Republic of the Philippines

CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT

DEPARTMENT OF HEALTH
City of San Fernando, Pampanga
centralluzon.doh.gov.ph

ANNEX 5_MOBILE VAN SUMMARY REPORT

Name of City/Municipality and CHC/CHU/RHU: GABALDON

Activity Date: April 19, 2023
Data as of: May 15, 2023 Report Status: Partial

No. Indicator Adult (15 y/o Child (14 y/o and below)
and above)
Male Female Male Female
SCREENING
1 Number of Screened by Chest X-ray 46 203 0 0

2 Number of Screened with (+) X-ray Result 3 4 0 0

3 Number of Screened with TB Signs and Symptoms only 0 0 0 0
4 Number of Presumptive patient identified 3 4 0 0
(Screened with (+) x-ray result and TB signs and symptoms)
DIAGNOSIS (TESTING)
5 Total no. Tested on Xpert MTB/Rif 1 1 0 0
6 No. of FINAL Xpert MTB/Rif Result: MTB NOT Detected; 1 1 0 0
Rifampicin Resistance NOT Detected (N)
7 No. of FINAL Xpert MTB/Rif Result: MTB Detected, Rifampicin 0 0 0 0
Resistance NOT Detected (T)

8 No. of FINAL Xpert MTB/Rif Result: MTB Detected, Rifampicin 0 0 0 0

Resistance INDETERMINATE (TI)

9 No. of FINAL Xpert MTB/Rif Result: MTB Detected, Rifampicin 0 0 0 0

Resistance DETECTED (RR)
ENROLLMENT TO TB TREATMENT
10 BC DSTB Cases enrolled 0 0 0 0
11 CD DSTB Cases enrolled 0 0 0 0
12 BC RRTB Cases enrolled 0 0 0 0
ENROLLMENT TO TB PREVENTIVE TREATMENT
0-4 5-14 0-4 5-14
13 No. of Contact traced from BC patients 0 o 0 0 0 0
14 No. of Contact traced from CD patients 0 0 0 0 0 0
15 No. of Contacts screened with X-ray or symptoms 0 0 0 0 0 0
16 TPT Cases enrolled 0 0 0 0 0 0
17 No. of TB Cases Notified from Contacts 0 0 0 0 0 0
PENDING
18 Xpert MTB/Rif Testing 2 3 0 0
19 BC DSTB Cases Enrollment 0 0 0 0
20 CD DSTB Cases Enrollment 0 0 0 0
21 BC RRTB Cases Enrollment 0 0 0 0
22 TPT Cases Enrollment 0 0 0 0
Remarks: Pending Testing Remarks: Pending Enrollment Remarks: (if previously screened but enrolled in
Unable to locate- Unable to locate- the current month, please provide breakdown)
Unable to expectorate- Unable to expectorate- BC DSTB –
Refused- Refused- CD DSTB –
Died- Died-0 BC DRTB –
TPT -
Prepared by:

MARVIE G. BARBOSA
NURSE III/ NTP COORDINATOR

Name/Designation/Signature
* Submit the CXR Provider Evaluation thru https://bit.ly/CXRProvider_EvaluationTool.
* Submit the signed copy of Summary Report at tb@centralluzon.doh.gov.ph.