M1

FHSIS REPORT for the MONTH: JUNE YEAR: 2024

Name of Health Facility: BAGONG PAG-ASA

Name of Municipality/City: QUEZON CITY

BRG
Name of Province: METRO MANILA
Projected Population of the Year: 30, 313

Y
Section F. Non-Communicable Disease Prevention and Control Services
Indicators Male Female Total Remarks Indicators Male Female Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5)
1. No. of adults risk-assessed using PhilPEN - 7. No. of adult women screened for Cervical
Total 50 86 136 Cancer using VIA/Pap Smear - Total
2. Current smokers - Total 9 7 16 8. No. of adult women found positive / suspect
3. Current smoker with BTI - Total 9 7 16 for Cervical Cancer using VIA or Pap Smear -
4. Alcohol binge drinkers - Total 0 4 4 Total
5. Alcohol binge drinkers with BAI - Total 0 4 4
6. Overweight/Obese - Total 27 41 68

Indicators Male Female Total Remarks Indicators Male Female Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5)
9. No. of adult women screened for breast mass
- Total
10. No. of adult women with suspicious breast 0
mass - Total
11. No. of identified hypertensive adults - 50 15. No. of senior citizens screened for visual
Total acuity - Total
12. No. of identified hypertensive adults provided
50 16. No. of senior citizens diagnosed with eye
with antihypertensives - 22 28
disease/s - Total
Total
13. No. of identified adults with Type 2 DM- 11 10 21 17. No. of senior citizens who received one (1)
Total dose of PPV - Total
14. No. of identified adults with Type 2 DM 18. No. of senior citizens who received one (1)
11 10 21
provided with diabetes medications - Total dose of influenza vaccine - Total
 Section E. Non-Communic
Eligible Population or Risk
Indicators assessed using the
PhilPEN protocol
(Col. 1) (Col. 2)
E1. Lifestyle Related
1.) 20-59 years old who were risk assessed using the PhilPEN protocol
1a.) Current smokers 20-59 years old
1b.) Binge drinkers 20-59 years old
1c.) Overweight or obese 20-59 years old
2.) 60 years old and above who were risk assessed using the PhilPEN protocol
2a.) Current smokers 60 years old and above
2b.) Binge drinkers 60 years old and above
2c.) Overweight or obese 60 years old and above
E2. Cancer Prevention and Control
3.) 20 years old and above screened for cervical cancer using Visual
Inspection with Acetic Acid (VIA) or Pap Smear
4.) 20 years old and above found positive or suspect for cervical cancer using
VIA or Pap Smear
5.) 20 years old and above screened for breast mass
6.) 20 years old and above with suspicious breast mass
E3. Cardiovascular Disease Prevention and Control
7.) Identified hypertensive 20-59 years old
8.) Identified hypertensive 20-59 years old provided with antihypertensive
medications
9.) Identified hypertensive 60 years old and above
10.) Identified hypertensive 60 years old and above provided with
antihypertensive medications
E4. Diabetes Mellitus Prevention and Control
11.) Identified with Type 2 Diabetes Mellitus 20-59 years old
12.) Identified with Type 2 Diabetes Mellitus 20-59 years old provided with
diabetes medications
13.) Identified with Type 2 Diabetes Mellitus 60 years old and above
14.) Identified with Type 2 Diabetes Mellitus 60 years old and above provided
with diabetes medications
E5. Blindness Prevention Program
15.) 60 years old and above screened for visual acuity
16.) 60 years old and above diagnosed with eye disease/s
Eligible Population or Risk
Indicators assessed using the
PhilPEN protocol
(Col. 1) (Col. 2)
E6. Immunization for Senior Citizens
17.) 60 years old above who received 1 dose of Pneumococcal Polysaccharide
Vaccine (PPV)
18.) 60 years old and above who received 1 dose of influenza vaccine
Section E. Non-Communicable Disease Prevention and Control Services
Counts % (Col.5 / Eligible
Population or Risked-
Male Female Total assessed * 100)
(Col. 3) (Col. 4) (Col. 5) (Col. 6)

34 62 96 #DIV/0!
8 6 14 #DIV/0!
0 3 3 #DIV/0!
18 30 48 #DIV/0!
16 24 40 #DIV/0!
1 1 2 #DIV/0!
0 1 1 #DIV/0!
9 11 20 #DIV/0!

