FAMILY HEALTH SERVICE AND PROGRESS RECORD

Head of the Family: NONITA MILANO VIRTUAL COMMUNITY: VITAS, TONDO MANILA
Address : BUILDING 50 VITAS, TONDO MANILA

Assessment of the family, Home and Environmental Condition

Occupation
Family Member Relation to Head Sex age Religion Educational Attainment
Type of work Place

No. Name
1 Nonita Milano Mother Female 49 years old None
2

Members not residing in the household but affect family resources generation and use
Occupation
Family Relation to Educational Type of monthly Remarks/Date
Member Head Sex Birthday Age Religion Attainment work Place salary Entered
Name

A. Home and Environment

Date Assessed: October 5, 2020
 1. Home
a. construction materials (✅) wood/bamboo ( )concrete ( ) mixed ; wood /concrete
b. Number of rooms used for sleeping 2 rooms
c. Lighting facilities (✅) electricity ( ) kerosene others specify
d. General sanitary condition
Narrow passage sorrounded by bags and plastic container. There home ceiling is quite low reasons why their home temperature is too hot.

2. Drinking Water Supply

Source : ( ) private (✅) public Potability
Distance from the house Appx. 5 to 10 meters meters
Storage : ( ) none direct from faucet () container with cover ( ✅) container w/o cover others specify _ _ _ _

3. Kitchen
Cooking Facility ( ) electric stove ( ) gas stove () fire wood/charcoal
Sanitary Condition Inadequate space, disorganized and unsanitized area
Drainage facility (✅) open () covered ( ) none

4. Waste Disposal
a. Garbage
Container ( ) covered (✅) open ( ) none
Method of Disposal
( ) hog feeding ( ) open burning
(✅) open ( ) garbage collection How many times a week
dumping ( ) others specify
( ) pit
( ) composting

b. Toilet Facility
type ( ) none
( ) water sealed ( ) flush (✅) buhos
( ) pit privy ( ) covered (✅) w/o cover
others specify
distance from the house Appx. 3 to 5 meters from the house
Sanitary condition Sorrounded by garbages
5. Domestic Animals
Kind: Number : Where Kept: Vaccine:
 6. The Community in General
a. General sanitary condition:
b. Housing congestion (✅) yes ( ) no
c. Presence of breeding sites of vectors of disease (✅) yes; specify Mosquito, Flies ( ) None
d. Recreational Facilities : Improvised basketball board and ring made by them
e. Availability of health care facilities / services; Near Vitas HCC Describe briefly They don´t have healthcare facility along the area

f. Distance of the house from the nearest health care facility Appx. 500 meters, 6 mins walk from their home and appx. 1 to 2km, 5 mins drive to tondo
medical center

B. Socio-economic
Average monthly income in peso
(approximation) 9,000 Average monthly expenses (approximation) 15,000

Recreational Activity / Activities:

C. Health Condition
1. Maternal and Child Health

Name of mother Place of Delivery Remarks

Any Pathological Condition current status Medication

Elevated B/P ( ) treated ( )
diabetes/history if diabetic ( ) ongoing ( )
diabetes/history if diabetic ( ) no action taken ( ) Reason
any respiratory disease ( )

D. Nutritional Status of Children (describe): Skinny, pale and dry skin, bloated tummy
E. Family Planning:
1. Birth spacing
2. Method of contraception
3. Mother of reproductive age: (✅) yes ( ) no
F. Health Status:
1. Common Illnesses for the past 2 years 2. Causes of death for the Past 5 years
Diarrhea -Inadequate or lack of information
TB about healthcare and it´s services
Malnutriton -Inadeuate financial supports
Scabies or skin infections
Severe anemia -Inadequate information about
diseases, it´s prevention and treatment