FHSIS REPORT for the MONTH: AUGUST YEAR: 2021

M1
Name of Barangay: BAHAY
Name of BHS: MAIN HEALTH CENTER
Name of Municipality/City: SAN POLICARPO

BRGY
Name of Province: EASTERN SAMAR
Projected Population of the Year:
For submission to PHA for consolidation

Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total A3. Deworming Services SES Total

(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)

15-19 20-49 NHTS Non-NHTS
1. No. of WRA with unmet 1. No. of women 20-49 years old given 2 doses of
0 7 7
need for modern FP - Total deworming drugs - Total
3 0 3
• NHTS 0 7 7
• Non-NHTS 0 0 0
A2. Use of FP Method Current User Acceptors Dropout Current User 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 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
a. Female Sterilization/ BTL -
0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
Total
• NHTS 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. Male Sterilization/ 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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. Pills - Total 0 0 40 40 0 0 3 3 0 0 0 0 0 0 0 0 0 0 40 43 0 0 3 3
• NHTS 0 0 40 40 0 0 3 3 0 0 0 0 0 0 0 0 0 0 43 43 0 0 3 3
• Non-NHTS 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
A2. Use of FP Method Current User Acceptors Dropout Current User 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 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
d.1 Pills-POP - 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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.2 Pills-COC - 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
• NHTS 0 0 40 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 40 0 0 0 0
• Non-NHTS 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
e. Injectables (DMPA/ POI) -
Total 0 0 17 17 0 0 1 1 0 0 0 0 0 0 0 0 0 0 17 17 0 0 1 1

• NHTS 0 0 15 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15 15 0 0 0 0
• Non-NHTS 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
f. Implant - 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
• NHTS 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and 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

• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
• NHTS 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
A2. Use of FP Method Current User Acceptors Dropout Current User 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 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total 10-14 15-19 20-49 Total
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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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
• NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
• Non-NHTS 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 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
• NHTS 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
• Non-NHTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 88 88 0 0 4 4 0 0 0 0 0 0 0 0 0 0 88 88 0 0 4 4
• NHTS 0 0 86 86 0 0 4 4 0 0 0 0 0 0 0 0 0 0 86 86 0 0 4 4
• Non-NHTS 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 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

1. No. of pregnant women w/ a. Number of pregnant women seen in the
at least 4 prenatal check- 0 1 0 1 first trimester who have normal BMI - 0 1 0 1
ups - Total Total
• NHTS 0 1 0 1 • NHTS 0 1 0 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
2. No. of pregnant women b. No. of pregnant women seen in the first
assessed of their nutritional 0 0 0 0 trimester who have low BMI - Total 0 0 0 0
status during the 1st tri. -Total
• NHTS 0 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0

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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

c. No. of pregnant women 7. No. of pregnant women given iodine
seen in the first trimester 0 1 0 1 capsules – Total 0 0 0 0
who have high BMI - Total
• NHTS 0 1 0 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
3. No. of pregnant women for 8. No. of pregnant women given one dose
the first time given 2 doses of 0 0 2 2 of deworming tablet - Total 0 1 2 3
Td vaccination - Total

• NHTS 0 0 2 2 • NHTS 0 1 2 3
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0

4. No. of pregnant women for 9. No. of pregnant women screened for

the 2nd or more times given syphilis - Total
0 1 0 1 0 0 0 0
at least 3 doses of Td
vaccination (Td2 Plus) - Total
• NHTS 0 1 0 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
5. No. of pregnant women who 10. No. of pregnant women tested positive
completed the dose of iron for syphilis - Total
0 0 1 1 0 0 0 0
with folic acid
supplementation - Total
• NHTS 0 0 1 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 1 1 • Non-NHTS 0 0 0 0
6. No. of pregnant women who 11. No. of pregnant women screened for
completed doses of calcium Hepatitis B - Total
0 0 1 1 0 0 0 0
carbonate supplementation -
Total
• NHTS 0 0 1 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 1 1 • Non-NHTS 0 0 0 0
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 B2. Intrapartum Care and Delivery Outcome

