BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

Region: __________
Province: _________________________
City/Municipality: _________________________

Name of Barangay: _________________________

Full Name
No. of
Registered
Year of Place of Year of Place of households
DOH ID No. BHW? Accreditation No. Sex
Registration Registration Accreditation Accreditation covered by the
(Y/N) Last Name First Name Middle Name
BHW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Codes for Sex:

Prepared by (LGU BHW Coordinator): _________________________ M - Male
Signature over Printed Name F - Female

Approved by (MHO/CHO): _________________________

Signature over Printed Name

Noted by (CHD/DOH-BARMM Coordinator): _________________________

Signature over Printed Name
EGISTRY FORM

Region: __________
Province: _________________________
Name of PHO/MHO/CHO: _________________________ City/Municipality: _________________________
Name of Rural Health Midwife: ________________________ Name of Barangay: _________________________

Complete Address
Highest Ethnicity /
Birthdate Contact With occupation? Occupation /
Civil Status Blood Type Educational Indigenous
(mm/dd/yyyy) Number (Y/N) Employment
House No. Sreet/Sitio/Purok Attainment Peoples (IP) group Training 1 Topic

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)

Codes for Sex: Codes for Civil Status: Codes for Blood Type: Codes for Educational Codes for Occupation/ Codes for Training:
M - Male S - Single O+ if O positive Attainment: Employment: MNCHN - trainings/seminars on Maternal, Neonatal and Child Health and Nutrition
F - Female M - Married O- if O negative EL - Elementary level GE - Government employee CD - trainings/seminars related to Communicable Diseases
Sp - Separated A+ if A positive EG - Elementary graduate PE - Private employee NCD - trainings/seminars related to Non-Communicable Diseases
W - Widowed A- if A negative HL - High school level O - Others, please spacify BLS - trainings/seminars on First Aid Techniques and Basic Life Support
L - Live-in/Common law B+ if B positive HG - High school graduate
B- if B negative CL - College level
AB+ if AB positive CG - College graduate
AB- if AB negative MD - Masteral degree
DNK - Do not know VD - Vocational degree
NFE - No formal education
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

_
________

_________

Trainings/Seminars attended in the last three years (2017 to present)

Date of training Date of training Date of training

Training 2 Topic Training 3 Topic Training 4 Topic
(mm/yyyy) (mm/yyyy) (mm/yyyy)
(25) (26) (27) (28) (29) (30) (31) (32) (33)

Examples of topics for each category of training/seminar:

Neonatal and Child Health and Nutrition 1) Topics on MNCHN - Breastfeeding/Lactation, Child Growth Standard/Child Growth Development, Early Childhood Care and Development (ECCD), Family Planning/Responsible Parenthood, First 1000 Days, Infant and
nicable Diseases Young Child Feeding Practices (IYCF), Maternal Care
ommunicable Diseases 2) Topics on CD - Dengue, Emerging and Re-Emerging Infectious Diseases, Filariasis, Flu, Hepatitis, HIV/AIDS, Leprosy, Malaria, Measles, Pneumonia, Polio, Rabies, Sexually Transmitted Disease (STD), Tuberculosis (TB)
iques and Basic Life Support 3) Topics on NCD - Cancer, Cardiovascular Diseases/Heart Attack/Stroke, Chronic Respiratory Diseases/Chronic Obstructive Pulmonary Disease (COPD)/Asthma, Diabetes, Mental Health
4) Topics on BLS - Burns/Choking/Neck- Head-Spinal Injuries/Poisoning, Cardio Pulmonary Resuscitation (CPR), Emergency Response/Rescue, Fire Safety
TRY FORM

Name of PHO/MHO/CHO: _________________________

Name of Rural Health Midwife: ________________________

Honorarium Received (monthly, quarterly, annually)

TESDA BHS NC II
Remarks
Date of training Date of training Other health-related Date of training Course
Training 5 Topic Province Municipality Barangay
(mm/yyyy) (mm/yyyy) training/seminar attended (mm/yyyy)
(34) (35) (36) (37) (38) (39) (40) (41) (42) (43)

