SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019

Clinic A
Target Client List for Lactation Ammenorheic Method
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

6/30/1985 2/27/19 3/27/19 4/24/19 5/22/19 6/19/19 7/17/19

1/30/2019 47 Adelantado, Adriana Block 1, Lot 21, Barangay Sampaguita NA NONE 12/31/19
33 2/27/19 3/27/19 4/24/19 5/22/19 6/19/19 7/17/19

12/30/1985 2/27/19 3/27/19 4/24/19 5/22/19 6/19/19 7/17/19 8/14/19 9/11/19 10/9/19 11/6/19 12/4/19
1/30/2019 48 Matabunkay, Cecille Block 1, Lot 3, Barangay Sampaguita NA NONE 12/31/19
33 2/27/19 3/27/19 4/24/19 5/22/19 6/19/19 7/17/19 8/14/19 9/11/19 10/9/19 11/6/19 12/4/19

1/15/1985 3/25/19 4/22/19 5/20/19 6/17/19 7/15/19 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19
2/25/2019 49 Halagor, Indira Block 1, Lot 2, Barangay Sampaguita NA NONE 12/31/19
34 3/25/19 4/22/19 5/20/19 6/17/19 7/15/19 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19

8/30/1987 3/26/19 4/23/19 5/21/19 6/18/19 7/16/19 8/13/19 9/10/19 10/8/19 11/5/19 12/3/19
2/26/2019 50 Garcia, Consolation Block 1, Lot 18, Barangay Sampaguita NA NONE 12/31/19
32 3/26/19 4/23/19 5/21/19 6/18/19 7/16/19 8/13/19 9/10/19 10/8/19 11/5/19 12/3/19

5/2/1988 3/28/19 4/25/19 5/23/19 6/20/19 7/18/19 8/15/19 9/12/19 10/10/19 11/7/19 12/5/19
2/28/2019 51 Nacional, Ada Block 1, Lot 19, Barangay Sampaguita NA NONE 12/31/19
31 3/28/19 4/25/19 5/23/19 6/20/19 7/18/19 8/15/19 9/12/19 10/10/19 11/7/19 12/5/19

9/25/1990 5/16/19 6/13/19 7/11/19 8/8/19 9/5/19 10/3/19 10/31/19 11/28/19

4/18/2019 52 Bienvenidas, Legarda Block 1, Lot 8, Barangay Sampaguita NA NONE 12/31/19
29 5/16/19 6/13/19 7/11/19 8/8/19 9/5/19 10/3/19 10/31/19 11/28/19

11/6/1981 5/26/19 6/23/19 7/21/19 8/18/19 9/15/19 10/13/19 11/10/19 12/8/19

4/28/2019 53 Juan, Jovy Block 1, Lot 4, Barangay Sampaguita NA NONE 12/31/19
38 5/26/19 6/23/19 7/21/19 8/18/19 9/15/19 10/13/19 11/10/19 12/8/19

2/28/1992 6/16/19 7/14/19 8/11/19 9/8/19 10/6/19 11/3/19 12/1/19

5/19/2019 54 Tramal, Anestesia Block 1, Lot 32, Barangay Sampaguita NA NONE 12/31/19
27 6/16/19 7/14/19 8/11/19 9/8/19 10/6/19 11/3/19 12/1/19

10/25/1993 6/23/19 7/21/19 8/18/19 9/15/19 10/13/19 11/10/19 12/8/19

5/26/2019 55 Bacus, Shay Block 1, Lot 5, Barangay Sampaguita NA NONE 12/31/19
26 6/23/19 7/21/19 8/18/19 9/15/19 10/13/19 11/10/19 12/8/19
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Clinic A
Target Client List for PILLS POP
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

6/5/1991 7/26/19 8/23/19 9/20/19 10/18/19 11/15/19 12/13/19

6/28/2019 56 Ilagan, Ana Block 1, Lot 9, Barangay Sampaguita CM LAM 12/31/19
28 7/26/19 8/23/19 9/20/19 10/18/19 11/15/19

