FHSIS REPORT for the MONTH: JANUARY YEAR: 2020

Number of Barangays:
Number of BHS:
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1) MUN
*To be accomplished by PHA/FHSIS Focal
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 4 4
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 5 239 244 0 0 3 3 0 0 0 0 0 0 0 0 0 5 242 247 0 0 7 7
d. Pills - Total 0 2 294 296 0 0 31 31 0 0 0 0 0 0 0 0 0 2 325 327 0 0 17 17
d.1 Pills-POP - Total 0 0 78 78 0 0 25 25 0 0 0 0 0 0 0 0 0 0 103 103 0 0 9 9
d.2 Pills-COC - Total 0 2 216 218 0 0 6 6 0 0 0 0 0 0 0 0 0 2 222 224 0 0 8 8
e. Injectables (DMPA/POI)-Tot. 0 0 168 168 0 0 5 5 0 0 0 0 0 0 0 0 0 0 173 173 0 0 7 7
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.1 IUD-I- Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 3 255 258 0 0 35 35 0 0 0 0 0 0 49 49 0 3 241 244 0 0 40 40
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 13 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 13 13 0 0 0 0
m. Total Current Users 0 10 975 985 0 0 74 74 0 0 0 0 0 0 49 49 0 10 1000 1010 0 0 71 71

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 1 54 55 completed doses of calcium carbonate 0 0 14 14
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 3 53 56
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 4 4

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 3 51 54 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 2 29 31 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 9 9

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 27 27
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 31 31 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 1 49 50 20. No. of deliveries attended by skilled
49
19. No. of live births – Total 0 0 50 50 health professionals - Total

a. No. of live births with 51 a. No. of deliveries attended by a 1

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 31

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 31

c. No. of live births with 0 c. No. of deliveries attended by 19

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 49 49
21. No. of health facility-based
deliveries - Total 47
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 48 24a. No. of full-term births – Total 0 0 46 46

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 1
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

1
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 48 48 0 0 20 20
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 35 35
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 23 22 45 11. PCV 1 - Total 28 26 54
2. BCG - Total 9 8 17 12. PCV 2 - Total 31 27 58
3. HepB, within 24 hours. - Total 26 20 46 13. PCV 3 - Total 31 29 60
4. DPT-HiB-HepB 1 - Total 26 25 51 14. MCV 1 - Total 26 23 49
5. DPT-HiB-HepB 2 - Total 29 25 54 15. MCV 2 - Total 21 29 50
6. DPT-HiB-HepB 3 - Total 28 30 58 16. FIC - Total 27 25 52
7. OPV 1 - Total 10 9 19 17. CIC - Total 12 20 32

8. OPV 2 - Total 13 11 24 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 15 13 28 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 21 18 39 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 28 23 51 27. Infants 6-11 mos. given 1 dose of Vitamin A 5 10 15
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 10 6 16
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 25 31 56 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 19 26 45 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 3 3 6

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 10 10 20
31. 1-19 y/o given 2 doses of deworming drug - Total 30 23 53
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 6 4 10
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 15 10 25
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
2 1 3 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

5 3 8 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
3 3 6
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 1 1 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 1 1 2
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
1 1 2 1 1 2
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 15 15 30 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 75 43 118

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 5 3 8

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 10 12 22 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 3 3 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0 2
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total 0 Total 2

b. No. of HHs with Level II - Total 0 b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
0 system - Total 0

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

0

3. No. of industrial establishments issued with sanitary permit -

Total 0
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 2 2 1. Livebirths - Total 25 26 51 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
ABDULLAH BUISAN, MASIU (SEPTEMBER)
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 770
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 1 1
Current Users Acceptors Drop-outs Current Users New Acceptors

122 (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 3 3 0 0 0 0 0 0 2 2 0 0 26 26 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 1 1 15. MCV 2 - Total 0 0 0
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 858
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 2 2 0 0 0 0 0 0 0 0 0 0 9 9 0 0 1 1
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 1 1
d.2 Pills-COC - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 4 4 0 0 0 0 0 0 2 2 0 0 29 29 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 0 0 0
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 0

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

0

3. No. of industrial establishments issued with sanitary permit -

Total 0
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 610
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 20 20 0 0 1 1 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 1 1

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 2 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 2 3
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 1 2 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 10 9 19

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 2043
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 20-49 y/o 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 2 2
d. Pills - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 0 0 0 0 16 16 0 0 2 2
d.1 Pills-POP - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.2 Pills-COC - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 2 2
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 49 49 0 0 2 2 0 0 0 0 0 0 2 2 0 0 49 49 0 0 8 8

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 4 4 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 4 4
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 4 4 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 2 2 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 2 2 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 4 4 20. No. of deliveries attended by skilled
4
19. No. of live births – Total 0 0 4 4 health professionals - Total

a. No. of live births with 4 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 4

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 4

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 4 4
21. No. of health facility-based
deliveries - Total 4
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 4 24a. No. of full-term births – Total 0 0 4 4

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 4 4 0 0 4 4
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 4 4
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 2 2 4 11. PCV 1 - Total 5 4 9
2. BCG - Total 0 0 0 12. PCV 2 - Total 4 3 7
3. HepB, within 24 hours. - Total 2 2 4 13. PCV 3 - Total 4 4 8
4. DPT-HiB-HepB 1 - Total 5 4 9 14. MCV 1 - Total 1 3 4
5. DPT-HiB-HepB 2 - Total 4 3 7 15. MCV 2 - Total 2 5 7
6. DPT-HiB-HepB 3 - Total 4 4 8 16. FIC - Total 1 3 4
7. OPV 1 - Total 0 0 0 17. CIC - Total 2 5 7

