C.

IMMUNIZATION

Res Ref C. Pangalan OPV MEASLES DPT

No.

1 2 3 4 1 2 3 4 1 2 3

1 #REF!
XXX
XXX
XXX
XXX
DPT HEPA B BCG PENTAVAC TT AT IBA PA

4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4
 A-B; D-Y
ND NUTRITIONAL STATUS
Res Ref Basic Information
No.

Petsa Pinuno ng Pamilya Purok Barangay Tagal ng Bilang ng Relihiyon RC INC Metho Adven Others Pangalan Edad Kasarian Male Female
Paninirahan Miyembro dist tist
sa Pamilya

1 2 3 4 5 1 2

1 31-Jan-19 Bulan,Gilbert P. 1 Malitao 1 year 4 RC 1 Bulan,Gilbert P. 33 Male 1

2 1 Malitao Bulan Ines 32 Female 1
3 1 Malitao Bulan, Elizabeth 9 Female 1
4 1 Malitao Bulan, Bethealyn 1 Female 1
5 31-Jan-19 Ualat, Rolando M. 1 Malitao 10 years 7 RC 1 Ualat, Rolando M. 52 Male 1
6 Ualat, Miriam 56 Female 1
7 Ualat, Aljur 26 Male 1
8 Ualat, John-John 24 Male 1
9 Ualat, Rommel 24 Male 1
10 Ualat, Romarc 19 Male 1
11 Ualat Romane 12 Female 1
12 31-Jan-19 Rivera,Ricardo U. 1 Malitao 52 years 4 RC 1 Rivera, Ricardo U. 52 Male 1
13 Rivera, Soledad 54 Female 1
14 Rivera, Liezel Rhian 28 Female 1
15 Sabbaluca, Paz 70 Female 1
16 30-Jan-19 Acosta, Froylan 1 Malitao New 3 RC 1 Acosta, Froylan 52 Male 1
17 12+A19:A36 Sanchez, Gretchen M. 28 Female 1
18 Acosta, Dancali 6 mons Male 1
19 31-Jan-19 Perez, Jesus I. 1 Malitao 10 years 3 RC 1 Perez, Jesus I. 38 Male 1
20 Perez, Gregoria 32 Female 1
21 Perez, Jijay 11 Male 1
22 31-Jan-19 Turingan, Manuel B. 1 Malitao 33 years 3 RC 1 Turingan, Manuel B. 55 Male 1
23 Turingan, Estrella 58 Female 1
24 Ballad, Filomena 78 Female 1
25 31-Jan-19 Manalo, Danilo S. 1 Malitao 16 years 3 RC 1 Manalo, Danilo S. 39 Male 1
26 Manalo, Maricel 34 Female 1
27 Manalo, Trishia Nicole 14 Female 1
28 31-Jan-19 Batag, Ernesto B. 1 Malitao 62 years 2 RC 1 Batag, Ernesto B. 60 Male 1
29 Batag, Nenita R. 62 Female 1
30 31-Jan-19 Sabbaluca, Ferdie M. 1 Malitao 28 years 3 RC 1 Sabbaluca, Ferdie 28 Male 1
31 Sabbaluca, Gemarie 28 Female 1
32 Sabbaluca, Sophia 2 Female 1
33 30-Jan-19 Sanchez, Teodulo 1 malitao 60 yers 8 RC 1 Sanchez,Teodulo 60 Male 1
34 Sanchez, Agustin 27 Male 1
35 Sanchez,Jay-Lord 21 Male 1
36 Sanchez,April Joy 14 Female 1
37 Ballad, Jemarie 8 Female 1
38 Ballad,Mikarose 10 Female 1
39 Acosta, Dwayne 3 Female 1
40 Sanchez, john Mark 15 Male 1
41 30-Jan-19 Curibang, Jericom 1 Malitao 23years 3 RC 1 Curibang,Jericom V. 23 Male 1
42 Sanchez, Divine Grace 22 Female 1
43 Curibang, Kaisely Jade 7 mons Female 1
44 31-Jan-19 Ualat, Jonel B. 1 Malitao 45 years 6 Rc 1 Ualat jonel 45 male 1
45 ualat, Janeth 44 Female 1
46 Ualat, Jonel jr. 9 Male 1
47 Ualat, jon- jon 20 Male 1
48 Ualat, jonathan 15 Male 1
49 Ualat, Jowell 10 Male 1
50 31-Jan-19 Rivera, Noel M 1 Malitao 19 years 5 Born Again 1 Rivera, Noel M. 44 Male 1
51 Rivera, Maria L. 43 Female 1
52 Rivera, Justin jhon 12 Male 1
53 Rivera, John Paul 11 Male 1
54 Rivera, Christian Jacob 7 Male 1
55 31-Jan-19 Gaffud, Robert R. Sr. 1 Malitao 3 years 2 RC 1 Gaffud, Robert Sr. 53 Male 1
56 Gaffud Mila 53 Female 1
57 31-Jan-19 Ballad,Generoso U. Sr. 1 Malitao 12 years 3 RC 1 Ballad,Generoso Sr. 66 Male 1
58 Ballad, Julie 61 Female 1
59 Ballad, angelika 20 Female
60 31-Jan-19 Aspa, Antonio C. 1 Malitao 5 years 3 RC 1 Aspa, Antonio C. 45 Male 1
61 Aspa, Ronalyn D. 38 Female 1
62 Aspa, Asyanti D. 3 Female 1
63 31-Jan-19 Rivera, Daniel M. 1 Malitao 49 years 2 JIL 1 Rivera, Daniel M. 64 Male 1
64 Rivera, Dina Joyce 28 Female 1
65 31-Jan-19 Ballad, Erlito U. 1 Malitao 33 years 2 RC 1 Ballad, Erlito U. 64 Male 1
66 Ballad, Norma P. 62 Female 1
67
68
69
70
71
72
73
74
75
 A. Miyembro ng Pamilya

