ANNEX E

SUMMARY REPORT ON PEN IMPLEMENTATION

Year/Quarter: ____________
Region: _____________ City/Municipality: ________________
Province: ___________ Health Facility: _________________

I. NCD RISK ASSESSMENT (Adults 25 years and above)

RISK ASSESSMENT (Adults 25 years and above)

Male Female TOTAL

II. HYPERTENSION (Adults 25 years and above)

HYPERTENSION (Adults 25 years and above)

Male Female TOTAL

III. DIABETES (Adults 25 years and above)

DIABETES (Adults 25 years and above)

Male Female TOTAL

IV. HIGH RISK ADULTS (>30% CVD RISK)

HIGH RISK (>30% CVD Risk)
Male Female TOTAL

Prepared by:

______________________________________
Signature over printed name and designation

Date submitted: __________________