12/26/1989 7/28/19 8/25/19 9/22/19 10/20/19 11/17/19 12/15/19

6/30/2019 57 Bronx, Joela Block 2, Lot 11, Barangay Sampaguita CM LAM 12/31/19
30 7/28/19 8/25/19 9/22/19

5/30/1989 7/28/19 8/25/19 9/22/19 10/20/19 11/17/19 12/15/19

6/30/2019 58 Tendacion, Teri Block 2, Lot 1, Barangay Sampaguita CM LAM 12/31/19
30 7/28/19 8/25/19 9/22/19

10/31/1984 8/9/19 9/6/19 10/4/19 11/1/19 11/29/19

7/12/2019 59 Cruz, Lala Block 2, Lot 2, Barangay Sampaguita CM LAM 12/31/19
35 8/9/19 9/6/19 10/4/19 11/1/19

1/25/1983 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19

7/15/2019 60 Insigida, Cresentia Block 2, Lot 33, Barangay Sampaguita CM LAM
36 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19

3/31/1991 8/27/19 9/24/19 10/22/19 11/19/19 12/17/19

7/30/2019 61 Tapale, Pauline Block 2, Lot 3, Barangay Sampaguita NA NONE
28 8/27/19 9/24/19 10/22/19 11/19/19 12/17/19

4/12/1993 9/23/19 10/21/19 11/18/19 12/16/19

8/26/2019 62 Hamak, Elena Block 2, Lot 4, Barangay Sampaguita NA NONE
26 9/23/19 10/21/19 11/18/19 12/16/19

8/15/1995 9/27/19 10/25/19 11/22/19 12/20/19

8/30/2019 63 Abandia, Killua Block 2, Lot 9, Barangay Sampaguita NA NONE
24 9/27/19 10/25/19 11/22/19 12/20/19

3/15/1995 10/15/19 11/12/19 12/10/19

9/17/2019 64 Eleveste, Manuela Block 2, Lot 7, Barangay Sampaguita NA NONE
24 10/15/19 11/12/19 12/10/19

7/31/1995 10/26/19 11/23/19 12/21/19

9/28/2019 65 Alapaap, Donna Block 2, Lot 8, Barangay Sampaguita NA NONE
24 10/26/19 11/23/19 12/21/19

7/31/2002 10/26/19 11/23/19 12/21/19

9/28/2019 66 Cruz, Donna Block 2, Lot 8, Barangay Sampaguita NA NONE
17 10/26/19 11/23/19 12/21/19

7/31/2003 10/26/19 11/23/19 12/21/19

9/28/2019 66 Bautista, Lani Block 2, Lot 8, Barangay Sampaguita NA NONE
16 10/26/19 11/23/19 12/21/19
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Clinic A
Target Client List for PILLS COC
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

6/5/1981 7/26/19 8/23/19 9/20/19 10/18/19 11/15/19 12/13/19

6/28/2019 56 Amando, Guia Block 1, Lot 9, Barangay Sampaguita NA NONE 12/31/19
38 7/26/19 8/23/19 9/20/19 10/18/19 11/15/19

12/26/1969 7/28/19 8/25/19 9/22/19 10/20/19 11/17/19 12/15/19

6/30/2019 57 Temano, Arianna Block 2, Lot 11, Barangay Sampaguita NA NONE 12/31/19
50 7/28/19 8/25/19 9/22/19

5/30/1968 7/28/19 8/25/19 9/22/19 10/20/19 11/17/19 12/15/19

6/30/2019 58 Toledo, Camille Block 2, Lot 1, Barangay Sampaguita NA NONE 12/31/19
51 7/28/19 8/25/19 9/22/19

10/31/1969 8/9/19 9/6/19 10/4/19 11/1/19 11/29/19

7/12/2019 59 Gapon, Alana Block 2, Lot 2, Barangay Sampaguita NA NONE 12/31/19
50 8/9/19 9/6/19 10/4/19 11/1/19 11/29/19

