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Select from Indicate the Select the sex Encode vaccinee's House
the birthdate of of the lot number, street name
dropdown the vaccinee vaccinee from
choices the using the the drop-
suffix of the prescribed down list
vaccinee. format
Select "N/A" (mm/dd/yyyy)
If the
individual "Select the 1st
does not have day of the
suffix. year of the
estimated
year of birth
for indigenous
members
that does not
know their
birthday. ex:
(01/01/2008)
(01/01/2001)
PERMANENT ADDRESS Data sets under the Permanent Address are used to measure the actual
vaccination coverage per region, province, city, and barangay
Select the Region of the Select the Province of the Select the
vaccinee's permanent address vaccinee's permanent Municipaliy/City of
address. (The choices in the vaccinee's
this column is dependent permanent address
on the Region column) (The choices in this
column is dependent
on the Province
column)
nder the Permanent Address are used to measure the actual PLACE OF VACCINATION
coverage per region, province, city, and barangay
Ilocos_Region_0100000000 ILOCOS_SUR_0102900000
Select the Barangay of the Select the Region of the Select the Province of the Select the
vaccinee's permanent place where the vaccinee place where the vaccinee Municipality/City of t
address (The choices in was vaccinated was vaccinated (The choices place where the vacci
this column is dependent in this column is dependent was vaccinated (The
on the City column) on the Region column) choices in this column
dependent on the
Province column)
LACE OF VACCINATION Data sets under the Place of Vaccinator are used to measure the actual
vaccination accomplishment per region, province, city, and barangay
DEFER 09/02/2023
REASON_FOR_REFUSAL/DEFERRAL
Child was absent/ away from home (indicate place in the remarks)_06
*Only populate this column if the vaccinee refused or was deferred. The
choices are dependent from the "Action Taken"
(01/01/2001)
DEFERRAL_DATE_OF_NEXT_ VACCINATOR_N
VISIT (MM/DD/YYYY) AME
03/01/2023
Indigenous BIRTHDATE
LAST_NAME* FIRST_NAME* MIDDLE_NAME* SUFFIX*
Member* (MM/DD/YYYY)*
PERMANENT ADDRESS
PERMANENT ADDRESS
PERMANENT ADDRESS PROVINCE* PERMANENT ADDRESS BARANGAY*
CITY*
PLACE OF VACCINATION
VACCINATION/
REFUSAL/
ACTION TAKEN*
DEFERRAL_DATE
(MM/DD/YYYY)*
VACCINATION INFORMATION
DEFERRAL_DATE_OF_NEXT_VISIT
REASON_FOR_REFUSAL/DEFERRAL
(MM/DD/YYYY)
VACCINATOR_NAME*