Examples of other health-related trainings/seminars: Codes for TESDA NC II Course:

od, First 1000 Days, Infant and
ase (STD), Tuberculosis (TB)
1) Basic Nutrition/Malnutrition, Nutrition in Emergencies and Disasters Og - On-going
2) Blood Pressure (BP) Apparatus Measurement Co - Completed
3) Disaster Risk Assessment/Disaster Risk Preparedness Ce - Certified
4) Environment Sanitation, Solid/Ecologic Waste Management D - Dropped
5) Food Preparation/Food Safety N - None
6) Healthy Lifestyle
7) Traditional/Alternative/Herbal Medicine
8) UHC, PHC, F1 Plus for Health, SDN
9) Women’s Health
10) Water Sanitation and Hygiene (WASH)
11) Zero Open Defecation (ZOD)
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM
Region: __________
Province: _________________________
City/Municipality: _________________________

Name of Barangay: _________________________

Full Name
No. of
Registered
Year of Place of Year of Place of households
DOH ID No. BHW? Accreditation No. Sex
Registration Registration Accreditation Accreditation covered by the
(Y/N) Last Name First Name Middle Name
BHW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Codes for Sex:

Prepared by (LGU BHW Coordinator): _________________________ M - Male
Signature over Printed Name F - Female

Approved by (MHO/CHO): _________________________

Signature over Printed Name

Noted by (CHD/DOH-BARMM Coordinator): _________________________

Signature over Printed Name
EGISTRY FORM

Region: __________
Province: _________________________
Name of PHO/MHO/CHO: _________________________ City/Municipality: _________________________
Name of Rural Health Midwife: ________________________ Name of Barangay: _________________________

Complete Address
Highest Ethnicity /
Birthdate Contact With occupation? Occupation /
Civil Status Blood Type Educational Indigenous
(mm/dd/yyyy) Number (Y/N) Employment
House No. Sreet/Sitio/Purok Attainment Peoples (IP) group Training 1 Topic

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)

Codes for Sex: Codes for Civil Status: Codes for Blood Type: Codes for Educational Codes for Occupation/ Codes for Training:
M - Male S - Single O+ if O positive Attainment: Employment: MNCHN - trainings/seminars on Maternal, Neonatal and Child Health and Nutrition
F - Female M - Married O- if O negative EL - Elementary level GE - Government employee CD - trainings/seminars related to Communicable Diseases
Sp - Separated A+ if A positive EG - Elementary graduate PE - Private employee NCD - trainings/seminars related to Non-Communicable Diseases
W - Widowed A- if A negative HL - High school level O - Others, please spacify BLS - trainings/seminars on First Aid Techniques and Basic Life Support
L - Live-in/Common law B+ if B positive HG - High school graduate
B- if B negative CL - College level
AB+ if AB positive CG - College graduate
AB- if AB negative MD - Masteral degree
DNK - Do not know VD - Vocational degree
NFE - No formal education
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

_
________

_________

Trainings/Seminars attended in the last three years (2017 to present)

Date of training Date of training Date of training

Training 2 Topic Training 3 Topic Training 4 Topic
(mm/yyyy) (mm/yyyy) (mm/yyyy)
(25) (26) (27) (28) (29) (30) (31) (32) (33)

Examples of topics for each category of training/seminar:

Neonatal and Child Health and Nutrition 1) Topics on MNCHN - Breastfeeding/Lactation, Child Growth Standard/Child Growth Development, Early Childhood Care and Development (ECCD), Family Planning/Responsible Parenthood, First 1000 Days, Infant and
nicable Diseases Young Child Feeding Practices (IYCF), Maternal Care
ommunicable Diseases 2) Topics on CD - Dengue, Emerging and Re-Emerging Infectious Diseases, Filariasis, Flu, Hepatitis, HIV/AIDS, Leprosy, Malaria, Measles, Pneumonia, Polio, Rabies, Sexually Transmitted Disease (STD), Tuberculosis (TB)
iques and Basic Life Support 3) Topics on NCD - Cancer, Cardiovascular Diseases/Heart Attack/Stroke, Chronic Respiratory Diseases/Chronic Obstructive Pulmonary Disease (COPD)/Asthma, Diabetes, Mental Health
4) Topics on BLS - Burns/Choking/Neck- Head-Spinal Injuries/Poisoning, Cardio Pulmonary Resuscitation (CPR), Emergency Response/Rescue, Fire Safety
TRY FORM