0
0 0 0
0 0 0 #DIV/0!

12 9 21
12 9 21 #DIV/0!
10 19 29
10 19 29 #DIV/0!

6 3 9
6 3 9 #DIV/0!
5 7 12
5 7 12 #DIV/0!

0 #DIV/0!
0
Counts % (Col.5 / Eligible
Population or Risked-
Male Female Total assessed * 100)
(Col. 3) (Col. 4) (Col. 5) (Col. 6)
 0 #DIV/0!
0 0 0
 January
Recommendations or
Interpretation
Actions to be Taken
(Col. 7) (Col. 8)

Recommendations or
Interpretation
Actions to be Taken
(Col. 7) (Col. 8)
 FHSIS - NIP PER BARANGAY
HEALTH CENTER: BAGONG PAG-ASA
MONTH/YEAR: MAY 2024

BCG ( after birth within 24hrs) <12 months PENTA 1 (0-12 mos) PENTA 2 (0-12 mos)
13-23
BARANGAY HC HC HC HC
TOTAL OHF LIC TOTAL OHF LIC TOTAL OHF mos TOTAL OHF
M F M F M F M F
PROPER 4 5 9 9 0 1 0 1 0 0 10 12 22 5 0 5 4 9 9
SAN ROQUE 21 25 46 46 0 7 9 16 1 0 46 62 108 10 0 9 5 14 14
0 0 0
TOTAL 25 30 55 55 0 8 9 17 1 0 56 74 130 15 0 14 9 23 23

OPV 1 ( 0-12 mos) OPV 2 ( 0-12 mos) OPV 3 ( 0-12 mos) IPV 1 (0-12 mos)
13-23 13-23
BARANGAY HC HC HC 13-23 mos HC
TOTAL OHF mos TOTAL OHF mos TOTAL OHF TOTAL
M F M F M F M F
PROPER 7 8 15 1 0 8 9 17 1 0 3 4 7 0 0 3 4 7
SAN ROQUE 35 49 84 5 0 21 19 40 3 0 27 28 55 3 0 28 27 55
0 0 0 0
TOTAL 42 57 99 6 0 29 28 57 4 0 30 32 62 3 0 31 31 62
ANGAY
Prepared by: JENNY L. ALBA Noted by: DR. FERDINAND CAVALIDA

2 (0-12 mos) PENTA 3 (0-12 mos)

13-23 13-23
HC
OHF mos TOTAL OHF mos
M F
9 0 2 4 6 6 0
14 0 8 15 23 23 0
0
23 0 10 19 29 29 0

PV 1 (0-12 mos) IPV 2 (9 mos) IPV 2 ( 10-23 mos)

13-23
HC HC
OHF mos TOTAL OHF TOTAL OHF
M F M F
0 0 1 1 2 0 2 2 4 0
2 0 0 0 0 0 2 6 8 0
0 0
2 0 1 1 2 0 4 8 12 0
Inventory of Vaccines and Syringes
Health Center: BAGONG PAG-ASA
Month/Year: MAY 2024
(A) (B) (C) (D) (E) (F) (G) (H) (I) (J)
Request/
Health Damaged Monthly
Stock on Hand New Stock Received Current Buffer Authorized Order
Antigen Center (VVM Requirement
Issuances Stock Expiry Date % Wastage Stock Stocklevel Total Remarks
Accomplish broken etc. (see formula
Quantity Batch No. Quantity Batch No. Available (1mo.) (F+G) Req. (H-
ment or expired) below)
E)
10 VIALS GIVEN TO
BCG 88 0372G072 0 1 16 77 05-2025 20% 6 6 12 (-65) ZETI'S LIC