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 4 4 8 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 2 2 4 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 4 4 8 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 3 3 6 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 2 2
31. 1-19 y/o given 2 doses of deworming drug - Total 3 2 5
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 1 0 1
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
1 0 1 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

2 2 4 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
2 2 4
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 2 3 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 2 2 4

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 2 2 4 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 524
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 20-49 y/o 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 1 5 6 0 0 1 1 0 0 0 0 0 0 0 0 0 1 6 7 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 1 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 1 4 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 17 18 0 0 3 3 0 0 0 0 0 0 1 1 0 1 19 20 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0, 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 0 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 0 0 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 0 0
3. HepB, within 24 hours. - Total 0 0 0 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 0 0 0 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 1 0 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 1 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 1 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 6 1 7

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 825
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 2 2
d. Pills - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 1 1 0 0 10 10 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 31 31 0 0 2 2 0 0 0 0 0 0 1 1 0 0 32 32 0 0 3 3

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 1 1 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 1 1 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 1 1 2 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 0
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 0 0

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 2 2 11. PCV 1 - Total 1 2 3
2. BCG - Total 0 2 2 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 0 2 2 13. PCV 3 - Total 1 1 2
4. DPT-HiB-HepB 1 - Total 1 2 3 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 1 1 2 16. FIC - Total 1 1 2
7. OPV 1 - Total 1 2 3 17. CIC - Total 1 1 2

8. OPV 2 - Total 1 1 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 1 2 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 1 2 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 2 0 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 1 2 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 1 2
31. 1-19 y/o given 2 doses of deworming drug - Total 2 1 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
1 1 2 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 2 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 494
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
m. Total Current Users 0 0 16 16 0 0 3 3 0 0 0 0 0 0 1 1 0 0 18 18 0 0 2 2

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 0 0 0
2. BCG - Total 0 1 1 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 0 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 0 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 0 1
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 1 0 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 1 2
31. 1-19 y/o given 2 doses of deworming drug - Total 1 2 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 1 1
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 1 0 1

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1039
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 0 0
d.1 Pills-POP - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 1 7 8 0 0 1 1 0 0 0 0 0 0 1 1 0 1 7 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 34 35 0 0 1 1 0 0 0 0 0 0 1 1 0 1 34 35 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 1 1 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 1 1 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 1 1 2 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 2 0 2 11. PCV 1 - Total 1 2 3
2. BCG - Total 2 0 2 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 2 0 2 13. PCV 3 - Total 1 1 2
4. DPT-HiB-HepB 1 - Total 1 2 3 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 1 1 2 16. FIC - Total 1 1 2
7. OPV 1 - Total 1 2 3 17. CIC - Total 1 1 2

8. OPV 2 - Total 1 1 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 1 2 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 1 2 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 2 0 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 1 2 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 1 2
31. 1-19 y/o given 2 doses of deworming drug - Total 2 1 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 4 0 4

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 2 0 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 680
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 1 1 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 22 22 0 0 1 1 0 0 0 0 0 0 1 1 0 0 22 22 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 0 0 11. PCV 1 - Total 1 0 1
2. BCG - Total 1 0 1 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 0 1 1 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 1 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 1 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 2 2
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1118
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 7 8 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7 8 0 0 0 0
d. Pills - Total 0 0 12 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12 12 0 0 0 0
d.1 Pills-POP - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 2 2 0 0 3 3 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 1 30 31 0 0 1 1 0 0 0 0 0 0 2 2 0 1 29 30 0 0 3 3

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

93
 94

Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 2 2
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 1 2 11. PCV 1 - Total 2 3 5
2. BCG - Total 0 0 0 12. PCV 2 - Total 2 2 4
3. HepB, within 24 hours. - Total 1 1 2 13. PCV 3 - Total 4 1 5
4. DPT-HiB-HepB 1 - Total 2 3 5 14. MCV 1 - Total 1 2 3
5. DPT-HiB-HepB 2 - Total 2 2 4 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 4 1 5 16. FIC - Total 1 2 3
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 1 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 4 1 5 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 2 2 4 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 2 1 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 0 1
31. 1-19 y/o given 2 doses of deworming drug - Total 2 1 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 1 0 1
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 1 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
1 1 2 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total >Given MultiVit. and Paracetamol
37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

1 1 2 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received >Given MultiVit. and Paracetamol
Vitamin A - Total
1 1 2
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 1 2 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 1 1 2

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1743
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 2 2
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 11 12 0 0 0 0 0 0 0 0 0 0 0 0 0 1 11 12 0 0 0 0
d. Pills - Total 0 0 11 11 0 0 1 1 0 0 0 0 0 0 0 0 0 0 12 12 0 0 3 3
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 1 1
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 2 2
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
m. Total Current Users 0 1 48 49 0 0 3 3 0 0 0 0 0 0 2 2 0 1 49 50 0 0 4 4

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 4 4 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 4 4
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 4 4 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 4 4 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 4 4 20. No. of deliveries attended by skilled
4
19. No. of live births – Total 0 0 4 4 health professionals - Total

a. No. of live births with 4 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 2

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 4 4
21. No. of health facility-based
deliveries - Total 4
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 4 24a. No. of full-term births – Total 0 0 4 4