Estadong Sibil Married Single Widow Sepa- Live In Kapanganakan Relasyon sa Pinuno ng Posisyon sa Pamilya Pinakamataas na Post College College High Sch High Sch Elem Naranasan na sakit sa Height Weight
rated grad Grad Level Grad level
Pamilya antas na natapos nakalipas na buwan

1 2 3 4 5 1 2 3 4 5 6

Married 1 18-Feb-85 Ama Grade 3 1 Trangkaso

Married 1 24-Aug-86 Asawa Ina 4th yr. HS 1 Trangkaso 145 cm 54 Kg.
Single 1 3-Sep-09 Anak Panganay na Anak Grade 4 1 Trangkaso
Single 1 12-Dec-17 Anak Bunsong Anak Ubo at Sipon 71 cm 7 Kg
Married 1 12-Jan-67 Ama 4th yr. HS 1 Trangkaso 172 cm 80 Kg
Married 1 27-Nov-64 Asawa Ina 4th yr. College 1 Trangkaso
Single 1 27-Sep-90 Anak panganay na anak College 1 Trangkaso
Single 1 9-Sep-92 Anak pangalawang anak 2nd yr. HS 1 Trangkaso
Single 1 29-May-92 Anak pangatlong anak 3rd yr. HS 1 Trangkaso
Single 1 30-Sep-99 Anak pangapat na anak 1st ur. College 1 Trangkaso
Single 1 18-Mar-07 Anak Bunsong Anak Grade 7 1 Trangkaso 174 cm 120 Kg
Married 1 9-Aug-66 Ama Vocational (2 yrs.) 1 Hypertension 153 cm 65 Kg
Married 1 7-Apr-65 Asawa Ina 4th year HS 1 Trangkaso
Single 1 1-Mar-91 Anak Anak 4th yr. College 1 Trangkaso
Widowed 1 10-Mar-47 Auntie Auntie Grade 6 1 Trangkaso 149 cm 34 Kg
Live- In 1 6-Jul-62 Ama 4th year HS 1 Trangkaso, Sipon
Live- In 1 18-Nov-90 Kinakasama Ina 4th year HS 1 Trangkaso 150 cm 51 Kg
Single 1 3-Jul-18 Anak Anak Sipon, Ubo 88 cm 10 Kg
Married 1 23-Dec-81 Ama 4th year HS 1 Trangkaso 160 cm 56 Kg
Married 1 29-Oct-86 Asawa Ina 4th year HS 1 Trangkaso 162 cm 54 Kg
Single 1 25-Nov-08 Anak Anak Grade 5 1 Trangkaso
Married 1 5-Dec-63 Ama Grade 6 1 Hypertension, Sipon 149 cm 60 kg
Married 1 6-Jan-61 Asawa Ina College Grad 1 Ubo, Pneumonia, Fever 150 cm 37 kg
Single 1 19-Nov-40 Auntie Auntie Grade 6 1
Married 1 26-Mar-79 Ama 2nd yr. College 1 Infection sa ngipin 169 cm 72
Married 1 11-Nov-83 Asawa Ina 2nd yr. College 1
Single 1 2-May-04 Anak Anak Grade 9 1 120 cm 32
Married 1 16-Mar-58 Ama 4th year HS 1 159 cm 52 Kg
Married 1 26-Sep-56 Asawa Ina Vocational (2 yrs.) 1 Ubo, Sipon, Fever, Strok153 cm 60 Kg
Married 1 30-Apr-90 Ama 1st yr. College 1 158 cm 47 Kg
Married 1 8-Jan-91 Asawa Ina College Grad 1 Mastitis 142 cm 51 Kg
Single 1 10-Jul-16 Anak Anak 86 cm 18 Kg
widower 1 2-Sep-58 ama Grade 6 1 trangkaso, blurred vissi 156 cm 50 kg
single 1 26-Feb-92 Anak anak 2nd yr. College 1 heart disease
single 1 21-Dec-98 anak anak 1st yr. HS 1 trangkaso 154 cm 46 kg
single 1 25-Apr-05 apo apo grade 9 1 hyper acidity,ulcer 149 cm 53 kg
Single 1 8-Sep-11 apo apo grade 1 1 trangkaso 116 cm 9 kg
Single 1 22-Aug-08 apo apo grade 5 1 139 cm 31 kg
Single 1 2-Sep-16 apo apo 88 cm 12 kg
Single 1 24-May-03 apo apo grade 7 1 trangkaso, goiter 150 cm 43 kg
Live in 1 4-Mar-96 ama 4th year H.S 1 trangkaso
live in 1 10-Jul-95 asawa asawa 2nd year college 1 nahimatay 145 cm 49 kg
Single 1 1-Jul-18 anak anak pneumonia 63 cm 6.6 kg
Married 1 10-Feb-74 ama 3rd yr. HS 1 lagnat, ubo 164 cm 61 kg
Married 1 4-Jul-75 asawa ina 4th yr. HS 1 lagnat, ubo 149 cm 64 kg
Single 1 28-Apr-09 Anak Anak grade 4 1 lagnat, ubo 128 cm 41 kg
Single 1 5-Jun-97 Anak Anak 3rd yr. HS 1 lagnat, ubo
Single 1 4-Feb-03 Anak Anak Grade 5 1 lagnat, ubo 157 cm 63 kg
Single 1 26-Sep-07 Anak Anak Grade 5 1 lagnat, ubo 134 cm 29 kg
Married 1 3-Aug-74 Ama 3rd yr. HS 1 hypertension
Married 1 22-Oct-75 asawa Ina 2nd yr. HS 1 Hypertension 149 cm 51 kg
Single 1 22-Aug-06 Anak Anak grade 7 1 ubo sipon 144 cm 35 kg
Single 1 13-Apr-08 Anak Anak Grade 5 1 ubo sipon 135 cm 30 kg
Single 1 2-Mar-12 Anak Anak grade 1 1 ubo sipon 111cm 19 kg
Married 1 1-Jun-66 ama 4th yr. College 1 Hypertension 166 cm 69 kg
Married 1 12-Sep-66 Asawa ina 4th year HS 1 Hypertension 156 cm 65 kg
Married 1 7-Mar-51 Ama 4th year H.S 1 ubo trangkaso 163 cm 47 kg
Married 1 27-May-57 Asawa Ina high school graduate 1 Hypertension 153 cm 54 kg
Single 1 26-Sep-98 Anak Anak 1st yr. College 1
Married 1 29-Jun-73 Ama College undergrad. 1 Trangkaso 172 cm 45 kg
Married 1 22-Feb-81 Asawa Ina HS graduate 1 Trangkaso 153 cm 66 Kg
Single 1 22-Nov-15 Anak Anak Ubo, Fever, Sipon 98 cm 15 Kg
widower 1 21-May-54 Ama 4th year H.S 1 Trangkaso 160 cm 48 Kg
Single 1 1-Nov-72 Anak Anak 2nd year college 1 Trangkaso
Married 1 12-Mar-58 Ama Grade 6 1 Trangkaso 153 cm 55 Kg
Married 1 13-Oct-54 Asawa Ina Grade 4 1 Trangkaso 150 cm 37 Kg
 B. Paraan ng Pagpapakain sa Anak noong sanggol pa lamang