12. No. of pregnant women 18. No. of deliveries – Total
tested positive for Hepatitis 0 0 0 0 0 0 1 1
B - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
13. No. of pregnant women 19. No. of live births – Total
0 0 0 0 0 0 1 1
screened for HIV - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
14. No. of pregnant women 20a. No. of live births with normal birth
tested for CBC or Hgb&Hct 0 0 0 0 weight - Total 0 0 1 1
count - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
15. No. of pregnant women 20b. No. of live births with low birth weight
tested for CBC or Hgb&Hct - Total
0 0 0 0 0 0 0 0
count diagnosed with
anemia - Total
• NHTS 0 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
16. No. of pregnant women 20c. No. of live births with unknown birth
screened for gestational 0 0 0 0 weight- Total 0 0 0 0
diabetes – Total
• NHTS 0 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
17.   No. of pregnant women 21. No. of deliveries attended by skilled
tested positive for 0 0 0 0 health professionals - Total 0 0 1 1
gestational diabetes – Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
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

B2. Intrapartum Care and Delivery Outcome

a. No. of deliveries attended 0 0 0 24a. No. of deliveries in public health 0 0 0 0
0
by a doctor - Total facility - Total
• NHTS 0 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
b. No. of deliveries attended 0 0 0 24b. No. of deliveries in private health 0 0 1 1
0
by a nurse – Total facility - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
c. No. of deliveries attended 0 1 1 25. No. of non-facility-based deliveries - 0 0 0 0
0
by midwives - Total Total
• NHTS 0 0 1 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
22. No. of deliveries attended
by non-skilled health 0 0 0 0 26a. No. of vaginal deliveries – Total 0 0 0 0
professionals - Total
• NHTS 0 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
a. No. of deliveries attended 0 0 0 26b. No. of deliveries by cesarean 0 0 1 1
0
by Hilot/TBA - Total section – Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
b. No. of deliveries attended 0 0 0 0 0 1 1
0 27a. No. of full-term births – Total
by others - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
23. No. of health facility-based 0 1 1 0 0 0 0
0 27b. No. of pre-term births – Total
deliveries - Total
• NHTS 0 0 1 1 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
 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