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 4 4 0 0 4 4
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 4 4
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 3 1 4 11. PCV 1 - Total 0 2 2
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 3 1 4 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 2 2 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 1 2 3
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 1 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 2 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 3 1 4 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 2 1 3 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 2 2 4 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 1 0 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 3 3 6
31. 1-19 y/o given 2 doses of deworming drug - Total 7 5 12
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 2 1 3
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 2 1 3
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 2 2

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 3 1 4 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 672
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 20 20 0 0 2 2 0 0 0 0 0 0 1 1 0 0 21 21 0 0 2 2

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 1 1
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 1 1

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 1 1

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 0 0 0
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 0 0 0
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 0 0
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 1 1

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 1 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 1 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 0 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 1 2
31. 1-19 y/o given 2 doses of deworming drug - Total 1 1 2
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 1 1 2
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 1 1 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 1 1 2
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 1 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 2 1 3

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 1 1 2

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
2
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 2

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

0

3. No. of industrial establishments issued with sanitary permit -

Total 0
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 733
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 23 23 0 0 2 2 0 0 0 0 0 0 1 1 0 0 24 24 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 1 2
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 2 0 2
5. DPT-HiB-HepB 2 - Total 0 0 0 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 0 0 0 16. FIC - Total 2 0 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 0 1

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 0 0 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 2 0 2

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 710
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 21 21 0 0 2 2 0 0 0 0 0 0 1 1 0 0 22 22 0 0 2 2

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 1 1 2 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 0 0 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 1 2 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 2 2
3. HepB, within 24 hours. - Total 1 1 2 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 2 2 15. MCV 2 - Total 0 0 0
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 1 0 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 2 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 0 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 0 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

2 0 2 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received >Cough and Fever,Given Multivitamins and Salbutamol
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 0 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 1 1

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 2 0 2

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 875
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 2 2
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 2 2 0 0 7 7 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 29 29 0 0 1 1 0 0 0 0 0 0 2 2 0 0 28 28 0 0 4 4

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 2 2
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 2 2

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 2 2
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 2 2 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 1 2 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 1 1 2 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 1 1 2 16. FIC - Total 1 1 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 1 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 1 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 0 1
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 1 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1020
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d. Pills - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 26 26 0 0 2 2 0 0 0 0 0 0 1 1 0 0 27 27 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 2 2
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 2 2 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 2

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 2 2
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 2 2 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 2 2 12. PCV 2 - Total 0 2 2
3. HepB, within 24 hours. - Total 0 2 2 13. PCV 3 - Total 1 2 3
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 0 2 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 1 2 3 16. FIC - Total 1 1 2
7. OPV 1 - Total 0 1 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 2 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 2 3 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 2 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 0 1
31. 1-19 y/o given 2 doses of deworming drug - Total 2 1 3
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 2 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 585
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 19 19 0 0 2 2 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 1 1

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 1 1 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 1 0 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 1 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 0 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 0 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 1 2
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 1 2 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 10 7 17

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total
0
a. No. of HH with pour/flush toilet connected to septic tank -
a. No. of HHs with Level I - Total Total 0

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total 0

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

0

3. No. of industrial establishments issued with sanitary permit -

Total 0
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 864
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 1 1 0 0 10 10 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 32 32 0 0 3 3 0 0 0 0 0 0 1 1 0 0 34 34 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 0 0 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 0 0 0 13. PCV 3 - Total 1 1 2
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 1 1 2 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 1 1 17. CIC - Total 0 1 1

8. OPV 2 - Total 1 1 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 1 2 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 1 2 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 1 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 1 1
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 1 2 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 739
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 1 1 0 0 7 7 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 2 2 0 0 0 0 0 0 1 1 0 0 28 28 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 0 0 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 796
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 2 2 0 0 0 0 0 0 1 1 0 0 26 26 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 1 1

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 0 0 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 1 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 1 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 1 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 1 2
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 2 2 4 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 10 9 19

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 2 1 3 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 1 1 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 684
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 2 2 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 1 1 0 0 2 2 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 17 17 0 0 3 3 0 0 0 0 0 0 1 1 0 0 19 19 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 1 2 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 4 2 6

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 1 2 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1 1 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0 Senility
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 891
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 31 31 0 0 2 2 0 0 0 0 0 0 2 2 0 0 31 31 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 0 0 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 1 1 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 1 1 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 2 2 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
0
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 1 2 11. PCV 1 - Total 0 0 0
2. BCG - Total 1 1 2 12. PCV 2 - Total 0 2 2
3. HepB, within 24 hours. - Total 1 1 2 13. PCV 3 - Total 2 1 3
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 2 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 2 1 3 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 2 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 2 1 3 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 2 1 3 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 2 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 1 1
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 0 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 459
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 19 19 0 0 2 2 0 0 0 0 0 0 1 1 0 0 20 20 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 1 1
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 1 0 1 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 1 0 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 1 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 1 1
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 0 1
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 0 1
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 1 0 1
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 0 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 627
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 1 1 0 0 4 4 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 21 21 0 0 2 2 0 0 0 0 0 0 1 1 0 0 22 22 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 1 1
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 1 1

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 0 0 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 0 1 1
5. DPT-HiB-HepB 2 - Total 0 1 1 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 1 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 0 1
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 1 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 1 0 1

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 1 0 1

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 615
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 1 1
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 2 2 0 0 8 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 1 1 0 0 0 0 0 0 2 2 0 0 24 24 0 0 2 2

