BNC FORM 1- G-a

BARANGAY CAMIAS

ESSENTIAL MATERNAL & CHILDHEALTH SERVICES-2023

DATE PUROK NAME OF PREGNANT WOMEN(AP) EXPECTED DATE W/3 PRENATAL VISIT GIVEN 5 DOSES SIGNATURE
OF DELIVERY (TT PLUS) DATE
DATE OF 1ST DATE OF 2ND DATE OF 3RD GIVEN THE 5TH
VISIT VISIT VISIT DOSE TT)
 BNC FORM 1-B

BARANGAY CAMIAS

PUROK NAME AGE N INDICATE DATE GIVEN SIGNATUR

MOS. E
APRIL VITAMIN A SUPPLEMENTATION ZINC
PRESCHOOL AGE N LACTATING IRON SUPPLEMENTATION SUPPLE
CHILDREN MOS. MENTA
INFANTS PRESCHOOL SCHOOL PREGNANT LACTATING
OCTOBER TION
April Oct. (6-11 (12-59 MOS.) CHILDREN
2022 2022 MOS.)

MICRONUTRIENT SUPPLEMENTATION -2023

BNC FORM 1-G-d

BARANGAY CAMIAS

ESSENTIAL MATERNAL AND CHILD HEALTH SERVICES 2023

Date Purok Name of Mother or Father Number Attended Practicing Responsible Parenthood Signature
Conducte of Responsible New Acceptor Current Users
d the Children Parenthood
Survey Living Classes Type of Date Type of Date Given
Contracrptives Given Contraceptives
Used Used