Hepa B (MULTI) 0 20 0333L009A 0 0 20 06/2026 0%

Hepa B (SINGLE) 0 - 0
RECEIVED 20 VIALS
Pentavalent 90 0 110 110 0 08/2024 0% 170 170 340 340 FROM BBHC

bOPV 25 U3E851V 0 19 359 6 04-2025 6% 13 13 26 20

HEXAXIM 5 - 0 5 5 0 11/2025 0%
PCV13 (MULTI-4) -
PCV10 (MULTI-4) 0 10 ASP4A308AA 10 40 0 05-2024 0%
IPV (MULTI-10) 10 W3B011V 30 24437008 8 74 32 12-2024/03-2026 9% 170 170 340 20
IPV (MULTI-5) - -
MR 22 0120W046 100 0123W034 1 5 121 08/2025 50%
MMR 65 0161N007 0 22 115 43 09/2025 48%
PPD 3 - 0 0 0 3 12/20/2024
Td (SINGLE) 0 0 0 0 0 0%
Td (MULTI) 0 110 2333L029C 10 100 100 06/2026 0% 17 17 34 (-66)
PNUEMO 153 0 45 22 108 03/05/2025
FLU (MULTI) 0 0 0 0 0
FLU(SINGLE) 0 0 0 0
HPV 132 W017093 0 20 20 112 02/2025
Syringes
AD .05cc 1626 0 16 1610 04-2025 56 56 112 (-1514)
AD 0.5cc 6091 0 471 5620 449 449 898 (-5193)
1cc 286 0 5 281
3cc 4931 0 0 4931 06-2026
5cc 3499 0 25 3474 06-2026
Others
Safety Boxes 102 0 4 98
Cotton Rolls 14 0 1 13
Cotton Balls 0 0 0 0
 Form 3a. Monthly Health Center Risk Assessment Report
For the Period: JUNE 2024
Health Center: BAGONG PAG-ASA
ADULT SENIOR TOTAL
MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL
Total No. Risk Asssessed 34 62 96 16 24 40 50 86 136
% of clients risk assessed over total pop x 0.5
With risk identified
· DM 4 1 5 1 2 3 5 3 8
- Properly Managed 4 1 5 1 1 2 5 3 8
· HPN 3 6 9 5 14 19 8 20 28
- Properly Managed 3 6 9 5 14 19 8 20 28
· HPN with DM 2 2 4 4 4 8 6 6 12
- Properly Managed 2 2 4 4 4 8 6 6 12
· Cancer, Specify Site 0 0 0 0 0 0 0 0 0
- Site 1: 0 0 0
- Properly Managed
- Site 2:
- Properly Managed
- Site 3:
- Properly Managed
- Site 4:
- Properly Managed
· COPD 1 0 1 0 0 0 1 0 1
- Properly Managed 1 0 1 0 0 0 1 0 1
· High Salt Intake 18 40 58 6 11 17 24 51 75
- Properly Managed 18 40 58 6 11 17 24 51 75
· Binge Alcohol Drinker 0 3 3 0 1 1 0 4 4
- Properly Managed 0 3 3 0 1 1 0 4 4
· No Regular Exercise 20 37 57 3 13 16 23 50 73
- Properly Managed 20 37 57 3 13 16 23 50 73
Risk Factors Identified
· Smoker 8 6 14 1 1 2 9 7 16
- Properly Managed 8 6 14 1 1 2 9 7 16
· With Stress 9 18 27 4 6 10 13 24 37
- Properly Managed 9 18 27 4 6 10 13 24 37
· Overweight/Obese 18 30 48 9 11 20 27 41 68
 - Properly Managed 18 30 48 9 11 20 27 41 68
· High FBS/High RBS 0 0 0 0 2 2 0 2 2
- Properly Managed 0 0 0 0 2 2 0 2 2
· DM 0 0 0 0 1 1 0 1 1
- Properly Managed 0 0 0 0 1 1 0 1 1
· Elevated BP 19 23 42 11 17 28 30 40 70
- Properly Managed 19 23 42 11 17 28 30 40 70
· HPN 7 1 8 1 1 2 8 2 10
- Properly Managed 7 1 8 1 1 2 8 2 10
· HPN with DM 0 0 0 0 0 0 0 0 0
- Properly Managed
· High Cholesterol 0 0 0 0 0 0 0 0 0
- Properly Managed
· Risk Status
- < 10% risk 18 52 70 5 2 7 23 54 77
- 11-29% risk
- ≥ 30% risk 16 10 26 11 22 33 27 32 59
· No. of adult women screened for Cervical
Cancer using VIA
· Abnormal VIA Results
- Properly Managed
· Abnormal CBE Results
- Properly Managed
· Blood tarry stool
- Properly Managed
· Abnormal DRE Result
- Properly Managed
With at least 1 risk identified 33 60 93 16 24 40 49 84 133
No. of Functional HD CLUBs