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 0 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 0 0 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 1 1 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 2 0 2
5. DPT-HiB-HepB 2 - Total 0 0 0 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 0 0 16. FIC - Total 2 0 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 1 1

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 1 0 1
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 1 0 1

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 1 1

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 963
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 1 1
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 2 2
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 2 2
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 10 10 0 0 1 1 0 0 0 0 0 0 2 2 0 0 9 9 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 30 30 0 0 2 2 0 0 0 0 0 0 2 2 0 0 30 30 0 0 4 4

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 2 2
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 2 2 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 1 0 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 1

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

1
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 1 0 1 12. PCV 2 - Total 2 0 2
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 2 0 2
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 2 0 2 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 2 0 2 16. FIC - Total 1 1 2
7. OPV 1 - Total 1 0 1 17. CIC - Total 0 0 0

8. OPV 2 - Total 2 0 2 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 2 0 2 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 1 2 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 1 2
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 1 1 2
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 2 1 3 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 1 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 2 0 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0£ 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 2411
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 1 1
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 16 17 0 0 0 0 0 0 0 0 0 0 0 0 0 1 16 17 0 0 1 1
d. Pills - Total 0 1 15 16 0 0 2 2 0 0 0 0 0 0 0 0 0 1 17 18 0 0 0 0
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 1 11 12 0 0 1 1 0 0 0 0 0 0 0 0 0 1 12 13 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 15 15 0 0 1 1 0 0 0 0 0 0 2 2 0 0 14 14 0 0 3 3
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 3 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
m. Total Current Users 0 2 57 59 0 0 3 3 0 0 0 0 0 0 2 2 0 2 58 60 0 0 4 4

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 3 3 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 3 3
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 3 3

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 3 3 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 3 3 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 2 2
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 3 3 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 1 2 11. PCV 1 - Total 1 2 3
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 2 3
3. HepB, within 24 hours. - Total 1 1 2 13. PCV 3 - Total 2 2 4
4. DPT-HiB-HepB 1 - Total 1 2 3 14. MCV 1 - Total 1 2 3
5. DPT-HiB-HepB 2 - Total 1 2 3 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 2 2 4 16. FIC - Total 1 2 3
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 2 3 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 2 1 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 1 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 1 2
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 1 2
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 2 1 3 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 10 3 13

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 1 1 2

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1 1 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 761
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 9 9 0 0 1 1 0 0 0 0 0 0 2 2 0 0 8 8 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 25 25 0 0 2 2 0 0 0 0 0 0 2 2 0 0 25 25 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 0 0
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 0 0

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 0 0 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 0 0 0
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 0 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 761
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d.1 Pills-POP - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 3 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 1 1 0 0 7 7 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 22 22 0 0 3 3 0 0 0 0 0 0 1 1 0 0 24 24 0 0 2 2

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 0 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 1
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 1 1
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 1 0 1 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 0 1 1 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 0 1
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 0 0 0
7. OPV 1 - Total 0 1 1 17. CIC - Total 1 0 1

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 0 1 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 0 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 1 0 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 1 0 1

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 0 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1626
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 12 13 0 0 0 0 0 0 0 0 0 0 0 0 0 1 12 13 0 0 0 0
d. Pills - Total 0 0 14 14 0 0 1 1 0 0 0 0 0 0 0 0 0 0 15 15 0 0 1 1
d.1 Pills-POP - Total 0 0 4 4 0 0 1 1 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
d.2 Pills-COC - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 14 14 0 0 1 1 0 0 0 0 0 0 2 2 0 0 13 13 0 0 2 2
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 47 48 0 0 2 2 0 0 0 0 0 0 2 2 0 1 47 48 0 0 3 3

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 3 3 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 3 3
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 3 3 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 3 3 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 3 3
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 3 3 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 2

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 2

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 0 0 11. PCV 1 - Total 1 1 2
2. BCG - Total 1 1 2 12. PCV 2 - Total 2 1 3
3. HepB, within 24 hours. - Total 2 1 3 13. PCV 3 - Total 2 1 3
4. DPT-HiB-HepB 1 - Total 1 1 2 14. MCV 1 - Total 0 0 0
5. DPT-HiB-HepB 2 - Total 2 1 3 15. MCV 2 - Total 0 0 0
6. DPT-HiB-HepB 3 - Total 2 1 3 16. FIC - Total 1 2 3
7. OPV 1 - Total 1 1 2 17. CIC - Total 1 2 3

8. OPV 2 - Total 2 1 3 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 2 1 3 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 2 1 3 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 3 2 5 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 1 1 2 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 4 2 6

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 1712
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 11 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 11 0 0 0 0
d. Pills - Total 0 0 13 13 0 0 1 1 0 0 0 0 0 0 0 0 0 0 14 14 0 0 1 1
d.1 Pills-POP - Total 0 0 3 3 0 0 1 1 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
d.2 Pills-COC - Total 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 2 13 15 0 0 1 1 0 0 0 0 0 0 2 2 0 2 12 14 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 2 42 44 0 0 2 2 0 0 0 0 0 0 2 2 0 2 42 44 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 3 3 completed doses of calcium carbonate 0 0 3 3
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 3 3
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 3 3 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 2 2 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 3 3
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 3 3 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 0 0