Body Mass BMI Very Severely Underw Normal Overwei Obese Obese Obese Nagpapa Artipisya Nagpapasuso At iba pa
Index Classification Severely Underw eight ght Class I Class II Class III suso l na at
Underwei eight gastas gumagamit
ght ng artipisyal
na gatas
Pangalan OPV MEASLES

1 2 3 4 5 6 7 8 1 2 3 4 1 2 3 4 1

26 Overweight 1

Bulan,Bethealyn 1 1
27 Overweight 1

40 Obese 1
28 Overweight 1

15 Underweight 1

23 Normal 1
1 Acosta, Dancali
22 Normal 1
21 Normal 1

27 Overweight 1
16 Underweight 1

25 Overweight 1

22 Normal 1
21 Normal 1
26 Overweight 1
19 Normal 1 Nagpapasuso at gumagamit ng artipisyal na gatas 1
25 Overweight 1
Sabbaluca, Sophia 1 1
20 normal 1

19 normal 1
24 normal 1

acosta, dwayne
19 normal 1

23 normal 1 nagpapasuso at artipisyal na gatas 1

Curibang,Kaiselt jade 1
23 normal 1
22 normal 1

26 Overweight 1

23 normal 1
17 normal 1

1
25 Overweight 1
27 Overweight 1
18 normal 1
23 Normal 1

15 Underweight 1 Artipisyal na gatas

28 Overweight 1
Normal 1 Aspa, Asyanti D.
19 Normal 1

24 Normal 1
16 Underweight 1
 C. Immunizations D. Uri ng Pamilya E. Trabaho F. Buwanang Kita

MEASLES DPT HEPA B BCG PENTAVAC TT At Iba pa Tatay: Nanay: At Iba Pa Buwanang Kita

2 3 4 1 2 3 4 1 2 3 4 1 1 2 3 1 2 3 4 1 2 1 2 3 4 5

Iisang Pamilya 1 Driver House keeper 5,000-10,000 1

1 1 1 HIB (3), IPV (1)

Iisang Pamilya 1 Farmer Comelec Officer 30,000-40,000 1

Pinalawak na Pamilya 1 Brgy. Official, Farmer o Vendor 20,000-30,000 1

Iisang Pamilya 1 Kabo,kobrador housewife 5,000 pababa 1

1 1 1
Iisang Pamilya 1 Farmer Housekeeper 5,000-10,000 1

Pinalawak Pamilya 1 Farmer owner Housewife 20,000-30,000 1

Iisang Pamilya 1 Real State Agent OFW 5,000-10,000 1

Iisang Pamilya 1 Vendor Vendor 5,000-10,000 1

 Iisang Pamilya 1 Vulcanizer Housewife 5,000-10,000 1

1 1 1 1 Pneumococcal (3), HIB(3), MMR(1)

pinalawak na pamilya 1 farmer deceased 5,000-10,000 1

1 1 1

pinalawak na pamilya 1 security guard housekeeping 20,000-30,000 1

1 1 1 1 HIB (3), Rota (1), pneumococcal (3),IPV (1)

isang pamilya 1 vendor vendor 5,000 pababa 1

iisang pamilya 1 PNOC (planta) vendor 5,000-10,000 1

iisang pamilya 1 farmer owner vendor 20,000-30,000 1

iisang pamilya 1 retired soldier massage therapist 30,000-40,000 1

Iisang Pamilya 1 Farmer owner Housewife 5,000-10,000 1

Iisang Pamilya 1 Farm owner deceased 5,000-10,000 1

Iisang Pamilya 1 farmer Housekeeper 5,000 pababa 1

 G. May Kaalaman ka ba sa Family H. Anong kontrasepsyon ang Ginagamit? I. Teenage Pregnancy J. Kasaysayan ng sakit sa pamilya
Planning?

A. May Anak Bang Lifestyle diseases

nabuntis na may B. Kung meron, ilan
edad 18 pababa? taon noong nabuntis? 10-12 13-14 15-16 17-18

6 7 1 2 1 2 3 4 5 6 7 8 9 1 2 1 2 3 4 1 2 3 4 5

Oo 1 Wala Wala/Hindo 1 Hypertension,Asthma,Men1 1 1

Oo 1 Wala Wala/Hindi 1 Hypertension 1

Oo 1 Wala Wala/Hindi 1 Hypertension, DM, Heart 1 1 1

Wala/Hindi 1 Wala Wala/Hindi 1 Wala

Oo 1 Oral Contraceptives 1 Wala/Hindi 1 Hypertension 1

Wala/Hindi 1 Wala Wala/Hindi 1 Hypertension, Asthma 1 1

Wala/Hindi 1 Wala Wala/Hindi 1 Hypertension 1

Wala/Hindi 1 Wala Wala/Hindi 1 Hypertension, DM, Asth 1 1 1

Oo 1 Wala Wala/Hindi 1 Hypertension 1

heart problem, goiter 1

hindi 1 wala hindi 1 asthma,heart disease 1 1

hindi 1 wala hindi 1 hypertension 1

oo 1 oral contraceptives 1 hindi 1 hindi hypertension 1

hindi 1 wala hindi 1 wala hypertension 1 1

DM
hindi 1 wala hindi 1 wala hypertension asthma 1 1

Oo 1 Wala hindi 1 wala Hypertension 1

Hindi 1 Wala Hindi 1 wala Hypertension , DM 1 1

hindi 1 wala hindi 1 wala wala

Kasaysayan ng sakit sa pamilya K. Kanino kumukunsulta kapag may sakit? L. Klase ng gamot na iniinom kapag may sakit? M. Kung walang reseta, anu-
ano ang gamot na iniinom?