Name of PHO/MHO/CHO: _________________________

Name of Rural Health Midwife: ________________________

Honorarium Received (monthly, quarterly, annually)

TESDA BHS NC II
Remarks
Date of training Date of training Other health-related Date of training Course
Training 5 Topic Province Municipality Barangay
(mm/yyyy) (mm/yyyy) training/seminar attended (mm/yyyy)
(34) (35) (36) (37) (38) (39) (40) (41) (42) (43)

Examples of other health-related trainings/seminars: Codes for TESDA NC II Course:

od, First 1000 Days, Infant and
ase (STD), Tuberculosis (TB)
1) Basic Nutrition/Malnutrition, Nutrition in Emergencies and Disasters Og - On-going
2) Blood Pressure (BP) Apparatus Measurement Co - Completed
3) Disaster Risk Assessment/Disaster Risk Preparedness Ce - Certified
4) Environment Sanitation, Solid/Ecologic Waste Management D - Dropped
5) Food Preparation/Food Safety N - None
6) Healthy Lifestyle
7) Traditional/Alternative/Herbal Medicine
8) UHC, PHC, F1 Plus for Health, SDN
9) Women’s Health
10) Water Sanitation and Hygiene (WASH)
11) Zero Open Defecation (ZOD)
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM
Region: __________
Province: _________________________
City/Municipality: _________________________

Name of Barangay: _________________________

Full Name
No. of
Registered
Year of Place of Year of Place of households
DOH ID No. BHW? Accreditation No. Sex
Registration Registration Accreditation Accreditation covered by the
(Y/N) Last Name First Name Middle Name
BHW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Codes for Sex:

Prepared by (LGU BHW Coordinator): _________________________ M - Male
Signature over Printed Name F - Female

Approved by (MHO/CHO): _________________________

Signature over Printed Name

Noted by (CHD/DOH-BARMM Coordinator): _________________________

Signature over Printed Name
EGISTRY FORM

Region: __________
Province: _________________________
Name of PHO/MHO/CHO: _________________________ City/Municipality: _________________________
Name of Rural Health Midwife: ________________________ Name of Barangay: _________________________

Complete Address
Highest Ethnicity /
Birthdate Contact With occupation? Occupation /
Civil Status Blood Type Educational Indigenous
(mm/dd/yyyy) Number (Y/N) Employment
House No. Sreet/Sitio/Purok Attainment Peoples (IP) group Training 1 Topic

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)

Codes for Sex: Codes for Civil Status: Codes for Blood Type: Codes for Educational Codes for Occupation/ Codes for Training:
M - Male S - Single O+ if O positive Attainment: Employment: MNCHN - trainings/seminars on Maternal, Neonatal and Child Health and Nutrition
F - Female M - Married O- if O negative EL - Elementary level GE - Government employee CD - trainings/seminars related to Communicable Diseases
Sp - Separated A+ if A positive EG - Elementary graduate PE - Private employee NCD - trainings/seminars related to Non-Communicable Diseases
W - Widowed A- if A negative HL - High school level O - Others, please spacify BLS - trainings/seminars on First Aid Techniques and Basic Life Support
L - Live-in/Common law B+ if B positive HG - High school graduate
B- if B negative CL - College level
AB+ if AB positive CG - College graduate
AB- if AB negative MD - Masteral degree
DNK - Do not know VD - Vocational degree
NFE - No formal education
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

_
________

_________

Trainings/Seminars attended in the last three years (2017 to present)

Date of training Date of training Date of training

Training 2 Topic Training 3 Topic Training 4 Topic
(mm/yyyy) (mm/yyyy) (mm/yyyy)
(25) (26) (27) (28) (29) (30) (31) (32) (33)

Examples of topics for each category of training/seminar:

Neonatal and Child Health and Nutrition 1) Topics on MNCHN - Breastfeeding/Lactation, Child Growth Standard/Child Growth Development, Early Childhood Care and Development (ECCD), Family Planning/Responsible Parenthood, First 1000 Days, Infant and
nicable Diseases Young Child Feeding Practices (IYCF), Maternal Care
ommunicable Diseases 2) Topics on CD - Dengue, Emerging and Re-Emerging Infectious Diseases, Filariasis, Flu, Hepatitis, HIV/AIDS, Leprosy, Malaria, Measles, Pneumonia, Polio, Rabies, Sexually Transmitted Disease (STD), Tuberculosis (TB)
iques and Basic Life Support 3) Topics on NCD - Cancer, Cardiovascular Diseases/Heart Attack/Stroke, Chronic Respiratory Diseases/Chronic Obstructive Pulmonary Disease (COPD)/Asthma, Diabetes, Mental Health
4) Topics on BLS - Burns/Choking/Neck- Head-Spinal Injuries/Poisoning, Cardio Pulmonary Resuscitation (CPR), Emergency Response/Rescue, Fire Safety
TRY FORM

Name of PHO/MHO/CHO: _________________________

Name of Rural Health Midwife: ________________________

Honorarium Received (monthly, quarterly, annually)

TESDA BHS NC II
Remarks
Date of training Date of training Other health-related Date of training Course
Training 5 Topic Province Municipality Barangay
(mm/yyyy) (mm/yyyy) training/seminar attended (mm/yyyy)
(34) (35) (36) (37) (38) (39) (40) (41) (42) (43)

Examples of other health-related trainings/seminars: Codes for TESDA NC II Course:

od, First 1000 Days, Infant and
ase (STD), Tuberculosis (TB)
1) Basic Nutrition/Malnutrition, Nutrition in Emergencies and Disasters Og - On-going
2) Blood Pressure (BP) Apparatus Measurement Co - Completed
3) Disaster Risk Assessment/Disaster Risk Preparedness Ce - Certified
4) Environment Sanitation, Solid/Ecologic Waste Management D - Dropped
5) Food Preparation/Food Safety N - None
6) Healthy Lifestyle
7) Traditional/Alternative/Herbal Medicine
8) UHC, PHC, F1 Plus for Health, SDN
9) Women’s Health
10) Water Sanitation and Hygiene (WASH)
11) Zero Open Defecation (ZOD)
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM
Region: __________
Province: _________________________
City/Municipality: _________________________

Name of Barangay: _________________________

Full Name
No. of
Registered
Year of Place of Year of Place of households
DOH ID No. BHW? Accreditation No. Sex
Registration Registration Accreditation Accreditation covered by the
(Y/N) Last Name First Name Middle Name
BHW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)

Codes for Sex:

Prepared by (LGU BHW Coordinator): _________________________ M - Male
Signature over Printed Name F - Female

Approved by (MHO/CHO): _________________________

Signature over Printed Name

Noted by (CHD/DOH-BARMM Coordinator): _________________________

Signature over Printed Name
EGISTRY FORM

Region: __________
Province: _________________________
Name of PHO/MHO/CHO: _________________________ City/Municipality: _________________________
Name of Rural Health Midwife: ________________________ Name of Barangay: _________________________

Complete Address
Highest Ethnicity /
Birthdate Contact With occupation? Occupation /
Civil Status Blood Type Educational Indigenous
(mm/dd/yyyy) Number (Y/N) Employment
House No. Sreet/Sitio/Purok Attainment Peoples (IP) group Training 1 Topic

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)

Codes for Sex: Codes for Civil Status: Codes for Blood Type: Codes for Educational Codes for Occupation/ Codes for Training:
M - Male S - Single O+ if O positive Attainment: Employment: MNCHN - trainings/seminars on Maternal, Neonatal and Child Health and Nutrition
F - Female M - Married O- if O negative EL - Elementary level GE - Government employee CD - trainings/seminars related to Communicable Diseases
Sp - Separated A+ if A positive EG - Elementary graduate PE - Private employee NCD - trainings/seminars related to Non-Communicable Diseases
W - Widowed A- if A negative HL - High school level O - Others, please spacify BLS - trainings/seminars on First Aid Techniques and Basic Life Support
L - Live-in/Common law B+ if B positive HG - High school graduate
B- if B negative CL - College level
AB+ if AB positive CG - College graduate
AB- if AB negative MD - Masteral degree
DNK - Do not know VD - Vocational degree
NFE - No formal education
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