1/25/1969 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19

7/15/2019 60 Cruz, Jaya Block 2, Lot 33, Barangay Sampaguita NA NONE 12/31/19
50 8/12/19 9/9/19 10/7/19 11/4/19 12/2/19

3/31/1969 8/27/19 9/24/19 10/22/19 11/19/19 12/17/19

7/30/2019 61 Salonga, Leona Block 2, Lot 3, Barangay Sampaguita NA NONE 12/31/19
50 8/27/19 9/24/19 10/22/19 11/19/19 12/17/19

4/12/1969 9/23/19 10/21/19 11/18/19 12/16/19

8/26/2019 62 Rebosura, Alicia Block 2, Lot 4, Barangay Sampaguita NA NONE 12/31/19
50 9/23/19 10/21/19 11/18/19 12/16/19

8/15/1969 9/27/19 10/25/19 11/22/19 12/20/19

8/30/2019 63 Tangga-an, Hie Block 2, Lot 9, Barangay Sampaguita NA NONE 12/31/19
50 9/27/19 10/25/19 11/22/19 12/20/19

3/15/1969 10/15/19 11/12/19 12/10/19

9/17/2019 64 Panares, Belina Block 2, Lot 7, Barangay Sampaguita NA NONE 12/31/19
50 10/15/19 11/12/19 12/10/19

7/31/1969 10/26/19 11/23/19 12/21/19

9/28/2019 65 Punzalan, Ruth Block 2, Lot 8, Barangay Sampaguita NA NONE 12/31/19
50 10/26/19 11/23/19 12/21/19
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Clinic A
Target Client List for DMPA
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

5/1/1969 1/15/19 4/15/19 7/15/19 10/15/19

10/15/2017 66 Cartageno, Jane Zone 1, Barangay Sampaguita CU NONE 12/31/19
50 1/15/19 4/15/19 7/31/19 10/31/19

2/21/1969 1/25/19 4/25/19 7/25/19 10/25/19

10/25/2017 67 Calaguas, Tala Zone 2, Barangay Sampaguita CU NONE 12/31/19
50 1/25/19 4/25/19 7/25/19 10/25/19

1/1/1977 1/25/19 4/25/19 7/25/19 10/25/19

7/29/2017 84 So, Rachel Zone 3, Barangay Sampaguita CU NONE
42 1/25/19 4/25/19 7/25/19 10/25/19

5/6/1973 2/17/19 5/17/19 8/17/19 11/17/19

8/17/2017 85 Navales, Helen Zone 4, Barangay Sampaguita CU PILLS 12/31/19
46 2/17/19 5/17/19 8/17/19

4/25/1972 2/28/19 5/28/19 8/28/19 11/28/19

8/28/2018 86 Entarega, Mona Zone 1, Barangay Sampaguita CU PILLS 12/31/19
47 2/28/19 5/28/19 8/28/19

3/25/1973 1/25/19 4/25/19 7/25/19 10/25/19

10/30/2018 87 Tamale, Dane Zone 2, Barangay Sampaguita CU PILLS 12/31/19
46 1/25/19 4/25/19

4/30/1975 1/25/19 4/25/19 7/25/19 10/25/19

10/25/2018 88 Ilagan, Gia Zone 3, Barangay Sampaguita CU NONE 12/31/19
44 1/25/19 4/25/19

6/12/1977 2/17/19 5/17/19 8/17/19 11/17/19

11/18/2018 89 Labendes, Ina Zone 4, Barangay Sampaguita CU NONE 12/31/19
42 2/17/19

10/17/1975
12/16/2018 90 Felinas, Sita Zone 5, Barangay Sampaguita CU NONE 12/31/19
44

3/16/1975
12/22/2019 91 Laaron, Ara Zone 1, Barangay Sampaguita NA NONE
44

5/25/1975
12/22/2019 92 Cartaguena, Meann Zone 1, Barangay Sampaguita NA NONE
44
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Clinic A
Target Client List for INTERVAL IUD
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