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 2 0 2
2. BCG - Total 1 0 1 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 2 3
4. DPT-HiB-HepB 1 - Total 2 0 2 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 0 3 3
6. DPT-HiB-HepB 3 - Total 1 2 3 16. FIC - Total 1 0 1
7. OPV 1 - Total 2 0 2 17. CIC - Total 0 0 0

8. OPV 2 - Total 1 0 1 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 1 2 3 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 1 2 3 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 1 2 3
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 3 0 3
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 3 3 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 3 3 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 1 0 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 1 0 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 875
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 1 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 1 5 6 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 1 1
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
e. Injectables (DMPA/POI)-Tot. 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 1 1 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 1 21 22 0 0 2 2 0 0 0 0 0 0 1 1 0 1 22 23 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 0

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 1 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 1 1 12. PCV 2 - Total 1 0 1
3. HepB, within 24 hours. - Total 0 1 1 13. PCV 3 - Total 0 0 0
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 0 0 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 0 0 16. FIC - Total 0 1 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 1 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 1 1 2
31. 1-19 y/o given 2 doses of deworming drug - Total 2 2 4
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 1 1
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 6 2 8

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 0 1 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 799
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0
d. Pills - Total 0 0 8 8 0 0 1 1 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 4 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 1 1 0 0 5 5 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 24 24 0 0 2 2 0 0 0 0 0 0 1 1 0 0 25 25 0 0 1 1

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 1 1
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 0 0 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 0 0 0 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 0 0 0 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 0 0 16. FIC - Total 1 0 1
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 1 1

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 1 1 2

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 884
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
d. Pills - Total 0 0 7 7 0 0 2 2 0 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0
d.2 Pills-COC - Total 0 0 5 5 0 0 1 1 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.1 IUD-I- Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 6 6 0 0 1 1 0 0 0 0 0 0 1 1 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 26 26 0 0 3 3 0 0 0 0 0 0 1 1 0 0 28 28 0 0 1 1

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 2 2 completed doses of calcium carbonate 0 0 2 2
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 2 2
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 2 2 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 0 0 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 2 2

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 2 2
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 2 2 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 2 2 20. No. of deliveries attended by skilled
2
19. No. of live births – Total 0 0 2 2 health professionals - Total

a. No. of live births with 2 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 1

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 1

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 2 2
21. No. of health facility-based
deliveries - Total 2
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 2 24a. No. of full-term births – Total 0 0 2 2

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 2 2 0 0 1 1
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 2 2
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 0 1 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 0 1 1
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 1 0 1
4. DPT-HiB-HepB 1 - Total 1 1 2 14. MCV 1 - Total 1 1 2
5. DPT-HiB-HepB 2 - Total 1 0 1 15. MCV 2 - Total 1 1 2
6. DPT-HiB-HepB 3 - Total 1 0 1 16. FIC - Total 1 1 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 1 1 2

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 0 0 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 1 2 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 1 1 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 1 1 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 1 0 1
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 1 0 1
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 1 1 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 1 1 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 1 2 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: 837
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0 0 0 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 1 1
d. Pills - Total 0 0 8 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 8 0 0 0 0
d.1 Pills-POP - Total 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0
d.2 Pills-COC - Total 0 0 6 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 6 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 5 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 7 7 0 0 1 1 0 0 0 0 0 0 2 2 0 0 6 6 0 0 1 1
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0
m. Total Current Users 0 0 27 27 0 0 1 1 0 0 0 0 0 0 2 2 0 0 26 26 0 0 2 2

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 0 1 1 completed doses of calcium carbonate 0 0 0 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0 0 0 0
their nutritional status during the 1st tri. 0 0 1 1
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0 0 0 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 0 1 1 syphilis - Total 0 0 0 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0 0 0 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 0 0 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0 0 0 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0 0 0 0
c. No. of pregnant women seen in the 0 0 0 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0 0 0 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 0 1 1 CBC or Hgb & Hct count - Total
vaccination-Total 0 0 0 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0 0 0 0
more times given at least 3 doses of Td 0 0 0 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0 0 0 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 0 0 0 positive for gestational diabetes – Total 0 0 0 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 0 1 1 20. No. of deliveries attended by skilled
1
19. No. of live births – Total 0 0 1 1 health professionals - Total

a. No. of live births with 1 a. No. of deliveries attended by a 0

normal birth weight - Total doctor - Total

b. No. of live births with low birth 0 b. No. of deliveries attended by a 0

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total 0 nurse – Total 0

c. No. of live births with 0 c. No. of deliveries attended by 1

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0 0 1 1
21. No. of health facility-based
deliveries - Total 1
23b. No. of deliveries by cesarean
section – Total 0 0 0 0
a. No. of deliveries in
public health facility-Total 1 24a. No. of full-term births – Total 0 0 1 1

24b. No. of pre-term births – Total 0 0 0 0

b. No. of deliveries in 0
private health facility-Tot.
24c. No. of fetal deaths - Total 0 0 0 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0 0 0 0

0
deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0 1 1 0 0 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0 0 0 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 1 0 1 11. PCV 1 - Total 1 0 1
2. BCG - Total 0 0 0 12. PCV 2 - Total 1 1 2
3. HepB, within 24 hours. - Total 1 0 1 13. PCV 3 - Total 0 1 1
4. DPT-HiB-HepB 1 - Total 1 0 1 14. MCV 1 - Total 1 0 1
5. DPT-HiB-HepB 2 - Total 1 1 2 15. MCV 2 - Total 0 1 1
6. DPT-HiB-HepB 3 - Total 0 1 1 16. FIC - Total 1 1 2
7. OPV 1 - Total 0 0 0 17. CIC - Total 0 0 0

