National Safe Motherhood Program

IPHO-Maguindanao

RHU- SULTAN KUDARAT MONTH/YEAR: _______

INDICATORS Accomplishment
(monthly report)
(10-19 years old) NUMBER %
Total Deliveries
Total Deliveries by adolescent girls (10-19 years old)

1. # pregnant tracked
2. # with birth plan
3. # with 4 ANC visits
4. # FBD
5. # SHP assisted
6. # with 2 PNC visits

Total Livebirths
Live Births by adolescent mothers
# Given Birth Dose:
BCG
Hepatitis B
7. # maternal deaths (MMR)
8. # Early Newborn deaths (ENMR)
9. # still births (SBR)

Note:
 Birth dose of BCG and Hepatitis B means given within 24 hours after birth, beyond 24 hours is
not considered birth dose anymore.

Submitted by:

____________________________
NDP
 National Safe Motherhood Progra
PREGNANCY TRACKING

Year: 2023 Birthing Center:BHS

Region: BARMM Address:CROSSING SIMUAY
Referral Center: RHU/DOC SWEET
Province: MAGUINDANAO HOSPITAL/COT SANITARIUM/CRMC
N
F
P
A
D
P
A
:M
Municipality: SULTAN KUDARAT Address: ___________ IL
Barangay: CROSSING SIMUAY

No. Name Age Gravidity Parity Expected Antenatal Care Check-Ups Pregnancy Outcome
(LN, FN, MI) Date of (Date) (Place a check)
Delivery
1st tri = 2nd tri 3rd tri = Live Preterm Stillbirth
up to = 28 birth Birth
12 13-27 weeks
weeks weeks AOG
and 6 and 6 and
days days more
AOG AOG
NOR,
PAMELA YE
1 BAYAO 15 1 1 3/26/2023 S
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Name of BHW: Barangay Health
______________________ Station:________________
Name of Rural Health Unit:
Midwife:__________________ _________________

Master List of Women of Reproductive Age and Adolescent Wom

 For the Quarter/Year: _______________
Barangay:
_________________________ Name of BHS Midwife:
__ _________________________
No HH Name of Address Age in Birthday SE Civil Do you plan to have Fecundity
. No. WRA Years (MM/DD/Y Statu Status more children? (Place a √)
(FN, MI, LN) Y) s (Place a √)

(1) (2) (3) (4) (5) (6 (7) (8) (9)

      10 15 20   1: (1) If Yes, when? No Fecund Infecu
- - - NHTS Currently (9a) d
14 19 49 2: Married No Spacin Limitin (9b)
Non- w g g
NHTS (2) Not (8a) (8b) (8c)
married
but in a
relationshi
p as if
married/
Living-in
(3) Not
married
and not in
any
relationshi
p with a
man
1                            
2                            
3                            
4                            
5                            
6                            
7                            
8                            
9