Professional Documents
Culture Documents
Recording Form 1: Philippine Health Agenda - First 100 Days
Recording Form 1: Philippine Health Agenda - First 100 Days
(Last, First, Middle Name) M/F Y/N (Phil health no.) etc.
Form 1 TSeKaP Services
# Name Sex Physical Exam Weight Length Eye Exam Ear Exam Significant Findings
M F
1
2
3
4
5
6
7
Form 1 TSeKaP Services
FORM
1A
NEWBORN 0-28 DAYS
Remarks/Actions Taken
Form 2 TSeKaP Services
# Name Sex Physical Length Weight Complete Blood Typing Urinalysis Stool Exam Eye Exam Ear Exam Significant Findings Remarks/Actions Taken
Exam Blood Count
Complete Stool
# Name SEX Physical Exam Blood Typing Urinalysis Eye Exam Ear Exam Oral Services Significant Findings Remarks/Actions Taken
Blood Count Exam
5
Form 5 TSeKaP Services
F TSeKaP Services
# Name M
Complete
Pregnant Post Partum Non-Pregnant Physical Exam Weight Height Blood Pressure Blood Count Blood Typing Urinalysis Fasting Blood Sugar Stool Exam Family Planing Eye Exam Ear Exam Oral Exam Significant Findings Remarks/Actions Taken
Y/N kg cm Y/N Y/N Y/N Y/N Y/N Y/N w/ Unmet need Counseling Commodities Y/N Y/N Y/N
Form 6 TSeKaP Services
F
# Name M Blood Complete Blood
Pregnant Post Partum Non-Pregnant Physical Exam Weight Height Pressure Count Blood Typing
TSeKaP Services
Urinalysis Fasting Blood Sugar Stool Exam Family Planing
# Name Sex PE Height Weight BP CBC Blood Typing Blood Sugar Urinalysis Stool Eye Exam Ear Exam Oral Services Significant Findings Remarks/Actions Taken
Test Exam
M F Y/N cm kg Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N fbs
Form 7 TSeKaP Services
# Name Sex PE Height Weight BP CBC Blood Typing Blood Sugar Urinalysis
Test
Stool
Exam Eye Exam Ear Exam Oral Services Significant Findings Remarks/Actions Taken
M F Y/N cm kg Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N