B2. Intrapartum Care and Delivery Outcome B3. Postpartum and Newborn Care
27c. No. of fetal deaths - Total 28. No. of postpartum women together
0 0 0 0 with their newborn who completed at 0 0 1 1
least 2 postpartum check-ups - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
29. No. of postpartum women who
27d. No. of abortion/ 0 completed iron with folic acid 0 0 1 1
0 0 0
miscarriage - Total supplementation - Total
• NHTS 0 0 0 0 • NHTS 0 0 1 1
• Non-NHTS 0 0 0 0 • Non-NHTS 0 0 0 0
30. No. of postpartum women with
0 0 1 1
Vitamin A supplementation – Total
• NHTS 0 0 1 1
• Non-NHTS 0 0 0 0
Section C. Child Care and Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C1. Immunization Services
1. CPAB - Total 1 0 1 6. DPT-HiB-HepB 3 - Total 0 0 0 11. PCV 1 - Total 0 2 2
• NHTS 1 0 1 • NHTS 0 0 0 • NHTS 0 2 2
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
2. BCG - Total 0 0 0 7. OPV 1 - Total 0 0 0 12. PCV 2 - Total 1 1 2
• NHTS 0 0 0 • NHTS 0 0 2 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
3. HepB, within 24 hours. - Total 0 0 0 8. OPV 2 - Total 0 1 1 13. PCV 3 - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 1 1 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
4. DPT-HiB-HepB 1 - Total 0 0 0 9. OPV 3 - Total 2 2 4 14. MMR 1 - Total 0 2 2
• NHTS 0 0 0 • NHTS 2 2 4 • NHTS 0 2 2
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
5. DPT-HiB-HepB 2 - Total 0 1 1 10. IPV - Total 2 2 4 15. MMR 2 - Total 2 2 4
• NHTS 0 0 0 • NHTS 2 2 4 • NHTS 2 2 4
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
16. FIC - Total 2 2 4 18. Td, Grade 1 (November) - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0
• NHTS 2 2 4 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
17. CIC - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0 21. MR, Grade 7 (November) - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
C2. Nutrition Services
22. Newborns initiated on breastfeeding
0 0 34. Children 12-23 mos. who completed 0
immediately after birth lasting to 90 mins - 28. Infants 6-11 mos. old seen - Total
MNP supplementation - Total
Total 0 0 0 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
23. Preterm/LBW infants given iron 0 29. Infants 6-11 mos. given 1 dose of 0 0 0 0
35. Children 0-59 mos. seen - Total
supplementation - Total 0 0 Vitamin A 100,000 I.U. - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
24. Infants 6 mos. old seen - Total 0 0 0 30. Children 12-59 mos seen - Total 0 0 0 36. Stunted - Total 0 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
25. Infants exclusively breastfed until 6th month - 0 31. Children 12-59 mos. old given 2 0 0 0 0
37. Wasted - Total
Total 0 0 doses of Vitamin A 200,000 I.U. - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
26. Infants 6 mos. old initiated to complementary 0 32. Infant 6-11 months old who completed 0 0 0 0
38. Overweight/Obese - Total
feeding with continued breastfeeding - Total 0 0 MNP supplementation - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
27. Infants 6 mos. old initiated to complementary
feeding but no longer or never been breastfed 0 33. Children 12-23 mos. seen - Total 0 0 0 39. Normal - Total 0 0 0
- Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C3. Deworming Services
40. 1-19 y/o given 2 doses of deworming drug - 57 60 117 42. SAC, 5-9 y/o dewormed (2 doses) - 0 0 0 43. Adolescents, 10-19 y/o dewormed 0 0 0
Total Total (2 doses) - Total
• NHTS 57 60 117 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
41. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
• NHTS 0 0 0
• Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
C4. Management of Sick Infants and Children
39. Sick Infants 6-11 mos. old seen - Total 42. Sick Children 12-59 mos. old 45. Diarrhea cases 0-59 mos. received
0 0 0
0 0 received Vitamin A - Total 0 0 ORS w/ zinc - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
40. Sick Infants 6-11 mos. old received 0 43. Diarrhea cases 0-59 months old seen 0 46. Pneumonia cases 0-59 mos. old 0
Vitamin A - Total 0 0 - Total 0 0 seen - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0

0 44. Diarrhea cases 0-59 months old 0 47. Pneumonia cases 0-59 mos. old 0
41. Sick Children 12-59 mos. old seen - Total
0 0 received ORS - Total 0 0 completed treatment - Total 0 0
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Section D. Oral Care and Services
To be submitted Quarterly
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
1. Orally fit children 12-59 months old upon oral 0 0 0 4. Children 1-4 years old who received 0 0 0 7. Adults 20-59 years old who received 0 0 0
exam plus orally fit after rehab - Total BOHC - Total BOHC - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0

