BRGY ___________________________________

SULAT EASTERN SAMAR

DOH SURVEY 2016
FAM MIDDLE Relation CIVIL UNME NHTS/4Ps PHILH CR
HH no. SURNAME GIVEN NAME DOD AGE SEX H2O DISPOSA
No. NAME to headd STATUS CLASS MCRA FP USER FP METHOD T L

12/7/1990 27
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
117
 117
12/8/1992 25
REMARKS
PROFILING LEGENDS
HH no
Fam no.
Name
Relation to head
DOB
Age
Sex
Civil statatus
Class
MCRA
FP user
FP method
Unmet
NHTS/4ps
PhilHealth
CR
H2O
Disposal
Remarks
F1 if first family, F2 if second, F3 and so on

1-head; 2-spouse; 3-son; 4-daughter; GC-grandchild; SonIL-son in law; DIL-daughter in law; nephew; neice; mother; MIL-mother in law and so on
Date of birth

M-male; F-female
M-married; S-single; Wid-widow; LI-live in Sep- separated
NP-not preg/not PP (15-49); I-infant;C-child; AD-adolescnt; SC-elderly (60& up); MARP; Preg-Pregnant; PP-postpartum ; Ad/NP- if adolescent and at the same time NP
Married couple of reproductive age; Y-if married woman (15-49); N or X if not. If answered by Y, proceed next question
Y if user, X if not. If answered Y, proceed next column
If answerd "Y" on previous column, indicate what type of FP method; if a none user put NONE
put Y, if not using FP and does not want to get pregnant, put N if not
to be answered by the HH Head: NHTS/4ps-if both; NHTS-if only NHTS not 4ps; NON-if non NHTS and NON 4ps
write Y, if HH has Philhealth and children age 21 and above
put Y if with CR; S if sharing (meaning has NO CR but shares with other HH); OD if Open defecation
source of drinking H2O; Level 1, level 2, deep well, spring; Community water system (CWS) or kalahi
manner of waste disposal: burning, dumping;etc.
all health problems; and other remarks like PWD, HIGHBLOOD, DM, MENTALLY ILL, PWD