A1

FHSIS REPORT for the year: _____________________________________________

Name of Health Facility: _____________________________________________
Name of Barangay: _____________________________________________
Name of Municipality/City: _____________________________________________
Name of Province: ____________________________________________
Projected Population of the Year: ____________________________________________
For submission to the next administrative level

Section C. Demographic Data

Recommendations/
Indicators LGU-hired DOH-hired Total Ratio to Population Interpretation
Actions to be Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)

1. No. of Barangays - Total

2. No. of Households - (Projected)
3. No.of Health Centers - Total
a. Main Health Centers - Total
b. City Health Centers - Total
c. Rural Health Units - Total
4. No.of Barangay Health Stations - Total
5. No. of Health Workers - Total
a. Physicians/Doctors - Total
b. Dentists - Total
c. Nurses - Total
d. Midwives - Total
e. Medical Technologists - Total
f. Nutritionists/Dietitians - Total
g. Sanitary Engineers - Total
h. Sanitary Inspectors - Total
i. Active BHWs - Total