_
________

_________

Trainings/Seminars attended in the last three years (2017 to present)

Date of training Date of training Date of training

Training 2 Topic Training 3 Topic Training 4 Topic
(mm/yyyy) (mm/yyyy) (mm/yyyy)
(25) (26) (27) (28) (29) (30) (31) (32) (33)

Examples of topics for each category of training/seminar:

Neonatal and Child Health and Nutrition 1) Topics on MNCHN - Breastfeeding/Lactation, Child Growth Standard/Child Growth Development, Early Childhood Care and Development (ECCD), Family Planning/Responsible Parenthood, First 1000 Days, Infant and
nicable Diseases Young Child Feeding Practices (IYCF), Maternal Care
ommunicable Diseases 2) Topics on CD - Dengue, Emerging and Re-Emerging Infectious Diseases, Filariasis, Flu, Hepatitis, HIV/AIDS, Leprosy, Malaria, Measles, Pneumonia, Polio, Rabies, Sexually Transmitted Disease (STD), Tuberculosis (TB)
iques and Basic Life Support 3) Topics on NCD - Cancer, Cardiovascular Diseases/Heart Attack/Stroke, Chronic Respiratory Diseases/Chronic Obstructive Pulmonary Disease (COPD)/Asthma, Diabetes, Mental Health
4) Topics on BLS - Burns/Choking/Neck- Head-Spinal Injuries/Poisoning, Cardio Pulmonary Resuscitation (CPR), Emergency Response/Rescue, Fire Safety
TRY FORM

Name of PHO/MHO/CHO: _________________________

Name of Rural Health Midwife: ________________________

Honorarium Received (monthly, quarterly, annually)

TESDA BHS NC II
Remarks
Date of training Date of training Other health-related Date of training Course
Training 5 Topic Province Municipality Barangay
(mm/yyyy) (mm/yyyy) training/seminar attended (mm/yyyy)
(34) (35) (36) (37) (38) (39) (40) (41) (42) (43)

Examples of other health-related trainings/seminars: Codes for TESDA NC II Course:

od, First 1000 Days, Infant and
ase (STD), Tuberculosis (TB)
1) Basic Nutrition/Malnutrition, Nutrition in Emergencies and Disasters Og - On-going
2) Blood Pressure (BP) Apparatus Measurement Co - Completed
3) Disaster Risk Assessment/Disaster Risk Preparedness Ce - Certified
4) Environment Sanitation, Solid/Ecologic Waste Management D - Dropped
5) Food Preparation/Food Safety N - None
6) Healthy Lifestyle
7) Traditional/Alternative/Herbal Medicine
8) UHC, PHC, F1 Plus for Health, SDN
9) Women’s Health
10) Water Sanitation and Hygiene (WASH)
11) Zero Open Defecation (ZOD)
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM
Region: VI
Province: AKLAN
City/Municipality: NEW WASHINGTON