Nakakahawang sakit

Halamang Gamot

1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 1 2 3 4

wala Pribadong Doctor 1 May Reseta 1 Tempra,Cephalexin Lagundi,Oregano

wala Self medication 1 Walang Reseta, Halamang Gamot 1 1 Alaxan, Biogesic, Neoblack Oregano
Guyabano
Atis

wala Pribadong Doktor 1 May reseta, Halamang gamot 1 1 Losartan Oregano

Guyabano

Wala Pribado at public Doctor 1 1 May reseta, Halamang gamot 1 1 wala Ampalaya, Lagundi,Kutchay
Paragis
Katas ng saging
Wala Private doctor 1 May reseta,walang reseta 1 1 Biogesic,Bioflu,Neozep

Wala Private/Public Doctor 1 1 May reseta, walang reseta 1 1 Paracetamol Lagundi, Camote
Tahibo

Wala Private Doctor 1 May reseta, Walang reseta 1 1 Paracetamol, Biogesic, Neozep

Wala Private Doctor 1 May reseta, Halamang gamot 1 1 Malunggay,Ampalaya, Guyaban

HEPA B 1 Private Doctor, BHW 1 1 May reseta, walamg reseta 1 1 Paracetamol, Alaxan

wala public doctor 1 may reseta walang reseta, halamang 1 1 1 alaxan, paracetamol paragis
ampalaya, lagundi

wala private doctor 1 may reseta,halamang gamot 1 1 oregano, lagundi

wala public doctor 1 may reseta walang reseta 1 1 paracetamol, amoxicillin,neozep wala

wala private doctor 1 may reseta,walang reseta,halamang g 1 1 1 biogeis,neozep,vitamin ,lady lagundi,oregano,kutchay

kalamansi

wala self medication 1 walang reseta halamang gamot 1 1 paracetamol,biogesic,neozep so lagundi

paragis
wala private doctor BHW 1 1 may reseta walang reseta halamang g 1 1 1 bioflu,tempra lagundi, oregano,tahebo

Measles 1 Public /Private Doctor 1 1 May reseta, walang reseta 1 1 Noxefine, Paracetamol,Neozep, Alaxan

wala Private Doctor 1 May reseta, Walang reseta 1 1 Amlodipine, Losartan, Neuronerve vit

wala BHS 1 Walang reseta 1 Mefenamic, Paracetamol

 N. Halamang Gamot O. Pag aalaga sa sarili P. Anu-ano ang kinain kahapon?

I. May sapat ka bang pahinga at II. A. May sapat ka bang II. B. Kung oo, anong Umaga Tanghali
tulog ehersisyo ehersisyo?

Parte ng Halaman Paraan ng Paggamit Para saan ginagamit

1 2 1 2

Dahon Decoction at Hugas Ubo Oo 1 oo 1 naglalaba,naglalakad,nagiigib Hotdog,Langgonisa kanin Malunggay,Talong at kanin

Dahon Decoction Ubo Oo 1 Oo 1 Takbo at Lakad Itlog,Tuyo,Dried pusot at kanin Kare-Kare at kanin
Dahon Decoction pampababa ng BP
Dahon Decoction pampababa ng BP

Dahon Babad sa mainit na tubig Ubo Oo 1 Oo 1 Jogging, Paglalakad Tuyo, Pritong talong, Kanin Fried chicken, Kalabasa, kanin
Dahon Decoction Pampababa ng BP

Dahon extraction Ubo Oo 1 Oo 1 Paglalakad Pancit Canton Diuguan, kanin

buong Halaman Decoction Urinary retention
Dahon extracting Wounds
Oo 1 Oo 1 paglilinis at paglalakad Talong, mustasa, kanin Upo, Kanin

Dahon decoction at salad Cough at dengue Hindi/Wala 1 Oo 1 Lakad, gawaing bahay Tinola, pechay, Kanin Igado, Kaldereta, Kanin
Tangkay at Dahon Infusion Cough

Oo 1 Oo 1 Lakad Kape, Tinapay Igado,Kaldereta, kanin

Dahon Decoction pampababa ng dugo at BP Oo 1 Oo 1 Lakad at linis Itlog, Tuyo, Kanin Pritong tilapya, kanin
 Oo 1 Oo 1 Lakad Itlog, Tuyo, Kanin Pakbet, Igado, Kanin

buong halaman decoction urinary retention oo 1 oo 1 naglalakad, bike tinalo at kanin dinuguan at kanin
dahon extraction and decoction cough

dahon infusion, decoction cough hindi 1 hindi 1 wala itlog, noodles,kanin hot fog dinuguan, kanin

oo 1 oo 1 lakad linis tuyo itlog beans

dahon infusion ubo sipon oo 1 oo 1 lakad, trabaho talong itlog noodles kanin chicken joy kanjn
bunga infusion ubo sipon

dahon decoction ubo oo 1 oo 1 lakad bike kape tinapay kalabasa kanin

buong halaman decoction panglinis ng bato
dahon decoction ubo, sakit ng tyan oo 1 oo 1 lakad,linis adobo kanin pritong isda, kanin

Oo 1 Oo 1 naglalakad lakad Munggo, adobong baboy kanin Munggo, adobong baboy, Kanin

Oo 1 Oo 1 Lakad Lugaw, kape Wala

Oo 1 Oo 1 Lakad Malunggay, sitaw kanin Malunggay, Sitaw, Kanin

kahapon? Q. Naghuhugas ba ng kamay bago R. May naninigarilyo Kung OO, S. May umiinom ba ng alak sa pam
kumain ang mga miyembro ng ba sa Pamilya?
pamilya?