8. OPV 2 - Total 0 0 0 18. Td, Grade 1 (November) - Total 0 0 0

9. OPV 3 - Total 0 0 0 19. MR, Grade 1 (November) - Total 0 0 0

10. IPV - Total 0 1 1 20. Td, Grade 7 (November) - Total 0 0 0

21. MR, Grade 7 (November) - Total 0 0 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 1 0 1 27. Infants 6-11 mos. given 1 dose of Vitamin A 0 0 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0 0 0 0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 0 0 supplementation - Total 0 0 0

25. Infants 6 mos. old initiated to complementary 0 0 0 30. Children 12-23 mos. who completed MNP 0 0 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0 0 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0 0 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0 0 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0 0 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0 0 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 0 0 36. Diarrhea cases 0-59 months old seen - Total 0 0 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 0 0 ORS - Total 0 0 0

34. Sick Children 12-59 mos. old seen - Total

0 0 0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0 0 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0 0 0
39. Pneumonia cases 0-59 mos. old seen - Total 0 0 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0 0 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 0 0 - Total 0 0 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 0 0 BOHC - Total 0 0 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0 0 0 0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 0 0 received BOHC - Total 0 0 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 0 0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0 0 0 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 0 0 6. No. of confirmed chronic cases - Total 0 0 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 0 0 Total 0 0 0
3. No. of acute clinically diagnosed cases - Total 0 0 0
4. No. of confirmed acute cases - Total 0 0 0 8. No. of cases treated - Total 0 0 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 0 0 hospital facility - Total 0 0 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0 0 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0 0 0 0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 0 0 treatment - Total 0 0 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0 0 0 0 0

• < 5 y/o - Total 0 0 0 • < 5 y/o - Total 0 0 0

• ≥ 5 y/o - Total 0 0 0 • ≥ 5 y/o - Total 0 0 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0 0 0 0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0 0 0 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 0 0 5. No. of adult women screened for Cervical Cancer 0
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0 0 0

3. Alcohol binge drinkers - Total 0 0 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total 0

4. Overweight/Obese - Total 0 0 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 0 11. No. of senior citizens screened for visual acuity - 0 0 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0 0 0 0

9. No. of newly-identified hypertensive adults - Total 0 0 0 13. No. of senior citizens who received one (1) 0 0 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 0 0 14. No. of senior citizens who received one (1) 0 0 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 0 0 1. Livebirths - Total 1 0 1 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0 0 0 0
3. Under-five Deaths - Total 0 0 0
4. Infant Deaths - Total 0 0 0
5. Neonatal Deaths - Total 0 0 0
6. Fetal Deaths - Total 0 0 0
7. Early Neonatal Deaths - Total 0 0 0
8. Perinatal Deaths - Total 0 0 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
 94

Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
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3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

95
 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

97
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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0
 FHSIS REPORT for the MONTH: JANUARY YEAR: 2020
Name of Barangay: TYPE HERE
Name of BHS: TYPE HERE
Name of Municipality/City:
Name of Province:
TYPE HERE
Lanao del Sur
(M1)BRGY
*To be accomplished by assigned personnel
Projected Population of the Year: TYPE HERE
For submission to RHU/MHC

Section A. Family Planning Services and Deworming for Women of Reproductive Age
Total for WRA
A1. Modern FP Unmet Need Age Remarks
10-49 y/o
(Col. 1) (Col. 2) (Col. 3) (Col. 4)

10-14 y/o 15-19 y/o 20-49 y/o

1. No. of WRA with unmet need for modern FP - Total 0
Current Users Acceptors Drop-outs Current Users New Acceptors

A2. Use of FP Method (Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) (Present Month)
(Previous Month) (Present Month)
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
10-14 15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49
Total 10-14
15-19 20-49 10-14 15-19 20-49
Total 10-14
15-19 20-49
Total Total
y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o y/o
a. BTL - Total 0 0 0 0 0 0 0 0 0
b. NSV - Total 0 0 0 0 0 0 0 0 0
c. Condom - Total 0 0 0 0 0 0 0 0 0
d. Pills - Total 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
d.1 Pills-POP - Total 0 0 0 0 0 0 0 0 0
d.2 Pills-COC - Total 0 0 0 0 0 0 0 0 0
e. Injectables (DMPA/POI)-Tot. 0 0 0 0 0 0 0 0 0
f. Implant - Total 0 0 0 0 0 0 0 0 0
g. IUD (IUD-I and IUD-PP)-Tot. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
g.1 IUD-I- Total 0 0 0 0 0 0 0 0 0
g.2 IUD-PP - Total 0 0 0 0 0 0 0 0 0
h. NFP-LAM - Total 0 0 0 0 0 0 0 0 0
i. NFP-BBT - Total 0 0 0 0 0 0 0 0 0
j. NFP-CMM - Total 0 0 0 0 0 0 0 0 0
k. NFP-STM - Total 0 0 0 0 0 0 0 0 0
l. NFP-SDM - Total 0 0 0 0 0 0 0 0 0
m. Total Current Users 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

91
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Section B. Maternal Care and Services

Indicators Age Total Remarks Indicators Age Total Remarks
(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

B1. Prenatal Care

6. No. of pregnant women who

1. No. of pregnant women w/ at least 4 0 completed doses of calcium carbonate 0
prenatal check-ups - Total supplementation - Total

