9/3/2012 Maria Delos Santos Adelaida Magdamo 123456789: Datevisit CHT Partner Nameofresp Nhtsidnum

DateVisit CHT Partner 9/3/2012 Maria Delos Santos
NameofResp Adelaida Magdamo
NHTSIDNUM 123456789
Name of FamMember Adelaida Magdamo
ReltoHH Head Wife
Sex Female
Age 23
DOB Brgy 8/15/89 Natividad
MunCity Capas
Province Tarlac
9 Yes Yes
9a No
9b No
9c No
10
11 Yes
PH Member Yes
PH IDNUM 12-000-63492327
Date next Interview 10/3/12
Endcoder virginia Wasawas
CHT Partner2 Profession Maria Delos Santos BHW
NameofResp Adelaida Magdamo
NHTSIDNUM 123456789
Name of FamMember Baby boy Wasawas
ReltoHH Head Son Male
Sex
Age 7 days
DOB Brgy 8/27/12 San Pablo
MunCity Capas
Province Tarlac
Date of Health Plan 09/03/12
Health Plan Yes
Referred to Hf San Pablo BHS
Date visit HF 09/04/12
NBS Yes Yes
BCG Yes
HEPB
Exclusive Bf Yes
A3 None
Referred to Hf for A3 N/A N/A
Date seen at HF for A3
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to HF
Plan Date of visit
Date Seen at HF
B1
B2
B3
B4
B5
B6
B7
Referred to Hf for B7
Date seen at HF for B7
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to Hf
Plan Date of visit
Date Seen at HF
C1
Vaccines recieved
C2
Date C2Given
C3
Referred to Hf for C3
Date seen at HF for C3
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to Hf
Plan Date of visit
Date Seen at HF
No. Of PNC
Date of last PNC
with BEP
Plan Date of Visit
HF Delivery Plan
FP Advice Given
Expected date of confinement
Month of Pregnancy
D3
Referred to Hf for D3
Date seen at HF for D3
D4
D5
D6
D7
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to Hf
Plan Date of visit
Date Seen at HF
Given postpartumcare
Referred by
Date care recieved
E1
E2
Referred to Hf for E2
Date seen at HF for E2
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to HF
Plan Date of visit
Date Seen at HF for FP
Name of HP
Address of HP
F1
F2
F3
F4
F5
F6
F7
Referred to Hf for F7
Date seen at HF for F7
Encoder
CHT Partner
Profession
NameofResp
NHTSIDNUM
Name of FamMember
ReltoHH Head
Sex
Age
DOB
Brgy
MunCity
Province
Health Plan
Date of Health Plan
Referred to HF
Plan Date of visit
Date Seen at HF for Cough
Name of HP
Address of HP
G1
G2
Referred to HFfor G2
Date seen at HF for G2
Sched of next visit

9/3/2012 Maria Delos Santos Adelaida Magdamo 123456789: Datevisit CHT Partner Nameofresp Nhtsidnum

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9/3/2012 Maria Delos Santos Adelaida Magdamo 123456789: Datevisit CHT Partner Nameofresp Nhtsidnum

Uploaded by

Copyright:

Available Formats

DateVisit CHT Partner 9/3/2012 Maria Delos Santos

NameofResp Adelaida Magdamo

Name of FamMember Adelaida Magdamo

ReltoHH Head Wife

DOB Brgy 8/15/89 Natividad

Date next Interview 10/3/12

Endcoder virginia Wasawas

CHT Partner2 Profession Maria Delos Santos BHW

NameofResp Adelaida Magdamo

Name of FamMember Baby boy Wasawas

ReltoHH Head Son Male

DOB Brgy 8/27/12 San Pablo

Date of Health Plan 09/03/12

Health Plan Yes

Referred to Hf San Pablo BHS

Date visit HF 09/04/12

NBS Yes Yes

Referred to Hf for A3 N/A N/A

Date seen at HF for A3

Date of Health Plan

Plan Date of visit

Date seen at HF for B7

Date of Health Plan

Plan Date of visit

Date seen at HF for C3

Date of Health Plan

Plan Date of visit

Date of last PNC

Plan Date of Visit

Expected date of confinement

Date seen at HF for D3

Date of Health Plan

Plan Date of visit

Date care recieved

Date seen at HF for E2

Date of Health Plan

Plan Date of visit

Date Seen at HF for FP

Date seen at HF for F7

Date of Health Plan

Plan Date of visit

Date Seen at HF for Cough

Date seen at HF for G2

Sched of next visit

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