Republic of the Philippines

Province of Antique
PROVINCIAL POPULATION OFFICE
San Jose, Antique
BSPO MIS REPORT

BULAN:__________ TUIG:___________ BARANGAY:_____________ MUNICIPALITY:_____________

I. POPULASYON
BULAN LALAKI BABAE TOTAL

II. LISTAHAN KANG NAGPAKASAL

Officiating
PETSA KANG RELIGION/RELIGIOUS LUGAR KANG
NGARAN ADDRESS EDAD PETSA KANG KASAL Clergyman
PAGKATAWO SECTOR KASAL
(Pari,Opisyal,Pastor)
LALAKI BABAE

III. LISTAHAN KANG NAGBATA

Lugar kang
Ngaran kang Religion/
Petsa Kang pagbata ngaran Birth Nakasal o Wara
NGARAN KANG SEX Nanay kag Edad kang Nanay Citizenship Religious Obra Remarks
Pagkabata kang hospital Order Naakasal
BATA Tatay Sector
Clinic/Instusyon
M F LALAKI BABAE YES NO
IV. LISTAHAN KANG NAPATAY
BULAN NGARAN KANG NAPATAY PETSA EDAD ESTADO GINKAMATAY V.
LALAKI BABAE V.
V.
V.
V.
V.
V.
V.
V.
V.
V.
LISTAHAN KANG NAGSURULOD SA BARANGAY

TINAPUSAN SA SPECIAL
BULAN NGARAN EDAD OBRA PETSA GINHALINAN RASON
PAG-ESKWELA SKILLS
L B ESTADO

VI. LISTAHAN KANG NAG-GURUWA SA BARANGAY

TINAPUSAN
SPECIAL
BULAN NGARAN EDAD SA PAG- OBRA PETSA BULAN NGARAN GINSAYLUHAN RASON
SKILLS
ESKWELA

Prepared by: Certified True & Correct:

 _____________________________ _________________________
BSPO PUNONG BARANGAY

Municipality______________
Barangay_________________
ACCOMPLISHMENT REPORT
Month___________________

Month: POPDEV Responsible Parenthood-Family Planning (RP-FP)

MIS Bahay-bahay FP Acceptors KATROPA AHD Class
Pop’n Births Deaths Marriages In- Out- Target Accom. Target Accom. Target Accom. Target Accom.
report Migration Migration
January
February
March
April
May
June
July
August
Septembe
r
October
November
December

Prepared by: Approved:

________________________________ ________________________________
Barangay Service Point Report Punong Barangay
 FP ACCEPTORS PROFILE
Region: VI
Province: ANTIQUE
City/Municipality: BUGASONG
Age Address Occupation Highest Philhealth No. of Method Reason for Health Health Service Facility Date accepted Reffered by:
Name of FP Acceptors Sex Civil Birth date (5) (6) Educational member? Children Accepted using FP service that provided FP ( 14 ) ( 15 )
(1) (2) Status (4) Attainment Yes No (9) ( 10 ) ( 11 ) provider Service
( 3) (7) ( 12 ) ( 13 )
(8)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.
15.

16.

17.

18.

19.

20.

Note: PLS.USE CODFE NO. BELOW FOR RELIGION, OCCUPATION, CIVIL STATUS, EDUC. ATTAINMENT, METHOD USED

Civil Status Occupation Highest Educational Attainment Method Accepted Method Accepted Reason for using FP Health Service Provider Health Service Facility Referred by:
( Column 3 ) ( Column 6 ) ( Column 7 ) ( Method 10 ) ( Method 10 ) ( Method 11 ) ( Column 12 ) ( Column 13 ) ( Column 15 )
Artificial Methods NFP Methods
1. Married 1. Govt. Employee 6. Laborers 1. No Education A1- Condom N1- CMM/Billings 1. Spacing 1. Doctor 1. BHS 1. BSPO
2. Single 2. Private Employee 7. Vendors 2. Elementary Level A2- IUD N2- BBT 2. Limiting 2. Nurse 2. RHU 2. BHW
3. Widow/Widower 3. Farmers 8. Others 3. Elementary Graduate A3- Pill N3- SDM 3. Achieving 3. Midwife 3. Hospital 3. BNS
4. Separated 4. Fisher Folks 4. HighSchool Level A4- Injectable N4- LAM 4. Others ( Specify ) 4. Others ( Specify ) 4. Others ( Specify )
5. Live-in 5. Housekeepers 5. HighSchool Graduate A5- Vasectomy N5- Undecided
6. Vocational A6- Tubal Ligation
7. College Level A7- Implanon if available
8. College Graduate
9. Post Graduate Approved By:
Prepared by : PREMO C. OGATIS JR.
STELLA GRACE B. SAREÑO Provincial Population Officer