Call Sheet

Topics: 2G, Tetanus, Childbirth Pages: 1 (343 words) Published: May 14, 2013
SUMMARY CALL SHEET
For the Month of:__________ Year:____________
Name of CHT Member (Last Name, First Name) Coverage Purok/Barangay Name of Midwife (Last Name, First Name) _________________________________________________ ______________________________________ _____________________________________ NHTS HOUSEHOLD ID NO./SURNAME| Family Data| Prenatal Checkup| Iron with Folic Acid supp.| Tetanus toxoid| Facilioty based delivery| Postpartum Checkup| Newborn Screening| Immunization| Child| Modern FP| ChronicCoughCheckup,SputumExam,Treatment| Others| | 4p| Located/Visited| With PhilHealth card| With Philheakth Plans| | | | | | | Hepa B| BCG| OPV| DPT| MEASLES| Deworming| Vit. A Supp.| FP Couns.| NFP| Pills| DMPA| Condom| IUD| Vasectomy| Ligation| | | | Y/N| L/V| Y/N| Y/N| 1 bar for every individual using the health service; write P if the service is obtained from a private facility and G if from a government facility (e.g 1-P, 1-G)| BHS GANGAHIN| 466| V| Y| Y| 33-G| 32-G| 25-G| 4-G| 14-G| 0| 61-G| 61-G| 61-G| 61-G| 26-G| 0| 26-G| 219-G| 105-G| 67-G| 12-G| 4-G| 7-G| 0| 1-G| 5-G| 102-G| BHS SAMPALOC| 308| V| Y| Y| 17-G| 14-G| 13-G| 3-G| 3-G| 0| 21-G| 8-G| 21-G| 24-G| 14-G| 0| 14-G| 42-G| 0| 12-G| 1-G| 0| 0| 0| 0| 1-G| 87-G| BHS POCTOL| 281| V| Y| Y| 9-G| 9-G| 5-G| 0| 4-G| 0| 21-G| 4-G| 17-G| 17-G| 9-G| 0| 7-G| 0| 2-G| 27-G| 17-G| 0| 4-G| 0| 6-G| 0| 22-G| BHS POBLACION| 281| V| Y| Y| 14-G| 10-G| 6-G| 1-G| 1-G| 0| 12-G| 1-G| 6-G| 7-G| 3-G| 0| 3-G| 42-G| 53-G| 22-G| 6-G| 1-G| 12-G| 0| 13-G| 4-G| 287-G| | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total No. of Members| | | | | | | | | | | | | | | | | | | |...
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