Gabi Pangalan Edad Ilang stick dahilan ng sinubukan bang itigil kung oo, Pangalan Edad Gaano
nagsimulang ang paninigarilyo kailan? nagsimulang kadalas
manigarilyo nakokonsum uminom ng uminom ng
o sa isang alak alak
araw

1 2 1 2

Tulia at kanin Oo wala/Hindi 1 Bulan,Gilbert P. 20 2x a week

Liempo,Munggo at kanin Oo 1 Wala/Hindi 1 Ualat, Rolando M. 14 Gabi gabi

Ualat, Rommel 18 Once a week
Ualat, Aljur 20 Once a week
Ualat, John-John 20 Once a week

Kanin at nilagang baboy Oo 1 Wala/Hindi 1 Rivera, Ricardo 18 occasionally

Malunggay, kanin Oo 1 Oo 1 Acosta, Froylan 16 2-3 times a pampagana Oo 2016 Acosta, Froylan 21 twice a week

Pritong isda, Kanin Oo 1 Hindi 1 Perez, Jesus I. 25 once a week

Tinola, Pechay, Kanin Oo 1 Hindi 1 Turingan, Manuel B. 20 occasionally

Munggo at kanin Oo 1 Hindi 1 Manalo, Danilo S. 18 Every night

Pritong tilapya at kanin Oo 1 Hindi 1 Wala

Pritong Tilapya, kanin Oo 1 Oo 1 Sabbaluca, Ferdie 17 10 sticks tanggal pagod Oo 26 yrs. old Sabbaluca, Ferdie 17 Thrice a wee

dinuguan, hotdog at kanin oo 1 oo 1 sanchez,teodulo 30 8-10 sticks pambugaw ng lamooo 35 years old Sanchez, Teodulo 35 4 times a we

dinuguan,kanin oo 1 wala 1 Curibang,Jericom 21 once a week

pakbet oo 1 oo 1 ualat,jonel 17 10 sticks pampagana hindi ualat, ionel 20 thrice a week

salmon pechay sili oo 1 hindi 1

kamatis bagoong kanin oo 1 oo 1 gaffud robert sr 30 3 sticks pantanggal pagod oo Dec-17 gaffud robert sr 30 twice a week

karahay,kanin oo 1 oo 1 ballad,generoso sr. 21 10 sticks libangan hindi ballad,generoso 21 once a week

ballad,angelika 19 2 sticks barkada hindi ballad angelika 20 occassional

adobong baboy, Kanin Oo 1 Oo 1 Aspa, Antonio C. 30 3 sticks malibang Oo 36 yrs. old Aspa, Antonio C. 30 twice a week

Tinapay Oo 1 Hindi 1

itlog Kanin Oo 1 Oo 1 Ballad, Erlito U. 30 20 sticks tanggal antok Oo 40 yrs. old Ballad, Erlito U. 30 once a mont
m ba ng alak sa pamilya? T. Tirahan I. Gaano kadalas naglilinis ng II. Kagamitan na pagmamay-ari ng pamilya
kapaligiran?

Ilang bote dahilan ng Sinubukan Kung oo, 1. Sa inyo ba ang bahay? 2. Sa inyo ba ang lupa? 3. Materyales na ginamit sa 4. Sukat ng
ang pag-inom ng bang itigil? kailan? paggawa ng bahay bahay (metro
nakokonsum alak kwadrado)
o

1 2 1 2 1 2 3 1 2 3 4
1 2 3 4 5 6 7 8

TV, Speaker,
1 bottle pampagana oo Nov-18 Oo 1 Oo 1 kahoy at cement 1 6x7=42 sqm2daily 1 Electric fan 1 1 1

Half bottle pampagana hindi Oo 1 Oo 1 Kahoy at Semento 1 14×14=196s daily 1 merun lahat 1 1 1 1 1 1 1
4 bottles hindi
4 bottles hindi
4 bottles hindi

half bottle Pampatulog Oo 5 yrs. ago Oo 1 Oo 1 Kahoy at Semento 1 72 sqm. daily 1 Merun lahat , Airco 1 1 1 1 1 1 1 1

1 bottle pampagana oo Mar-17 Oo 1 Hindi 1 Kahoy at semento 1 20 sqm. daily 1 Electricfan 1

half bottle pampagana Hindi Oo 1 Oo 1 Kahoy at semento 1 7x8=56 sqm daily 1 TV, Radio,DVD,Speak1 1 1 1 1 1

1 bottle NagkayayaanOo 50 years old Oo 1 Oo 1 Semento 1 5x6= 30 sqm.daily 1 TV, Speaker, Ref 1 1 1

2 bottles pampatanggaOo 35 years old Oo 1 Oo 1 Kahoy at Semento 1 40 sqm. Daily 1 TV,radio,DVD,Speake1 1 1 1 1 1 1

Oo 1 Oo 1 Kahoy at Semento 1 30 sqm. Daily 1 TV, radio,Ref,Elctr 1 1 1 1 1

Half bottle tanggal pago Oo 26 years old Oo 1 Oo 1 Kahoy at semento 1 10x12=120 s Daily 1 TV, Radio, Speaker, 1 1 1 1 1 1

1 bottle pampagana koo 35 years old oo 1 oo 1 semento 1 5x6=30 sqm daily 1 TV, speaker, electr 1 1 1 1

