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Pregnant Women BARANGAY: - NAME OF CHT PARTNER: - Name AGE Outcome

The document contains forms for collecting demographic information from residents of a barangay, including pregnant women, newborns, children under 5, senior citizens, disabled persons, family planning practices, sanitary facilities, and patients with tuberculosis, high blood pressure, or diabetes. It also includes forms to track attendance at community health team meetings.

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Martin Federic Palco
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73 views12 pages

Pregnant Women BARANGAY: - NAME OF CHT PARTNER: - Name AGE Outcome

The document contains forms for collecting demographic information from residents of a barangay, including pregnant women, newborns, children under 5, senior citizens, disabled persons, family planning practices, sanitary facilities, and patients with tuberculosis, high blood pressure, or diabetes. It also includes forms to track attendance at community health team meetings.

Uploaded by

Martin Federic Palco
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PREGNANT WOMEN

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE OUTCOME


NEWBORN (0-29 DAYS)

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE BIRTHDAY


UNDER FIVE CHILDREN (30 DAYS-BELOW 5 YRS OLD)

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE BIRTHDAY


SENIOR CITIZENS

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE BIRTHDAY


PERSONS WITH DISABILITY

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE TYPE OF DISABILITY


FAMILY PLANNING

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE METHOD USED


FAMILY WITH SANITARY TOILET

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

WITH SANITARY TOILET WITHOUT SANITARY TOILET


NAME OF HEAD OF THE FAMILY NAME OF HEAD OF THE FAMILY
PATIENTS WITH TB

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE DATE STARTED TREATMENT


PATIENTS WITH HIGH BLOOD

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE
PATIENTS WITH DIABETES

BARANGAY:___________________________________________
NAME OF CHT PARTNER:_________________________________

NAME AGE
CHT MEETING ATTENDANCE

DATE NAME BARANGAY SIGNATURE

CHT MEETING ATTENDANCE

DATE NAME BARANGAY SIGNATURE

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