PREPARED BY: NOTED BY:

JENNY L. ALBA, RN
NURSE
 FORM 4 A : Quarterly Consolidated DM and HPN Management and Treatment Report
FOR THE PERIOD OF: 2nd QUARTER 2024
BAGONG PAG-ASA HEALTH CENTER

HYPERTENSION WITH
MANAGEMENT AND TREATMENT HYPERTENSION DIABETES MELLITUS DIABETES MELLITUS
219 28 78
Controlled
29 2 6
Uncontrolled
13 23
Undetermined
0 0 0
Defaulter
0 1 0
Died
248 44 107
Total Number of Cases

PREPARED BY: NOTED BY:

 Form 5. Health Facility FHSIS LRD Morbidity Report
Health Facility: BAGONG PAG-ASA
For the Month/Quarter: JUNE 2024

70 and
1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 Total
over

LRDs/NCD ICD10 M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F

Cardiovascular Diseases I10

1 2 1 1 2 1 2 2 1 2 2 4 3 2 4 8 16 22
(Hypertension, Stroke) I63

Diabetes Mellitus E10

(Diabetes mellitus-Type 1,
E11 1 1 3 1 2 1 5 4
Diabetes mellitus – Type 2,
Gestational Diabetes)
O24

HPN+DM 1 1 1 1 3 1 1 3 6 6

COPD J43
(Emphysema, Chronic 1 1 0
bronchitis)
J42

Cancer
- breast D05
- cervix D06
- colon C18
- lung C34
- liver C22
- prostate C61
- thyroid 0
Total 0 0 0 0 0 0 0 2 1 3 0 0 3 4 2 1 0 7 3 8 3 3 7 0 12 28 32
 KAGAWARAN NG KALUSUGAN NG LUNGSOD QUEZON
QUEZON CITY HALL COMPOUND
DILIMAN, QUEZON CITY

HEALTH AND WELLNESS PROGRAM FOR PERSONS WITH DISABILITIES

Reporting Form
Year/Month: JUNE 2024
City/Municipality: QUEZON CITY
Health Facility: BAGONG PAG-ASA

I. DISABILITY ASSESSMENT USING WHO-DAS (Adults 25 years old and above)

WHO – Disability Assessment (Adults 25 years old and above)
Male Female TOTAL
4 5 9

II. DISABILITY ASSESSMENT USING WHO-DAS (PWDs 25 years old and above)
WHO – Disability Assessment (Adults 25 years old and above)
Male Female TOTAL
0 0 0

III. No. of PWDs (25 years old above) assesses and referred to a higher level of health care facility

Male Female TOTAL

0 0 0

IV. No. of PWDs who availed health services at the health facility
PWDs availing health services at the health centers
Male Female TOTAL
0 0 0

V. No. of clients assessed for issuance of Medical Certificate

Clients assessed for issuance of Medical Certificate to be used in availing PWD ID
Male Female TOTAL
0 0 0

Prepared by: JENNY L. ALBA

Date submitted: ________________________

 PHILIPPINE BLINDNESS PROGR
For the Period: JUNE 2024
HEALTH CENTER: BAGONG PAG-ASA

SC 60 & above identified w

visual problems and referr
SC 60 & above Screened for VA
Barangay to a health facility for furt
assessment
MALE FEMALE TOTAL MALE
23 37 60 1

EYE DISEASES 0-9 10-19 y/o

M F M F
1. CONJUNCTIVITIS 2
2. ERROR OF REFRACTION
3. CATARACT
4. STYE/HORDEOLUM
5. PTERYGIUM
6. BLEPHARITIS
7. FOREIGN BODY
8. GLAUCOMA
9. TRAUMA
10. BITOT'S SPOT
11. HEMORRHAGE
12. DACROCYSTITIS
13. SQUINT
14. ABCESS
15. OTHERS
Retinoblastoma R eye CA
TOTAL # of Patient seen 2
No. of Patients Treated 2
No. of Patients Referred
No. of Patients Operated
E BLINDNESS PROGRAM ACCOMPLISHMENT REPORT
NE 2024
NG PAG-ASA