1/10/1979
11/24/2013 95 Casparov, Petra Block 3, Lot 9, Barangay Sampaguita CU PILLS 12/4/19
40 12/4/19

8/5/1969
11/25/2014 96 Samparas, Andrea Block 3, Lot 7, Barangay Sampaguita CU PILLS 12/31/19
50

9/23/1970
11/26/2015 97 Rigudon, Hamtara Block 3, Lot 8, Barangay Sampaguita CU PILLS
49 12/4/19

2/9/1970
11/27/2013 98 Garcia, Feliciano Block 3, Lot 12, Barangay Sampaguita CU PILLS
49 1/10/19

4/11/1981
11/28/2017 100 Garamond, Charisse Block 3, Lot 16, Barangay Sampaguita CU PILLS
38 12/4/19

4/15/1981
11/28/2017 100 Gonzaga, Celestine Block 3, Lot 16, Barangay Sampaguita CU PILLS
38 12/4/19

4/15/1981
11/28/2017 100 Gonzaga, Alexa Block 3, Lot 16, Barangay Sampaguita CU PILLS
38 12/4/19

4/25/1981
11/28/2017 100 Santos, Elisa Block 3, Lot 16, Barangay Sampaguita CU PILLS
38 12/4/19
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Barangay Sampaguita
Target Client List for PROGESTIN ONLY SUB DERMAL IMPLANT
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

2/10/1975 1/22/19
1/22/2016 70 Daquia, Lena Block 1, Lot 21, Barangay Sampaguita CU NONE
44 1/29/19

12/5/1978 1/26/19
1/26/2016 71 Rama, Elena Block 1, Lot 3, Barangay Sampaguita CU NONE
41 2/2/19

1/1/1979
2/19/2017 72 Felizar, Hazel Block 1, Lot 2, Barangay Sampaguita CU NONE
40 2/26/19

6/18/1978
12/22/2018 93 Nacional, Teresa Block 3, Lot 3, Barangay Sampaguita CU NONE
41 12/29/19

10/10/1983
12/28/2019 99 Dela Cruz, Aleta Block 3, Lot 14, Barangay Sampaguita RS PILLS
36

5/8/1985
12/23/2019 94 Hinalugad, Areana Block 3, Lot 4, Barangay Sampaguita RS PILLS
34
SAMPLE TARGET CLIENT LIST (TCL) FOR FAMILY PLANNING 2019
Clinic A
Target Client List for BTL
Follow up Visits
Date of Drop-Outs
Age (Upper Space: Next Service Date / Lower Space: Date Accomplished)
Registration No. Client Name Address Type of Client Previous Method Remarks
Birthdate
(mm/dd/yy) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Date Reason***

5/1/1964
10/15/2017 66 Cartageno, Jazzie Zone 1, Barangay Sampaguita CU NONE 12/31/19
55

2/21/1964
10/25/2017 67 Calaguas, Trella Zone 2, Barangay Sampaguita CU NONE 12/31/19
55

1/1/1977
7/29/2017 84 So, Gigi Zone 3, Barangay Sampaguita CU NONE 12/31/19
42

5/6/1973
8/17/2017 85 Navales, Helena Zone 4, Barangay Sampaguita CM PILLS
46

4/25/1964
8/28/2018 86 Entarega, Ramona Zone 1, Barangay Sampaguita CM PILLS 12/31/19
55

3/25/1963
10/30/2018 87 Tamale, Dabiana Zone 2, Barangay Sampaguita CM PILLS 12/31/19
56

4/30/1975
10/25/2018 88 Ilagan, Hadog Zone 3, Barangay Sampaguita CU NONE
44

6/12/1977
11/18/2018 89 Labendes, Inocencia Zone 4, Barangay Sampaguita CU NONE
42

10/17/1975
12/16/2018 90 Felinas, Hazel Zone 5, Barangay Sampaguita CU NONE
44