Name of Barangay: CAWAYAN

Full Name
No. of
Registered
Year of Place of Year of Place of households
DOH ID No. BHW? Accreditation No. Sex
Registration Registration Accreditation Accreditation covered by the
(Y/N) Last Name First Name Middle Name
BHW
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
NA Y 2020 NEW WASHINGTON NWS-2020-A-027 2023 NEW WASHINGTON 52 PASTRANA VERGIE OTE F
NA Y 2010 NEW WASHINGTON NWS-2019-A-019 2019 NEW WASHINGTON 50 PASTRANA FELICITA ARMIZA F
NA Y 2010 NEW WASHINGTON NWS-2019-A-018 2020 NEW WASHINGTON 48 PASTRANA DIVINIA BAUTISTA F
NA Y 2010 NEW WASHINGTON NWS-2019-A-015 2019 NEW WASHINGTON 105 LIBO-ON JOEWIL DELA CRUZ M
NA Y 2020 NEW WASHINGTON NWS-2020-A-025 2023 NEW WASHINGTON 77 FRANCISCO MILDRED CAPORAL F
NA Y 2020 NEW WASHINGTON NWS-2020-A-024 2023 NEW WASHINGTON 34 OLIVEROS LETECIA ARGUELLES F
NA Y 2010 NEW WASHINGTON NWS-2019-A-011 2019 NEW WASHINGTON 39 GABINO WELVENIA ANDRADE F
NA Y 2010 NEW WASHINGTON NWS-2019-A-010 2019 NEW WASHINGTON 51 EL NIGOMI CYNTHIA REGALADO F
NA Y 2020 NEW WASHINGTON NWS-2020-A-023 2023 NEW WASHINGTON 98 BAUTISTA JEAN ANDRADE F
NA Y 1996 NEW WASHINGTON NWS-2019-A-020 2019 NEW WASHINGTON 90 REGALADO LUZVIMINDA KISMUNDO F
NA Y 2010 NEW WASHINGTON NWS-2019-A-013 2019 NEW WASHINGTON 43 JIMUNDO LORNA RESURRECCION F
NA Y 2020 NEW WASHINGTON NWS-2020-A-028 2023 NEW WASHINGTON 43 ISMAEL NELLYN NATAL F
NA Y 1996 NEW WASHINGTON NWS-2019-A-009 2019 NEW WASHINGTON 45 ANDRADE FLORDELIZA DAVID F
NA Y 2010 NEW WASHINGTON NWS-2020-A-022 2019 NEW WASHINGTON 45 TORRES LEA DELFIN F
NA Y 2020 NEW WASHINGTON NWS-2020-A-029 2023 NEW WASHINGTON 57 PARCE JANELYN RONASE F
NA Y 2010 NEW WASHINGTON NWS-2019-A-012 2019 NEW WASHINGTON 73 IDORETA FE LIBO-ON F
NA Y 2010 NEW WASHINGTON NWS-2019-A-021 2019 NEW WASHINGTON 57 TAPLERAS CECELIA DELFIN F
Codes for Sex:
Prepared by (LGU BHW Coordinator): _________________________ M - Male
Signature over Printed Name F - Female

Approved by (MHO/CHO): _________________________

Signature over Printed Name

Noted by (CHD/DOH-BARMM Coordinator): _________________________

Signature over Printed Name
EGISTRY FORM

Region: __________
Province: _________________________
Name of PHO/MHO/CHO: _________________________ City/Municipality: _________________________
Name of Rural Health Midwife: ________________________ Name of Barangay: _________________________

Complete Address
Highest Ethnicity /
Birthdate Contact With occupation? Occupation /
Civil Status Blood Type Educational Indigenous
(mm/dd/yyyy) Number (Y/N) Employment
House No. Sreet/Sitio/Purok Attainment Peoples (IP) group Training 1 Topic

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)
11/11/1960 M DISTRICT 1 N/A O+ HG N N/A
11/27/1946 W DISTRICT 1 N/A O+ EL N N/A
12/22/1957 M DISTRICT 1 0946-215-9701 O+ HG N N/A
7/31/1962 S DISTRICT 7 0927-497-30008 A+ CG N N/A
8/31/1975 M DISTRICT 3 0919-757-7811 O+ EG N N/A
12/10/1955 W DISTRICT 2 N/A O+ HG N N/A
2/3/1961 W DISTRICT 5 0963-464-6745 O+ HG N N/A
5/24/1964 W DISTRICT 4 N/A O+ CG N N/A
4/19/1976 M DISTRICT 4 0963-767-2847 B+ CG N N/A NCD Mental Health
6/2/1959 M DISTRICT 4 0912-782-0225 O+ HG N N/A
12/22/1956 M DISTRICT 7 0910-131-8974 A+ HG N N/A
7/16/1977 M DISTRICT 7 0931-775-8360 O+ CL N N/A
5/13/1949 M DISTRICT 7 0930-277-0042 O+ CL N N/A
1/9/1960 W DISTRICT 7 0961-8072-337 A+ HG N N/A
1/15/1978 M DISTRICT 2 0948-172-4127 O+ HG N N/A
8/3/1958 W DISTRICT 7 0927-497-30008 AB+ HG N N/A
7/30/1958 W DISTRICT 7 0998-468-3426 B+ HG N N/A
Codes for Sex: Codes for Civil Status: Codes for Blood Type: Codes for Educational Codes for Occupation/ Codes for Training:
M - Male S - Single O+ if O positive Attainment: Employment: MNCHN - trainings/seminars on Maternal, Neonatal and Child Health and Nutrition
F - Female M - Married O- if O negative EL - Elementary level GE - Government employee CD - trainings/seminars related to Communicable Diseases
Sp - Separated A+ if A positive EG - Elementary graduate PE - Private employee NCD - trainings/seminars related to Non-Communicable Diseases
W - Widowed A- if A negative HL - High school level O - Others, please spacify BLS - trainings/seminars on First Aid Techniques and Basic Life Support
L - Live-in/Common law B+ if B positive HG - High school graduate
B- if B negative CL - College level
AB+ if AB positive CG - College graduate
AB- if AB negative MD - Masteral degree
DNK - Do not know VD - Vocational degree
NFE - No formal education
 BARANGAY HEALTH WORKER (BHW) REGISTRY FORM