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2. Clients 5 years old and above with new cases 0 0 0 5. Children 5-9 years old who received 0 0 0 8. Senior citizens 60 years old and above 0 0 0
of DMFT - Total BOHC - Total who received BOHC - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators 20-49 20-49 20-49 Total
3. Infants 0-11 months old who received BOHC - 0 0 0 6. Adolescents 10-19 years old who 0 0 0
Total received BOHC - Total 9. Pregnant women who received BOHC 0 0 0 0
- Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0 0
Section E. Infectious Disease Prevention and Control Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
0 0 0 0 0 0 7. No. of confirmed cases (acute and 0 0 0
1. No. of patients seen - Total 4. No. of confirmed acute cases - Total
chronic) - Total
0 0 0 5. No. of chronic clinically diagnosed 0 0 0 0 0 0
2. No. of suspected cases seen 8. No. of cases treated - Total
cases - Total
0 0 0 0 0 0 9. No. of confirmed chronic cases 0 0 0
3. No. acute clinically diagnosed cases - Total 6. No. confirmed chronic cases - Total
referred to a hospital facility - Total
E3. Soil Transmitted Helminthiasis Prevention and Control (reflected under Child Care, Family Planning and Maternal Care)
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
3. Number of TB, all forms that are cured 4. No. of registered bacteriology
1. Number of notified TB cases, all forms - Total 0 0 0
and completely treated - Total 0 0 0 confirmed drug resistant TB Cases 0 0 0
(RR/MDR-TB) cured & completed
2. No. of registered bacteriologically confirmed 0 0 0 treatment - Total
drug resistant TB (RR/MDR-TB Cases)-Total
E6. Malaria Prevention and Control
1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths -
0 0 0 0 0 0
diagnosed malaria and confirmed case-Total Total
• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0
• ≥ 5 y/o - Total 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of Leprosy Cases on treatment during 2. No. of newly detected cases during 1. No. of deaths due to rabies - Total
0 0 0 0 0 0 0 0 0
reporting period - Total reporting period - Total
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
3. Alcohol binge drinker - Total 5. No. of adult women screened for
1. No. of adults risk-assessed using PhilPEN - 20 20 40 0 0 0 Cervical Cancer using VIA/Pap Smear 0
Total - Total
• NHTS 20 20 40 • NHTS 0 0 0 • NHTS 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0
2. Current smoker - Total 4. Overweight/Obese - Total 6. No. of adult women found positive /
0 0 0 0 0 0 suspect for Cervical Cancer using VIA 0
or Pap Smear - Total
• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0
Smokers provided with brief tobacco intervention Adults 20 years old and above who are Physically inactive adults 20 years old and
(BTI) 0 0 0 physically inactive 0 0 0 above given initial management 0 0 0

• NHTS 0 0 0 • NHTS 0 0 0 • NHTS 0 0 0

• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Indicators Male Female Total Indicators Male Female Total Indicators Male Female Total
(Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4) (Col. 1) (Col 2) (Col 3) (Col 4)
7. No. of adult women screened for breast mass 10. No. of newly-identified adults with Type 13. No. of senior citizens who received
0 0 0 0 0 0 0
- Total 2 DM-Total one (1) dose of PPV - Total
• NHTS 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
14. No. of senior citizens who received
8. No. of adult women with suspicious breast 0 11. No. of senior citizens screened for 0 0 0 one (1) dose of influenza vaccine - 0 0 0
mass - Total visual acuity - Total Total
• NHTS 0 • NHTS 0 0 0 • NHTS 0 0 0
• Non-NHTS 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
9. No. of newly-identified hypertensive adults 12. No. of senior citizens diagnosed with Newly identified hypertensive 20 years old
0 0 0 0 0 0 0 0 0
- Total eye disease/s - Total and above adults given initial management
• NHTS 0 0 0 • NHTS 0 0 0 •one (1) dose of PPV - Total
NHTS 0 0 0
• Non-NHTS 0 0 0 • Non-NHTS 0 0 0 • Non-NHTS 0 0 0
Section G. Environmental Health and Sanitation Services
Indicators Total Indicators Total
(Col. 1) (Col. 2) (Col. 1) (Col. 2)
Total No. of HHs:
1. No. of HHs with access to basic safe water supply - Total 224 3.1 No. of HH with pour/flush toilet connected to septic tank - Total 0
• NHTS 143 • NHTS 0
• Non-NHTS 81 • Non-NHTS 0
1.1 No. of HHs with Level I - Total 0 3.2 No. of HHs with pour/flush toilet connected to community sewer/ 224
• NHTS 0 sewerage system or any other approved treatment system - Total 143
• Non-NHTS 0 • NHTS 81
1.2 No. of HHs with Level II - Total 224 • Non-NHTS 0
• NHTS 143 3.3 No. of HHs with ventilated improved pit latrine (VIP) - Total 0
• Non-NHTS 81 • NHTS 0
1.3 No. of HHs with Level III - Total 0 • Non-NHTS 0
• NHTS 0 4. No. of industrial establishments issued with sanitary permit - Total 0
• Non-NHTS 0
3. No of HHs with basic sanitation facility - Total 0
• NHTS 0
• Non-NHTS 0
 Morbidity Disease Report (M2)
FHSIS Monthly Report for : MONTH: JULY YEAR: 2021
Name of BRGY and BHS: BAHAY
Catchment Health Center : MAIN HEALTH CENTER