3 bottles kailangan ng oo last year hindi 1 hindi 1 kahoy at semento 1 30 sqm daily 1 1 1 1 1 1 1 1

half bottle pampagana hindi oo 1 oo 1 kahoy at semento 1 50 sqm daily 1 tv radio ref electr 1 1 1 1 1

oo 1 oo 1 kahoy at semento 1 7×8=46sqm daily 1 tv,radio,ref,electr 1 1 1 1 1 1

2 bottles pantanggal phindi oo 1 oo 1 semento 1 120 sqm daily 1 meron lahat 1 1 1 1 1 1 1

half bottle pampatulog hindi oo 1 oo 1 semento at kahoy 1 11×6=66sqmdaily 1 plantsa,rice cooker 1 1 1 1 1 1 1 1

1 bottle barkada hindi

2 bottles nagkakayaya Oo 36 yrs. old Oo 1 Oo 1 Semento 1 32 sqm. daily 1 TV, Radio, Speaker, 1 1 1 1 1 1

Oo 1 Oo 1 Kahoy at semento 1 9x4=36 sqm.daily 1 merun lahat, Airco 1 1 1 1 1 1 1 1 1

half bottle pakikisama Oo 40 years old Oo 1 Oo 1 Kahoy 1 5x6=30sqm daily 1 TV 1

 III. Saan kumukuha ng tubig IV. Uri ng Pagtatapon ng Basura V. Uri ng palikuran VI. Gamit sa Pagluluto

1. Uri ng palikuran 2. Layo ng pozo

sa kuhanan ng
tubig (metro)

1. Saan kumukuha ng tubig 2. Lagayan ng Inumin

1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 6 1 2 3 4 5 1 2

Poso 1 Jug 1 Sinusunog 1 Binubuhusan 1 10 meters Gas stove 1

Poso 1 Pitsel at Jug 1 1 Sinusunog, Bina 1 1 Flush 1 4 meters Gas stove, Kaho 1 1

Poso 1 Jug 1 Kinokolekta 1 Flush 1 3 meters Gas stove 1

Poso 1 Jug 1 Sinusunog 1 Binubuhusan 1 7 meters Gas,kahoy,uling 1 1

Poso 1 Jug 1 Sinusunog 1 Binubuhusan 1 15 meters kahoy 1

Poso 1 Pitsel, Jug 1 1 Sinusunog 1 Binibuhusan 1 20 meters Kahoy 1

Poso 1 Jug 1 Sinusunog 1 Binubuhusan 1 5 meters Gas stove 1

Poso 1 Pitsel, Jug 1 1 Sinusunog 1 Binubuhusan 1 5 meters Gas stove 1

Poso 1 Jug 1 sinusunog, Bina 1 1 Binubuhusan 1 4 meters Gas stove, kaho 1 1

poso 1 jug 1 sinusunog 1 binubuhusan 1 7 meters gas stove kahoy 1 1

poso 1 jug 1 sinusunog 1 binubuhusan 1 7 meters gas stove kahoy 1 1

poso 1 pitsel 1 sinusunog 1 binubuhusan 1 4 meters gastove uling 1

poso 1 jug 1 sinusunog bina 1 1 binubuhusan 1 15 meters gastove kahoy 1 1

poso 1 water dispenser 1 kinokolecta 1 flush 1 10 meters kahoy 1

poso 1 pitsel jug 1 1 sinusunog bina 1 1 binubuhusan 1 2 meters Gas stove 1

Refilling station 1 Water dispenser 1 Sinusunog at Bi 1 1 Binubuhusan 1 10 meters Gas stove 1

Poso 1 Jug 1 Sinusunog 1 Binubuhusan 1 5 meters Gas stove 1

Poso 1 Jug 1 Sinusunog 1 binubuhusan 1 10 meters kahoy 1

mit sa Pagluluto VII. Alagang hayop U. Paghahanda sa mga Sakuna

Alagang Bilang Kulungan Nababakunahan I. Nagkakaroon na ba ng II. Anu-anong kagamitan at III. May kaalaman ka ba sa Kung OO, ano
hayop ba or hindi? pagsasanay sa mga dapat materyales ang nakahanda paunang lunas? ang ginagawa?
gawin kung may sakuna? kung sakaling may sakuna

Sagot Sagot

3 4 5 1 2 1 2 Nalason Nasugatan

Aso 2 wala OO Hindi 1 Flashlight,Kandila Oo 1 1 Katas ng Saging

Pusa 1 wala
Ibon 1 merun

Aso 6 nakatali at nakak Oo Hindi 1 Flashlight, candles, canned Oo 1 1 Hugasan

Pato 4 merun
Pusa 1 wala

Manok 3 wala Hindi 1 Flashlight, pagkain, damit hindi 1

1 Manok 1 Oo Hindi 1 Damit, Pagkain, Tubig, FlashOo 1 Oo Alcohol, Betadine

pato 1 Oo

Manok 1 Oo Hindi 1 Damit, Flashlight , Kandila, Oo 1 Wala Oo Alcohol, Agua oxinada

Aso 3 Hindi 1 vaccinated, 2 unv Hindi 1 Camned goods, Kandila, KapHindi 1

Pusa 1 Hindi
Baboy 1 Oo
Aso 2 Wala Oo Hindi 1 Flashlight, canned goods, d Oo 1 wala Oo Alcohol, Betadine, Agua oxi
Manok 5 Oo
Pato 2 Oo
Aso 1 Hindi Hindi Hindi 1 Flashlight, pagkain, tubig, KOo 1 Wala Oo Betadine at Alcohol
 Pato 11 Oo Hindi Hindi 1 Tubig, Pagkain, Flashlight Oo 1 Oo Hospital Oo Betadine hugasan

aso 1 oo oo hindi 1 fkashlight,kandila,kapote,b hindi 1

kambing 1 oo
pato 4 oo
manok 1 oo

baboy 1 oo hindi 1 pagkain damit tubig hindi 1

itik 2 oo
aso 1 wala oo
1 aso 1 oo oo hindi 1 flashlight tubig pagkain oo 1 wala oo saging
pusa 1 wla
pato 10 oo hindi

aso 3 wala oo hindi 1 pagkain tubig flashlight oo 1 wala oo hugasan, alcohol

pusa 1 wala
manok 70 oo

aso 1 oo oo hindi 1 flashlight gamot tubig pagkoo 1 oo tubig oo bandage

aso 1 oo oo hindi 1 flashlight oo 1 wala oo katas ng saging at bayabas

Baka 1 oo Hindi 1 Flashlight, Kandila, kapote Oo 1 wala Oo Hugasan,Betadine at alcohol