_
________

_________

Trainings/Seminars attended in the last three years (2017 to present)

Date of training Date of training Date of training

Training 2 Topic Training 3 Topic Training 4 Topic
(mm/yyyy) (mm/yyyy) (mm/yyyy)
(25) (26) (27) (28) (29) (30) (31) (32) (33)
Jul-23
Jul-23
Jul-23
Jul-23
Jul-23
Jul-23
Jul-23
Jul-23
Mar-23 Jul-23 Aug-23
Jul-23
Jul-23
Jul-23 Aug-23
Jul-23
Jul-23
Jul-23 Aug-23
Jul-23
Jul-23
Examples of topics for each category of training/seminar:
Neonatal and Child Health and Nutrition 1) Topics on MNCHN - Breastfeeding/Lactation, Child Growth Standard/Child Growth Development, Early Childhood Care and Development (ECCD), Family Planning/Responsible Parenthood, First 1000 Days, Infant and
nicable Diseases Young Child Feeding Practices (IYCF), Maternal Care
ommunicable Diseases 2) Topics on CD - Dengue, Emerging and Re-Emerging Infectious Diseases, Filariasis, Flu, Hepatitis, HIV/AIDS, Leprosy, Malaria, Measles, Pneumonia, Polio, Rabies, Sexually Transmitted Disease (STD), Tuberculosis (TB)
iques and Basic Life Support 3) Topics on NCD - Cancer, Cardiovascular Diseases/Heart Attack/Stroke, Chronic Respiratory Diseases/Chronic Obstructive Pulmonary Disease (COPD)/Asthma, Diabetes, Mental Health
4) Topics on BLS - Burns/Choking/Neck- Head-Spinal Injuries/Poisoning, Cardio Pulmonary Resuscitation (CPR), Emergency Response/Rescue, Fire Safety
TRY FORM

Name of PHO/MHO/CHO: _________________________

Name of Rural Health Midwife: ________________________

Honorarium Received (monthly, quarterly, annually)

TESDA BHS NC II
Remarks
Date of training Date of training Other health-related Date of training Course
Training 5 Topic Province Municipality Barangay
(mm/yyyy) (mm/yyyy) training/seminar attended (mm/yyyy)
(34) (35) (36) (37) (38) (39) (40) (41) (42) (43)
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY ACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY RESIGNED/2023
ANNUALLY NONE MONTHLY ACTIVE
ANNUALLY NONE MONTHLY RESIGNED/2024
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY ACTIVE
ANNUALLY NONE MONTHLY ACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
ANNUALLY NONE MONTHLY INACTIVE
Examples of other health-related trainings/seminars: Codes for TESDA NC II Course:
od, First 1000 Days, Infant and 1) Basic Nutrition/Malnutrition, Nutrition in Emergencies and Disasters Og - On-going
2) Blood Pressure (BP) Apparatus Measurement Co - Completed
ase (STD), Tuberculosis (TB) 3) Disaster Risk Assessment/Disaster Risk Preparedness Ce - Certified
4) Environment Sanitation, Solid/Ecologic Waste Management D - Dropped
5) Food Preparation/Food Safety N - None
6) Healthy Lifestyle
7) Traditional/Alternative/Herbal Medicine
8) UHC, PHC, F1 Plus for Health, SDN
9) Women’s Health
10) Water Sanitation and Hygiene (WASH)
11) Zero Open Defecation (ZOD)