Section H. MORBIDITY DISEASES REPORT

For submission to the RHU
ICD 10 0-6 days 7-28 days 29 days-11 mos 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49
DISEASE
Code M F M F M F M F M F M F M F M F M F M F M F M F M

Acute Watery Diarrhea A09.0 (watery)

Acute Bloody Diarrhea A09.0 (bloody)

Influenza-like Illness J11.1

Influenza J11.1
Acute Flaccid Paralysis G83.9

Acute Hemorrhagic Fever Syndrome (Dengue) A97.0-A97.2

Acute Lower Respiratory Tract Infection J22

Pneumonia J18.90-J18.99 1
Cholera A00.0-A00.9
Diphtheria A36.0-A36.9
Filariasis B74.0-B74.9
Leprosy A30.0-A30.9
Leptospirosis A27.0-A27.9
Malaria B50-B54
Measles B05.0-B05.9
Meningococcemia A39.2-A39.4
Neonatal Tetanus A33
Non-neonatal Tetanus A35
Paralytic Shellfish Poisoning T61.2
Animal Bites T14.1
Schistosomiasis B65.0-B65.9
Typhoid and paratyphoid A01.1-A01.4
Viral Encephalitis A83-A86
Acute Viral Hepatitis B15-B17
 M2
DITY DISEASES REPORT
submission to the RHU
BRGY
45-49 50-54 55-59 60-64 65-69 ≥ 70 TOTAL
F M F M F M F M F M F M F
 Morbidity Disease Report (M2)
FHSIS Monthly Report for : MONTH: JULY YEAR: 2021
Name of BRGY and BHS: BAHAY
Catchment Health Center : MAIN HEALTH CENTER

Section H. MORBIDITY DISEASES REPORT

For submission to the RHU
ICD 10 0-6 days 7-28 days 29 days-11 mos 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44
DISEASE
Code M F M F M F M F M F M F M F M F M F M F M F M F
Viral Meningitis A87.0-A87.9
Syphilis A50-A53
Gonorrhea A54.0-A54.9
Urethral Discharge R36

N48.5, N50.8,
Genital ulcer N76.5, N76.6,
N89.8

Other Diseases
ARI in below 5
ARI for 5 and above
FUO
Diseases of the heart
Skin diseases
UTI
COPD
Tuberculosis (All forms)

Lacerated/punctured wound
Animal Bite
Oral Diseases
A. Bronchitis
B. Asthma
AGE
 M2
BIDITY DISEASES REPORT
For submission to the RHU
BRGY
45-49 50-54 55-59 60-64 65-69 ≥ 70 TOTAL TOTAL
M F M F M F M F M F M F M F M F
 FHSIS REPORT FOR MONTH: JULY YEAR: 2021
Name of Barangay: BAHAY
Municipality/City Name: SAN POLICARPO
Province: EASTERN SAMAR
Projected Population of the Year:

Section I. Mortality
Number Ratio to
Indicators Interpretation
Male Female Total Population
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5 Col. 6

1. Livebirths 1 0 1

2. Total Deaths 0 0 0

3. Maternal Deaths 0 0 0

4. Under-five deaths 0 0 0

5. Infant Deaths 0 0 0

6. Neonatal Deaths 0 0 0

7. Fetal Deaths 0 0 0

8. Early Neonatal Deaths 0 0 0

9. Perinatal Deaths 0
Denominator: - population - live births
Section II. Natality
10.  Livebirths 1 0 1
Recommendation/
Actions Taken
Col. 7
 FHSIS REPORT FOR MONTH: JULY YEAR: 2021
Name of Barangay: BAHAY
Municipality/City Name: SAN POLICARPO
Province: EASTERN SAMAR
Projected Population of the Year:

Section II. Mortality by Specific Cause

Number Ratio to
DISEASE (underlying Cause)
Male Female Total Population
Col. 1 Col. 2 Col. 3 Col. 4 Col. 5

NONE
 Ratio to
Population
Col. 5