Children 5-6 years

SC 60 & above identified with
identified with visu
visual problems and referred Children 5-6 years old Screened
problems and referre
to a health facility for further for VA
health facility for fur
assessment
assessment
FEMALE TOTAL MALE FEMALE TOTAL MALE
2 3 0 0 0 0

20-29 30-39 40-49 50-59

M F M F M F M
1 1 2
2

1 1

2 2 2 2
2 2 2
2
 Children 5-6 years old
identified with visual
problems and referred to a
health facility for further
assessment
FEMALE TOTAL
0 0

50-59 60-69 70-79 80 up TOTAL

F M F M F M F
6
2 4
1 2 3
2

2 1 2 15
8
2 1 2 7
ELDERLY REPORT QUEZON CITY
BAGONG PAG-ASA HEALTH CENTER
Reporting Month/Year: JUNE 2024

Immunization
LGU Purchased 59 y/o & Below 60 y/o 61-65y/o 66 & Above TOTAL
Male Female Male Female Male Female Male Female
Pneumonia Single Dose 0 0 0 0 0 0 0 0 0
Pneumonia Multi-Dose 0 0 0 0 0 0 0 0 0
Flu Single Dose 0 0 0 0 0 0 0 0 0
Flu Multi-Dose 0 0 0 0 0 0 0 0 0
Tetanus Toxoid 0 0 0 0 0 0 0
Anti-Rabies 0 0 0 0 0 0 0
Covid-19 Vaccination Status 0 0 0 0 0 0 0

Lifestyle Related Diseases (LRD)

# Risk Assessed Male Female TOTAL

# Risk Assessed 16 24 40

# Diagnosed as HPN 6 15 21
# Properly Managed 6 15 21

# Diagnosed as DM 1 3 4
# Properly Managed 1 3 4

# Diagnosed as BOTH 4 4 8
# Properly Managed 4 4 8
 Cancer Prevention & Control Program
TOTAL
A. Breast Male Female
Breast Examination done
# Breast Mass
# referred for Assesment
# referred for Management

B. Prostate
# screened (DRE)
# result +
# referred
C. Lung
# of Smokers
# Given BTI
# Quit Smoking

Blood Chemistry done in Klinika Laboratory, Health Center, Caravan

Normal Elevated Total
Blood Sugar
Cholesterol
HgbAIC
Lipid Profile
BUN/CREA
SGOT/SGPT
URIC

Submitted by:

Noted by:
Immunization
DOH Purchased 59 y/o & Below 60 y/o 61-65 y/o 66 & Above TOTAL
Male Female Male Female Male Female Male Female
Pneumonia Single Dose
Pneumonia Multi-Dose 0 0 0 0 0 0 0 0 0
Flu Single Dose 0 0 0 0 0 0 0 0 0
Flu Multi-Dose 0 0 0 0 0 0 0 0 0
Tetanus Toxoid 0 0 0 0 0 0 0
Anti-Rabies 0 0 0 0 0 0 0
Covid-19 Vaccination Status 0 0 0 0 0 0 0

Health education & Information/lifestyle & Behavior Modification

A. # of clients counseled Male Feamle TOTAL
Oral care 16 24 40
Personal Hygiene 16 24 40
Smoking Cessation 0 0 0
Proper Diet & Nutrition 16 24 40
Reproductive Health 0 0 0
Physical Activity 16 24 40
B. # clients seen
Focus Discussion 16 24 40
Health Forum 0 0 0
Health caravan 0 0 0
Medical Mission 0 0 0
TB PROGRAM Male Female TOTAL
No. of TB Diagnosed iniated Tx
No.TB Registered Screened for DM
No. of DM (+) properly managed
No. of DM screened for TB
No. of DM screened (+) for TB
No. of DM - TB iniated Tx
Patient Undergoing Treatment
Tx Regimen:
TB HIV Screened

