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  • CHN Survey New

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    Evelyn Buen
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    This document contains a community survey of a Filipino family living in Quezon City, Metro Manila. It provides details about the family such as their names, address, religion, place of origin, and children. It also summarizes information about their home, sanitary conditions, excretal disposal, backyard gardening, communicable diseases, source of healthcare, water supply, garbage disposal, dental source, food storage, infant feeding, food supplements given to babies, family planning practices, and source of family planning information. The survey was conducted by Karen Cabillo Sulpico.

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    CHN Survey New.docx

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    This document contains a community survey of a Filipino family living in Quezon City, Metro Manila. It provides details about the family such as their names, address, religion, place of origin, and children. It also summarizes information about their home, sanitary conditions, excretal disposal, backyard gardening, communicable diseases, source of healthcare, water supply, garbage disposal, dental source, food storage, infant feeding, food supplements given to babies, family planning practices, and source of family planning information. The survey was conducted by Karen Cabillo Sulpico.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    5 views3 pages

    CHN Survey New

    Uploaded by

    Evelyn Buen
    This document contains a community survey of a Filipino family living in Quezon City, Metro Manila. It provides details about the family such as their names, address, religion, place of origin, and children. It also summarizes information about their home, sanitary conditions, excretal disposal, backyard gardening, communicable diseases, source of healthcare, water supply, garbage disposal, dental source, food storage, infant feeding, food supplements given to babies, family planning practices, and source of family planning information. The survey was conducted by Karen Cabillo Sulpico.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 3

    Familyon

    H.C No. HOME


    A)Tpefobuilding (UrignBhay)
    Republic fo the Phiipines Strong ( ) t()
    MetroManila (Matibay) (M
    SAN ISIDRO OPERATION

    COMMUNITY SURVEY Mixed ( Makeshift ( )


    Fat BUEN DANILO M. (Magkhalo) (Pangs (Pan gsam
    Last irst M.I.
    Mot BUEN EVELYN E. )B General Sanitary Condition
    Last irst M.I. Religion Place fo Con (Kalhatinglgay
    Origin OLIC Place of Origin ngkalinisan) la gay ng k1
    Address__BATASAN HILLS, QUEZON CITY God ( ) t ( )
    Religion PROMAN CATHOLIC Place of Origin OCC. MINDORO

    DataonFamily: ldren: C) Excretal Disposal


    Purok No BN/A N.y No. N/A Zone No. N/A
    (PagtataponngDumi) ng Dumi)
    Sewage (Kantariliya) (
    )

    Living_ _ Abortion ________ SepticTank ()


    Water sealed ()
    Name Date PublicComfort Rom Room (palikuran) ( )

    foBirth
    D) BackyardGardening
    Vegatable (Gulay)
    AL-JOHN DALE E. BUEN 01/15/2001 Ornamental(Palamuti/dekorasyon)
    Fruittree (Puongnamumunga) (
    JOHN ALEXANDER E. BUEN 03/04/2002 Others (Iba)pa pa) (
    None (Wala)na na) (

    Date Surveyed : COMMUNICABLE


    DISEASEB N
    2 No.fo TB cases N
    Length fo No.foLeposy
    Residency: 2 Under
    Not under treatment (
    District 2 Why?_______________

    Other members fo 3
    SOURCEOFHEALTHCARE
    A.) ealth Center
    B.) ospital ( D.) Industrial Dentst ( ) E.)Others )
    C.)Private (

    D.)Others )
    WATER SUPPLY
    A.) Source (Pin
    Private (Pribado) ( ) (

    Public(Publiko) ( (

    )1
    Pipe(Tubo) ( )
    2. Ho
    se
    (hos)
    B
    Drinking waterstoragestorage
    (Pagli~~Ib~~~~ ng tubig)
    Covered (N~Ika (
    Uncovered (W~~Ilan) ( ) (

    )1Can(Lata) ( )
    2. D
    rum
    (Dram)
    (
    3. Botle (Bote) ( )
    4) Faucet (Gripo) ( ) 5.)Others(Ibapa)()
    GARBAGE DISPOSAL
    A.)Methodfo
    DisposalDisposal
    ~~~~I~I~~~~~t~~a~a~ ng
    Basura)
    DPScollection ~~~~~~~aIngng~ ng DPS) (
    Burning (Pag (
    Dumping ~~~~I~I~~ta (
    Burying (P (
    Recycling (
    Others (Ib pa)__________________
    DENTAL SOURCE
    A.)Health Center (

    B.)Hosptal (

    C.)Private (
    OTHERINFORMATIONRELATEDTOFAMILY
    HEALT ~~~~pang~~~~~~a~~~~~~~~~~~ (DESIGNATI
    ~~~~s~~~~~~~~~~~~~~ sa kalusugana
    A Fod storage ~~~~~agll~~~~~~ba ngpagkain)
    Covered (N~Ika ( )

    Uncovered (W~~Ilan~ takip) ( )

    B. TypefoInfantFeedng(0-2yrs)
    (0-2yrs) ( (Uri ng pagpapakain)
    Breastfeeding ~~~~~~agp ( )

    Aritificial (I~~~~i~~~snaIuali natural) ( )

    C.Type fo Artficial Feeding Feeding


    Condensed(Malapot(Malapot) (

    Evaporated(Malbnaw) ( ) (

    Powdered (Pulbos) (

    D.Fod Suplements Given toBabies to


    Babie ~~~~~~~ ~~~~~~~~~~~~~~~~~~a
    ~~~~~ pagkainnabinibigaysasa
    Plain(Lugaw) (
    Mashed yellow fruits and vegetables () (

    (Dila w Ia ~I ruta at gulay)


    Egg (Itl (
    Flake fsh,meat,chicken (
    (Manipas ~na pinas ng isda,kanne,manok)

    FAMILY PLANNING
    Acceptor ( )

    What method?________________
    NonAcceptor ( )

    Why? _________________
    SourcefoinformationfoFP:
    of FP:
    HC ( Mass media
    Hospital ( ) () Others, specify: (
    Neighbor ( ) )

    SURVEYED BY: KAREN CABILLO SULPICO


    (NAME)

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