7. No. of pregnant women given

2. No. of pregnant women assessed of iodine capsules – Total 0
their nutritional status during the 1st tri. 0
-Total 8. No. of pregnant women given one
dose of deworming tablet - Total 0

a. Number of pregnant women seen in 9. No. of pregnant women screened for

the first trimester who have normal 0 syphilis - Total 0
BMI - Total
10. No. of pregnant women tested
positive for syphilis - Total 0
b. No. of pregnant women seen in the
first trimester who have low BMI - 0 11. No. of pregnant women screened
Total for Hepatitis B - Total 0

12. No. of pregnant women tested

positive for Hepatitis B - Total 0
c. No. of pregnant women seen in the 0
first trimester who have high BMI-Total
13. No. of pregnant women screened
for HIV - Total 0
3. No. of pregnant women for the first 14. No. of pregnant women tested for
time given at least 2 doses of Td 0 CBC or Hgb & Hct count - Total
vaccination-Total 0

15. No. of pregnant women tested for

CBC or Hgb & Hct count diagnosed with
4. No. of pregnant women for the 2nd or anemia - Total 0
more times given at least 3 doses of Td 0
vaccination (Td2 Plus) - Total
16. No. of pregnant women screened
for gestational diabetes – Total 0

5. No. of pregnant women who 17. No. of pregnant women tested

completed the dose of iron with folic 0 positive for gestational diabetes – Total 0
acid supplementation - Total

B2. Intrapartum Care and Delivery Outcome

18. No. of deliveries – Total 0 20. No. of deliveries attended by skilled
19. No. of live births – Total 0 health professionals - Total

a. No. of live births with a. No. of deliveries attended by a

normal birth weight - Total doctor - Total

b. No. of live births with low birth b. No. of deliveries attended by a

weight - Total nurse – Total
b. No. of live births with low birth b. No. of deliveries attended by a
weight - Total nurse – Total

c. No. of live births with c. No. of deliveries attended by

unknown birth weight-Total midwives - Total

93
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Indicators Age Total Remarks Indicators Age Total Remarks

(Col. 1) (Col. 2) (Col. 3)  (Col. 4) (Col. 1) (Col. 2) (Col. 3)  (Col. 4)

 10-14   15-19 20-49  10-14   15-19 20-49

23a. No. of vaginal deliveries – Total
0
21. No. of health facility-based
deliveries - Total 23b. No. of deliveries by cesarean
section – Total 0
a. No. of deliveries in
public health facility-Total 24a. No. of full-term births – Total 0

24b. No. of pre-term births – Total 0

b. No. of deliveries in
private health facility-Tot.
24c. No. of fetal deaths - Total 0

22. No. of non-facility-based 24d. No. of abortion/miscarriage - Total 0

deliveries - Total

B3. Postpartum and Newborn Care

27. No. of postpartum women with
25. No. of postpartum women together Vitamin A supplementation – Total
with their newborn who completed at 0 0
least 2 postpartum check-ups -Total

26. No. of postpartum women who

completed iron with folic acid 0
supplementation - Total

Section C. Child Care and Services

Femal Femal
Indicators Male Total Remarks Indicators Male Total Remarks
(Col. 1) (Col. 2) (Col.
e (Col. 4) (Col. 5) (Col. 1) (Col. (Col.
e (Col. 4) (Col. 5)
3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents 2) 3)
1. CPAB - Total 0 11. PCV 1 - Total 0
2. BCG - Total 0 12. PCV 2 - Total 0
3. HepB, within 24 hours. - Total 0 13. PCV 3 - Total 0
4. DPT-HiB-HepB 1 - Total 0 14. MCV 1 - Total 0
5. DPT-HiB-HepB 2 - Total 0 15. MCV 2 - Total 0
6. DPT-HiB-HepB 3 - Total 0 16. FIC - Total 0
7. OPV 1 - Total 0 17. CIC - Total 0

8. OPV 2 - Total 0 18. Td, Grade 1 (November) - Total 0

9. OPV 3 - Total 0 19. MR, Grade 1 (November) - Total 0

10. IPV - Total 0 20. Td, Grade 7 (November) - Total 0

21. MR, Grade 7 (November) - Total 0

 Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
C2. Nutrition Services for Infants and Children 3) 2) 3)

22. Newborns initiated on breastfeeding immediately 0 27. Infants 6-11 mos. given 1 dose of Vitamin A 0
after birth lasting to 90 mins - Total 100,000 I.U. - Total

23. Preterm/LBW infants given iron 28. Children 12-59 mos. old given 2 doses of
0 0
supplementation - Total Vitamin A 200,000 I.U. - Total

29. Infant 6-11 months old who completed MNP

24. Infants exclusively breastfed until 6th month - Total 0 supplementation - Total 0

25. Infants 6 mos. old initiated to complementary 0 30. Children 12-23 mos. who completed MNP 0
feeding with continued breastfeeding - Total supplementation - Total

26. Infants 6 mos. old initiated to complementary

feeding but no longer or never been breastfed - Total 0

C3. Deworming Services for Infants, Children and Adolescents

b. SAC, 5-9 y/o dewormed (2 doses) - Total 0
31. 1-19 y/o given 2 doses of deworming drug - Total 0
c. Adolescents, 10-19 y/o dewormed (2
doses) - Total 0
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 0
C4. Management of Sick Infants and Children
32. Sick Infants 6-11 mos. old seen - Total
0 36. Diarrhea cases 0-59 months old seen - Total 0