Manok 2 oo

Pusa 1 hindi Hindi Hindi 1 Delata, Flashlight kapote Hindi 1 wala wala

Aso 1 hindi hindi Hindi 1 Flashlight, Kapote, Bota Oo 1 wala Oo Tubig sabon
Manok 2 oo hindi hi
Sakuna V. Coping Mechanism

I. Paano niyo hinahara ang iyong II. Dahilan ng Stress III. Ano-ano ang libangan ng I. Ikaw ba ay isang miyembro ng
suliranin? pamilya organisasyon sa komunidad?

Sagot Sagot Sagot

Nakagat
Nabalian Nahimatay (tukuyin)

1 (Aso o Ahas) Hugasan ng tubig at Sabon Nagpapa advise Bisyo panunuod ng Tv at BINGO Oo

(Aso o Ahas) Higasan ng tubog at sabon pinag uusapan Wala Pasyal at nanunuod ng TV Hindi

nagpapa advice wala namamasyal Oo

Pakikinig ng Music, kain at tra Financial, Family Problem TV, Music Hindi

Oo (Aso) Tandok Pinaguusapan Wala Music, TV Oo

pinaguusapan, humihingi ng adWala Kwentuhan, TV Oo

Wala Wala Oo(Aso) Dagta ng papaya Umiinom ng alak Family Pasyal Hindi

Wala Wala Oo (Aso) Bawang Nagpapa advice Wala TV, Pagtitinda Oo

Wala Wala Oo(Aso) Hugasan, sabunin Pinaguusapan Financial Pag dadamo, TV Hindi

nagrerelax o naglalakad lakad awala nagluluto, nagtatanim oo

nag uusap financial,ugali pasyal simba music hindi

wala wala oo ( aso) alcohol tahimik wala tv oo

wala wala oo (aso) tubig sabon ipinapanalangin kabuhayan simba pasyal kain oo

oo immobilize oo white flower oo(aso) bandage pag usapan misunderstanding pasyal,tindahan oo

wala wala oo (aso) bawang,hugasan ng sabon tulong sa iba wala music,tv pasyal oo

wala wala Oo ( Aso) Hugasan nananahimik at pinaguusapan wala Nagluluto, Pasyal Hindi

wala wala wala pray wala TV hindi

wala wala Oo ( Aso) Tandok pinaguusapan karamdaman sa mata TV Hindi

 W. Partisipasyon ng Pamilya sa Komunidad X. Blood Pressure

sang miyembro ng II. Kung OO, anong III. Alam mo ba ang mga IV. Sa paanong paraan nakikilahok ang pamilya sa mga I. May regular bang pagkuha ng II. BP III. Ito ba ang regular IV. Kanino nagpapakonsulta? V. May nirereseta ba na
n sa komunidad? organisasyon? aktibidades at mga aktibidades ng komunidad BP? mong BP? gamot ang doctor?
proyekto sa komunidad?

1 2 1 2 1 2 3 4 1 2 1 2 1 2 3 4 5 1 2

1 Mengal women Oo 1 Nakikilahok sa mga aktibidad 1 Oo 1 110/80 mmHg Oo 1 Public Doctor 1 Hindi 1

1 Oo 1 plano at nakikilahok sa actibi 1 1 Oo 1 140/110 Hindi 1 Nars, BHW 1 1 Oo 1

1 Brgy. Official, Liga ng mga Brgy. Oo 1 Lahat 1 1 1 Oo 1 160/110 Oo 1 Public Doctor 1 Oo 1

1 Oo 1 Tumutulong at nakikilahok 1 1 Oo 1 110/90 Oo 1 public/privat 1 1 Hindi 1

1 Mengal Women Oo 1 Nakikilahok 1 Oo 1 120/80 Oo 1

1 Mengal women Oo 1 tumutulong at nakikilahok 1 1 Oo 1 100/70 Oo 1 Midwife 1 Hindi 1

1 Wala Oo 1 Nakikihalok 1 Oo 1 180/130 Hindi 1 Public Doctor 1 Oo 1

1 Mengal women Oo 1 Nakikilahok 1 Hindi 1 110/80 Hindi 1 Private Doctor 1 Oo 1 Losartan, B-Comp
 1 Wala Oo 1 Nakikilahok 1 Oo 1 120/90 Oo 1 Public Doctor 1 hindi 1

1 lupon ng tagapamayapa oo 1 nakikilahok 1 hindi 1 120/90 hindi 1 public doctor 1 hindi 1

1 wala oo 1 nakikilahok 1 hindi 1 120/80 oo 1 wala hindi 1

1 mengal women oo 1 nakikilahok 1 oo 1 140/90 hindi 1 public doctor 1 hindi 1

1 green lady oo 1 nakikilahok 1 oo 1 120/90 oo 1 public doctor 1 oo 1

1 farmers association oo 1 tumutulong at nakikilahok 1 1 oo 1 150/110 hindi 1 wala hindi 1

1 senior citizen, mengal women oo 1 nakikilahok 1 hindi 1 160/100 hindi 1 public doctor 1 oo 1

1 Wala Oo 1 nakikilahok 1 Oo 1 120/80 Hindi 1 Wala Hindi 1

1 wala Oo 1 nakikilahok 1 Oo 1 150/100 Hindi 1 Private Doctor 1 Oo 1

1 wala Oo 1 tumutulong at nakikilahok 1 1 Hindi 1 110/80 Oo 1 Public Docot 1 Hindi 1

 Y. Mayroon ba kayong vegetable garden sa inyong
bakuran?

VI. Anong gamot VII. Iniinom ba ang VIII. Ilang IX. Nakarehistro ba sa Mayroon ba? Ano-ano ang mga tanim sa
ang nireseta sa gamot sa wastong oras? beses sa Health Center? inyong bakuran?
iyo? isang araw?