Oral Health Program Male Female TOTAL

Oral Examination
Gum Treatment
Tooth Extraction
Provided BOHC
# of Edentulous
# of patient needs Denture

Visual Health (PEC) Male Female TOTAL

# Screened for Visual Acuity 23 37 60
# Diagnosed with Eye Diseases 1 2 3
# Given Treatment 0 0 0
#referred for further Management 1 2 3
 QUEZON CITY HEALTH DEPARTMENT
COMPREHENSIVE HEALTH CARE PACKAGE FOR ELDERLY
Health Center: BAGONG PAG-ASA District: 1
Month/Year: MAY 2024

Elderly Profiled

HEALTH CARE PACKAGE Old Registrants New Registrants Current Total Remarks
A. No. Profiled Elderly
Total No. of Bedridden 28 0 28
No. with QC ID 28 0 28
No. Referred for QC ID 0 0 0
B. Home Visits done 28 0 28
C. Health Care Services
VACCINATION
No. given Pneumococcal 28 0 28
No. given Anti-Flu 21 0 21
No. given Covid-19 Vaccination 21 0 21
No. given Anti-Rabies Vaccination 0 0 0
ORAL EXAMINATION
Oral Examination done 21 0 21
Edentolous 1 0 1
Gingivitis/Peridontal Disease 2 0 2
Debris/Calcular Deposits 2 0 2
Others___________________ 0
MEDICAL CONSULTATION
No. Check-up 28 0 28
No. Given HD Medicine 14 0 14
No. Refer to Hospital 0 0 0
C. NUTRITION COUNSELLING
No. Counselled 28 0 28
No. given Milk Supplement 7 0 7
D. PERSONAL NEEDS
No. given wheelchair 0 0 0
No. given diaper 0 0 0
No. given walker 0 0 0
E. PROVIDED FOR FREE LABORATORY
FBS 0 0 0
Cholesterol 0 0 0
Others 0 0 0
F. ASSISTANCE
No. referred for further management 0 0 0
Confinement 0 0 0
Rehabilitation 0 0 0
Dialysis 0 0 0
For Specialized Case 0 0 0
F. COMMON HEALTH CONDITION (Main Cause)
Malnutrition 0 0 0
Stroke 7 0 7
Hypertension 4 0 4
Diabetes Mellitus 5 0 5
DM and HPN 3 0 3
Cancer 1 0 1
Blindness 2 0 2
Chronic Respiratory Diseases 0 0 0
Dementia 1 0 1
Others:________________________________ 5 0 5

Prepared by:
JENNY L. ALBA
 NURSE

Noted by:

Submitted by:

Noted by:
 LGU LRD PER CATEGORY
MONTH: JUNE 2024 HC: BAGONG PAG-ASA
NON-SENIOR SENIOR
A. HYPERTENSIVE ALONE 17 21
1. AMLODIPINE ALONE 2 12
2. LOSARTAN ALONE 11 6
3. LOSARTAN + AMLODIPINE 4 3

B. DIABETIC ALONE 5 4
1. METFORMIN ALONE 5 3
2. METFORMIN + GLICLAZIDE 1
3. INSULIN ALONE
4. METFORMIN + INSULIN

C. HYPERTENSIVE & DIABETIC 4 8

1. AMLODIPINE ALONE 1 1
2. LOSARTAN ALONE 2 3
3. LOSARTAN + AMLODIPINE 1 4
4. METFORMIN ALONE 4 7
5. METFORMIN + GLICLAZIDE 1
6. INSULIN ALONE
7. METFORMIN + INSULIN