33. Sick Infants 6-11 mos. old received Vitamin A - Total

37. Diarrhea cases 0-59 months old received
0 ORS - Total 0

34. Sick Children 12-59 mos. old seen - Total

0 38. Diarrhea cases 0-59 mos. received ORS w/ zinc -
Total 0
35. Sick Children 12-59 mos. old received
Vitamin A - Total
0
39. Pneumonia cases 0-59 mos. old seen - Total 0

40. Pneumonia cases 0-59 mos. old completed

treatment - Total 0

Section D. Oral Care and Services

To be submitted Quarterly
Male Femal
Femal
Indicators Total Remarks Indicators Male Total Remarks
(Col. 2) (Col.
e (Col. (Col.
e
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam 6a. Adolescents 10-14 years old who received BOHC
plus orally fit after rehab - Total 0 - Total 0

2. Clients 5 years old and above with cases 6b. Adolescents 15-19 years old who received
of DMFT - Total 0 BOHC - Total 0

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 96

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total
0 0

4. Children 1-4 years old who received BOHC - Total 8. Senior citizens 60 years old and above who
0 received BOHC - Total 0

5. Children 5-9 years old who received BOHC - 10-14 15-19 20-49
0 Indicators Total Remarks
Total y/o y/o y/o

9. Pregnant women who received BOHC - Total 0

 Section E. Infectious Disease Prevention and Control Services
Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 0 6. No. of confirmed chronic cases - Total 0
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total 0 Total 0
3. No. of acute clinically diagnosed cases - Total 0
4. No. of confirmed acute cases - Total 0 8. No. of cases treated - Total 0
9. No. of confirmed chronic cases referred to a
5. No. of chronic clinically diagnosed cases - 0 hospital facility - Total 0
Total
E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care)
1. No. of WRA, 20-49 years old, who completed 0
2 doses of deworming tablet - Total
E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care)
E5. Tuberculosis Prevention and Control
1. Number of notified TB cases, all forms - Total
3. Number of TB, all forms that are cured and
0 0
completely treated - Total
4. No. of registered bacteriology confirmed drug
2. No. of registered bacteriologically confirmed drug resistant TB Cases (RR/MDR-TB) cured & completed
resistant TB (RR/MDR-TB Cases) - Total 0 treatment - Total 0

E6. Malaria Prevention and Control

1. No. of patients with probable/clinically 2. No. of lab-confirmed Malaria deaths - Total
diagnosed Malaria and confirmed case-Total 0 0

• < 5 y/o - Total 0 • < 5 y/o - Total 0

• ≥ 5 y/o - Total 0 • ≥ 5 y/o - Total 0
E7. Leprosy Prevention and Control E8. Rabies Prevention and Control
1. No. of animal bites - Total
1. No. of Leprosy cases on treatment during
0 0
reporting period - Total
2.. No. of deaths due to Rabies - Total
2. No. of newly detected cases during
reporting period - Total 0 0

Section F. Non-Communicable Disease Prevention and Control Services

Femal Femal
Indicators Male (Col.
e Total Remarks Indicators Male
(Col. (Col.
e Total Remarks
(Col. 1) (Col. 2) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
3) 2) 3)
1. No. of adults risk-assessed using PhilPEN - 0 5. No. of adult women screened for Cervical Cancer
Total using VIA/Pap Smear - Total

2. Current smokers - Total 0

3. Alcohol binge drinkers - Total 0 6. No. of adult women found positive / suspect for
Cervical Cancer using VIA or Pap Smear - Total

4. Overweight/Obese - Total 0

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Femal Femal
Indicators Male (Col. Total Remarks Indicators Male
(Col. (Col. Total Remarks
(Col. 1) (Col. 2) e (Col. 4) (Col. 5) (Col. 1) e (Col. 4) (Col. 5)
3) 2) 3)
7. No. of adult women screened for breast mass - Total 11. No. of senior citizens screened for visual acuity - 0
Total

12. No. of senior citizens diagnosed with eye

8. No. of adult women with suspicious breast disease/s - Total
mass - Total 0

9. No. of newly-identified hypertensive adults - Total 0 13. No. of senior citizens who received one (1) 0
dose of PPV - Total
10. No. of newly-identified adults with Type 2 DM-Total 0 14. No. of senior citizens who received one (1) 0
dose of influenza vaccine - Total
Section G. Environmental Health and Sanitation Services
Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HH with pour/flush toilet connected to septic tank -

a. No. of HHs with Level I - Total Total

b. No. of HHs with Level II - Total b. No. of HHs with pour/flush toilet connected to community
c. No. of HHs with Level III - Total sewer/sewerage system or any other approved treatment
system - Total

c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit -

Total
Section H. Mortality Section I. Natality
Femal Femal
Indicators Male Total Remarks Indicators Male (Col. Total Remarks
(Col. 2) (Col.
e (Col. e
(Col. 1) 3) (Col. 4) (Col. 5) (Col. 1) 2) 3) (Col. 4) (Col. 5)
1. Total Deaths 0 1. Livebirths - Total 0 CBR:
ABR:
a. Livebirths among 15-19 y/o women-Tot.
2. Maternal Deaths - Total 0
3. Under-five Deaths - Total 0
4. Infant Deaths - Total 0
5. Neonatal Deaths - Total 0
6. Fetal Deaths - Total 0
7. Early Neonatal Deaths - Total 0
8. Perinatal Deaths - Total 0