 0 0 0 0 0
Round 1 Accomplished by Provincial/HUC IHCP Point Person
Noted by Provincial/City Health Officer
Date Accomplished
 HO Form 2B. Consolidation of Deworming Coverage at the Provincial/HUC Level

1st Round (July)

/o) dewormed No. of Adol. (10-19 y/o) dewormed No. of PSAC (1-4 y/o) dewormed
orm 1B From HO Form 1C From HO Form 1A
No. with Adverse
Reaction
No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

0 0 0 0 0 0 0 0 0 0 0
Round 2 Accomplished by Provincial/HUC I
Noted by Provincial/City Health O
Date Accomplished
vincial/HUC Level

Region

2 Round (January)
/o) dewormed No. of SAC (5-9 y/o) dewormed No. of Adol. (10-19 y/o) dewormed
orm 1A From HO Form 1B From HO Form 1C

No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total No. w/
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS ADR

0 0 0 0 0 0 0 0 0 0 0
mplished by Provincial/HUC IHCP Point Person
d by Provincial/City Health Officer
Accomplished
 No. of children given
No. with Adverse 2 doses in a year
Reaction

0 0
Region

1st Round (July)

No. of PSAC (1-4 y/o) dewormed No. of SAC (5-9 y/o) dewormed
From HO Form 1A From HO Form 1B
Province/HUC
NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

1
2
3
4
5
6
7
8
9
10
TOTAL 0 0 0 0 0 0 0 0 0
Round 1 Accomplished by CHD IHCP Point Person
Noted by ClusterHead/CHD Director
Date Accomplished
 HO Form 2C. Consolidation of Deworming Coverage at the Regional Level

1st Round (July)

/o) dewormed No. of Adol. (10-19 y/o) dewormed No. of PSAC (1-4 y/o) dewormed
orm 1B From HO Form 1C From HO Form 1A
No. with Adverse
Reaction
No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

0 0 0 0 0 0 0 0 0 0 0
Round 2 Accomplished by CHD IHCP Point P
Noted by ClusterHead/CHD Direct
Date Accomplished
Regional Level

2 Round (January)
/o) dewormed No. of SAC (5-9 y/o) dewormed No. of Adol. (10-19 y/o) dewormed
orm 1A From HO Form 1B From HO Form 1C

No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total No. w/
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS ADR

0 0 0 0 0 0 0 0 0 0 0
mplished by CHD IHCP Point Person
d by ClusterHead/CHD Director
Accomplished
 No. of children given
No. with Adverse 2 doses in a year
Reaction

0 0
 1st Round (July)
No. of PSAC (1-4 y/o) dewormed No. of SAC (5-9 y/o) dewormed
From HO Form 1A From HO Form 1B
CHD
NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

Ilocos
Cagayan Valley
Central Luzon
Calabarzon
Bicol
Western Visayas
Central Visayas
Eastern Visayas
Zamboanga Peninsula
Northern Mindanao
Davao
Soccsksargen
Caraga
CAR
Metro Manila
BARMM
TOTAL 0 0 0 0 0 0 0 0 0
Round 1 Accomplished by IHCP Technical Staff
Noted by National IHCP Manager
Date Accomplished
 HO Form 2D. Consolidation of Deworming Coverage at the National Level

1st Round (July)

/o) dewormed No. of Adol. (10-19 y/o) dewormed No. of PSAC (1-4 y/o) dewormed
orm 1B From HO Form 1C From HO Form 1A
No. with Adverse
Reaction
No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS

0 0 0 0 0 0 0 0 0 0 0
Round 2 Accomplished by IHCP Technical S
Noted by National IHCP Manager
Date Accomplished
National Level

2 Round (January)
/o) dewormed No. of SAC (5-9 y/o) dewormed No. of Adol. (10-19 y/o) dewormed
orm 1A From HO Form 1B From HO Form 1C

No. w/ NHTS NHTS Non Total No. w/ NHTS NHTS Non Total No. w/
ADR 4Ps Non4Ps NHTS ADR 4Ps Non4Ps NHTS ADR

0 0 0 0 0 0 0 0 0 0 0
mplished by IHCP Technical Staff
d by National IHCP Manager
Accomplished
 No. of children given
No. with Adverse 2 doses in a year
Reaction

0 0