1 2 1 2 1 2

Oo 1 Oo 1 Malunggay,Talong, Saluyot, Papaya, Luya

Neoblack Oo 1 once a day Oo 1 Hindi 1

Losartan Oo 1 Once a day Oo 1 Oo 1 Talong, ampalaya ,kalabasa, patola , upo

Wala hindi 1 Wala Oo 1 Oo 1 Pechay, Mustasa, Upo,Patola,Kangkong, Camote, sitaw, Baguio beans, Talong, Kamatis, Ampalaya, Gabi

Oo 1 Hindi/Wala 1

Wala Oo 1 Oo Oo 1 Oo 1 Mustasa, Talong, gabi,Kamatis, Malunggay,Pechay,Kamote,Sitaw

Neoblack wala 1 Wala Oo 1 Oo 1 Talong, Malunggay,okra,saluyot

Losartan, B-Complex
Oo 1 Once a weekOo 1 Oo 1 Sili, Talomg, Saluyot
 wala 1 wala Oo 1 Oo 1 Talong, Okra, Kalabasa

hindi hindi 1 hindi hindi 1 oo 1 pechay mustasa patola,upo,kamatis,talong,okra,malunggay,kangkong,gabi

hindi hindi 1 hindi hindi 1 oo 1 pechay mustasa kalabasa kangkong kamote talong upo

losartan oo 1 once a day oo 1 wala 1

losartan oo 1 once a day oo 1 oo 1 baguio beans talong petchay kamatis papaya kalamansi upo

wala hindi 1 hindi oo 1 oo 1 gabi mustasa kalabasa

neoblack oo 1 once a day oo 1 oo 1 talong malunggay ampalaya guyabano mustasa labasa pechay

wala Hindi 1 Wala Hindi 1 Oo 1 Mustasa at Baguio Beans

Losartan Oo 1 once a day Oo 1 Hindi 1

wala hindi 1 wala Oo 1 Oo 1 Mustasa, Talong, petchay, sitaw, ampalaya, kabatiti, baguio beans
Legend: RELIGION
1 RC
2 INC
3 Methodist
4 Adventist
5 Other

Legend Civil status

1 Married
2 Single
3 Widow
4 Seperated

Legend Pinakamataas na antas na natapos

1 Post graduate
2 College graduate
3 College level
4 High School graduate
5 High School level
6 Elementary level

Legend BMI Classification

1 Very Severely Underweight
2 Severely Underweight
3 Underweight
4 Normal
5 Overweight
6 Obese Class I
7 Obese Class II
8 Obese Class III

Legend Paraan ng pagpapakain sa anak noong sangol pa lamang

1 Nagpapasuso
2 Artipisyal na gatas
3 Nagpapasuso at gumagamit ng artipisyal na gatas
4 At iba pa

Legend Buwanang Kita

1 5000
2 5000-10000
3 11,000-19,000
4 20,000-30,000
5 30,000-40,000
6 40,000-50,000
7 50,000 pataas
Legend Anong Kontrasepsyon ang ginagamit?
1 Condom
2 Calendar Method
3 Depo Provera
4 Basal Body Temperature
5 IUD
6 Oral Contraceptives
7 Implant
8 Tubal Ligations
9 At iba pa

Legend Edad ng anak na buntis

1 10--12
2 13--14
3 15--16
4 17--18

Legend Lifestyle Disease

1 Hypertension
2 Diabetes
3 Asthma
4 Cancer
5 At iba pa

Legend Nakakahawang Sakit

1 Tuberculosis
2 Rabies
3 Measles
4 Dengue
5 Chickepox
6 Leptospirosis
7 At iba pa

Legend kanino kumukunsulta kapag may sakit

1 Pribadong Doctor
2 Pampublikong Doktor
3 Barangay health Worker
4 Midwife
5 Nars
6 Manghihilot
7 Albularyo
8 At iba pa

Legend Klase ng gamot na iniinom kapag may sakit?

 1 May reseta
2 Walang reseta
3 Halamang gamot
4 At iba pa

Legend Tirahan na ginamit sa paggawa ng bahay

1 Kahoy
2 Semento
3 Kahoy at Semento

Legend Gaano Kadalas naglinis ng kapaligiran

1 araw-araw
2 tatlong beses sa isang lingo
3 dalawang beses sa isang lingo
4 minsan sa isang lingo

Legend Kagamitan na pagmamay-ari ng pamilya

1 TV
2 Radio
3 Dvd Player
4 Speaker
5 Refrigerator
6 Electric Fan
7 Washing Machine
8 At iba pa

Legend Saan kumukuha ng tubig

1 Poso
2 Irigasyon
3 Balon
4 Nawasa
5 Bukal
6 At iba pa

Legend Lagayan ng inumin

1 Pitsel
2 Plastik na bote
3 Jars
4 Banga
5 Jug
6 At iba pa

Legend Uri ng pagtatapon ng basura

1 Sinusunog
2 Binabaon
 3 Kinokolekta
4 Pinapakain sa hayop
5 Tinatapon sa ilog
6 At iba pa

Legend Uri ng palikuran

1 Binubuhusan
2 Di-hukay
3 Butas
4 Binabalot at tinatapon
5 At iba pa

Legend Gamit sa pagluluto

1 Gas stove
2 Kahoy
3 Uling
4 Electric stove
5 At iba pa

Legend Sa panahong paraan nakikilahok ang pamilya sa mga aktibidades ng komunidad?

1 Tumutulong sa pagpaplano at pagpapatupad
2 Nagbibigay ng tulong pinansyal
3 Nakikilahok sa mga aktibidad ng komunidad
4 At iba pa

Legend Kanino nagpapakonsulta?

1 pampublikong doktor
2 Pribadong doktor
3 Nars
4 Midwife
5 At iba pa