CBDRP REPORTING FORM 1

Participants

With DOH
Name of
certified
Barangay
CBDRP?
Total no. of
Total no. of
Total no. of readmitted Total no. of
new CBDRP
surrenderer CBDRP graduates
participants
participants

Prepared and Submitted by:

Barangay Secretary

Good day! Please faithfully follow the following guidelines in filling-out the CBDRP Reporting Form 1

A. LGU
1. In Column C, kindly indicate your City/Municipality as the first entry, followed by your respective barangays.
2. Kindly indicate in Column D "1" if there is existing DOH-certified CBDRP and "0" if there is none.
 3. If there are no surrenderers or if the LGU is drug-free or drug-cleared, please indicate "1" if there is a CBDRP Plan ready

l and for Barangays. As per the JMC, all cities/municipalities should have CBDRPs, while for barangays, it is optional, considering the need thereof and the capacity of

B. Participants
1. In Column F, kindly indicate the total no. of surrenderers for the quarter being covered
2. In Column G, kindly indicate the total no. of CBDRP participants that are new to the program
3. In Column H, kindly indicate the total no. of CBDRP participants that were once admitted to the program but stopped, th
4. In Column I, kindly indicate the total no. of CBDRP participants who completed the program during the quarter being co

C. Referral
1. In Column K, kindly indicate the total no. of clients with Low Risk and were referred to General Intervention
2. In Column L, kindly indicate the total no. of clients with Moderate Risk/MILD SUD and were referred to CBDRP
3. In Column M, kindly indicate the total no. of clients with Moderate SUD and were referred to out-patient facility/progra
4. In Column N, kindly indicate the total no. of clients with Severe SUD and were referred to in-patient facility/program
4. In Column O, kindly indicate the total no. of clients with risk and co-occuring psychiatric/medical comorbidity and were

Note: The total number in column L should be the same with the sum of the total number in column G and H.

Column L = Column G +
(Total no. of CBDRP Participants) (New CBDRP Participants)

Note: The total number in column F should be the same with the sum of the total number in column K, L, M, N, and O.

Column F = Column K +
Total no. of Surrenderees (GI Participants)

D. CBDRP Interventions
1. In Columns Q-AA, kindly indicate "1" if the intervention is being implemented and "0" if there is no available interventio
Note: Please do not encode the total no. of participants in each intervention, just kindly encode "1" if the intervention is available and "0"
 COMMUNITY-BASED DRUG REHABILITATION PROGRAM QUARTERL
Municipality of GUIMBA
Province of Nueva Ecija
Region III
1st Quarter of 202__

Com

Referral Community-based
Treatment Services

Total
Total Total
Total no. of Health
no. of no. of
Total no. of no. of clients Medication- Services
clients clients
clients referred clients referred assisted and
referred referred
to General referred to Treatment, Wellness
to Out- to In-
Interventions to mental Detoxification Promotion
patient patient
CBDRP health Programs
facility facility
facility

Noted:

Punong Barangay

e barangays.
e is a CBDRP Plan ready should the need arise, and "0" if there is none.

d thereof and the capacity of the barangay. All CBDRPs should be certified by the DOH as per DDB BR 4 2020 before implementation.

program but stopped, then presented themselves again to continue the program
ing the quarter being covered

ntervention
rred to CBDRP
ut-patient facility/program
tient facility/program
l comorbidity and were referred to mental health facilty/medical professionals

in column G and H.

Column H
(Readmitted/Old CBDRP Participants)

lumn K, L, M, N, and O.

Column L + Column M +
(CBDRP Participants) (Out-patient clients)

no available intervention in the LGU

tervention is available and "0" if not.
PROGRAM QUARTERLY REPORT
MBA
Ecija

2__

Community-based Drug Rehabilitation Program Interventions

Community-based Support Services Aftercare Interventions

Life Skills
Training,
Vocational
Skills
Relapse
Spirituality Individual, training, Literacy and
Psychoeducation management
and moral Group and Livelihood, Educational
/psychosocial and early
recovery Family Micro_Credit, Programs or
support recovery
programs Counselling Employment support
skills
and Other
Support for
Income
Generation

ed:

ong Barangay
 Column N + Column O
(In-patient clients) (Clients referred to Mental Health Facilities)
ventions

Reintegration Services

Preventive
Drug
Community
Family Education,
service, Civic
relationship community-
and
restoration reconciliation
Environment
sessions and sessions or
Awareness
counselling community
programs
information
sessions
Column O
o Mental Health Facilities)