Republic of the Philippines

Province of Zamboanga Sibugay

Municipality of Ipil
BARANGAY LOWER IPIL HEIGHTS / TIRSO BABIERA

GARANTISADONG PAMBATA

Name of Assigned BHW: _______________________________ Purok: _____________________

DEWORMING
VITAMIN A GIVEN GIVEN
Age Birth
NHTS
Rem
Name of Parents Name of Child in Or 60- 12-
date NONE 6-11 12-59 24-59 arks
Month 71 23
M F M F M F M F M F
PUROK: _______________________

NAME OF BHW: ________________________________

Consolidation

VITAMIN A
TARGET ACCOMPLISHMENT
NHTS NONE NHTS NONE
Age
MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
6-11        
12-59        
60-71
TOTAL

DEWORMING
TARGET ACCOMPLISHMENT
NHTS NONE NHTS NONE
Age
MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
1 to 4 yo
 5 to 9 yo        
 10 to 19
       
yo
TOTAL