OTHER MAINTENANCE MEDICINE

1. ATORVASTATIN
2. ROSUVASTATIN
3. SIMVASTATIN 1 2
4. CLOPIDOGREL
5. ASPIRIN
6. MULTIVITAMINS
Submitted by:

Noted by:
 MEDICAL CARAVAN
DISTRICT 1
BAGONG PAG-ASA HEALTH CENTER
DATE:
VENUE: Bagong Pag-asa Multi-purpose Covered Court
NEW
SENIOR
OLD
No.Risk Assessed TOTAL
NEW
No. HPN OLD
TOTAL
NEW
No. DM OLD
TOTAL
NEW
No HPN w/ DM OLD
TOTAL
NORMAL
FBS
ELEVATED
NORMAL
RBS
ELEVATED
NORMAL
Cholesterol
ELEVATED
NORMAL
ELEVATED
Normal
Urinalysis
Glucose +
Protein +
Ketone +
LOSARTAN
AMLODIPINE
METFORMIN
SIMVASTATIN
NO.OF SENIOR GLICLAZIDE
PROVIDED MEDS X ROSUVASTATIN
30 TABS ATORVASTATIN
CLOPIDOGREL
MULTIVITAMINS
ASCORBIC ACID
VIT B COMPLEX
MEDICAL CONSULT
NO. GIVEN PNEUMOCOCCAL
 NO. GIVEN FLU VACC
Covid Vaccinated
QCID
NON SENIOR
NEW
59 Y/O AND BELOW
OLD
No.Risk Assessed TOTAL
NEW
No. HPN OLD
TOTAL
NEW
No. DM OLD
TOTAL
NEW
No HPN w/ DM OLD
TOTAL
NORMAL
FBS
ELEVATED
NORMAL
RBS
ELEVATED
NORMAL
Cholesterol
ELEVATED
NORMAL
ELEVATED
Normal
Urinalysis
Glucose +
Protein +
Ketone +
LOSARTAN
AMLODIPINE
METFORMIN
SIMVASTATIN
NO.OF SENIOR GLICLAZIDE
PROVIDED MEDS X ROSUVASTATIN
30 TABS ATORVASTATIN
CLOPIDOGREL
MULTIVITAMINS
ASCORBIC ACID
VIT B COMPLEX
MEDICAL CONSULT
NO. GIVEN PNEUMOCOCCAL
NO. GIVEN FLU VACC
Covid Vaccinated
QCID
0
 FORM 8
NATIONAL DENGUE PREVENTION AND CONTROL PROGRAM
BAGONG PAG-ASA HEALTH CENTER /DISTRICT I
MONTH/YEAR: JUNE 2024

I. CASEFINDING AND MANAGEMENT

1.No. of Clinically Diagnosed
1.1 Dengue Fever
1.2 Dengue hemorrhagic fever
2. No. of Dengue Cases Suspect referred/confirmed by serology/virology
2.1 Dengue Fever
2.2 Dengue Hemorrhagic Fever
3. No. of Deaths
3.1 Dengue fever
3.2 Dengue Hemorrhagic fever
4. No. of Dengue Cases followed up/investigated
II. INTEGRATED VECTOR CONTROL
5. No. Household Inspected
6. No. of houses ( + ) for larvae
NEW
7. No. of Elem Schools practicing 4 o'clock habit
7.1 No. of Elem schools with little Dengue Brigade
III. OUTBREAK MANAGEMENT
8. No. of Outbreaks
8.1 No. of Cases
8.2 No. of Deaths
9. Spraying/Fogging Operations
9.1 No. of houses
9.2 No. of schools
9.3 Others
IV. HEALTH EDUCATION # of Sessions # of Particpants
A. Dengue Lecture
B. Dengue Forum
C. Bench Conference
D. Pre Clinic Lecture
E. Others
V. IEC MATERIALS
A. Flyers
B. Pamphlets
C. Posters
D. Tarpaulin
E. Others

Prepared / Submitted By : JENNY L. ALBA

Noted By:
 OVILARVI TRAP /SPRAYING REPORT
MONITORING FORM
BAGONG PAG-ASA HEALTH CENTER
MONTH/YEAR: JUNE 2024

LARVI TRAP index SPACE SPRAYING POST INTERVENTION LARVITRAP

# OF # OF
BARANGAY/ # INSECTICIDE
ADDRESS HECTARES LITERS REMARKS
HEALTH CENTER HOUSEHOLD SET UP COLLECTION 1ST 2ND 3RD SET UP COLLECTION COVERED USED
LI (10%) LI (10%) USED
DATE DATE CYCLE CYCLE CYCLE DATE DATE

BAGONG PAG-ASA Hona st 6/6/2024 11/6/2024 1/20=5%

PREPARED BY: NOTED BY: