Section F.

Non-Communicable Disease Prevention and Control Services

Indicators Male Female Total Remarks Indicators Male Female Total Remarks
(Col. 1) (Col. (Col. (Col. 5) (Col. 1) (Col. (Col. (Col. 5)
(Col. 4) (Col. 4)
2) 3) 2) 3)
1. No. of adults risk-assessed using PhilPEN -Total 10. No. of adult women with suspicious breast mass - Total

2. Current smokers - Total 11. No. of identified hypertensive adults - Total

3. Current smoker with BTI - Total 12. No. of identified hypertensive adults provided with antihypertensives - Total

4. Alcohol binge drinkers - Total 13. No. of identified adults with Type 2 DM- Total
14. No. of identified adults with Type 2 DM provided with diabetes medications -
5. Alcohol binge drinkers with BAI - Total
Total

6. Overweight/Obese - Total 15. No. of senior citizens screened for visual acuity - Total

7. No. of adult women screened for Cervical Cancer using VIA/Pap Smear -
16. No. of senior citizens diagnosed with eye disease/s - Total
Total
8. No. of adult women found positive / suspect for Cervical Cancer using VIA
17. No. of senior citizens who received one (1) dose of PPV - Total
or Pap Smear - Total
9. No. of adult women screened for breast mass
18. No. of senior citizens who received one (1) dose of influenza vaccine - Total
- Total

Section G. Environmental Health and Sanitation Services

Indicators Total Remarks Indicators Total Remarks
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)
1. No. of HHs with access to basic safe water supply - Total 2. No of HHs with basic sanitation facility - Total

a. No. of HHs with Level I - Total a. No. of HH with pour/flush toilet connected to septic tank - Total
b. No. of HHs with pour/flush toilet connected to community
b. No. of HHs with Level II - Total
sewer/sewerage system or any other approved treatment system - Total
c. No. of HHs with Level III - Total c. No. of HHs with ventilated improved pit latrine (VIP) - Total

3. No. of industrial establishments issued with sanitary permit - Total

Section H. Mortality
Section I. Natality
Male Female Total Indicators Male Female Total Remarks
Indicators Remarks
(Col. (Col. (Col. 1) (Col. (Col. (Col. 5)
(Col. 1) (Col. 4) (Col. 5) (Col. 4)
2) 3) 2) 3)
1. Total Deaths 1. Livebirths - Total

2. Maternal Deaths - Total a. Livebirths among 15-19 y/o women-Tot.

3. Under-five Deaths - Total b. Livebirths among 15-19 y/o women WITHIN EL SALVADOR CITY - Total

CBR:
4. Infant Deaths - Total
ABR:
5. Neonatal Deaths - Total

6. Fetal Deaths - Total AGE 10 11 12 13 14 15-19 20-49 Total YEAR 2024 TOTAL

7. Early Neonatal Deaths - Total NEW PREGNANT

Number of HOUSEHOLD
8. Perinatal Deaths - Total TRACKED for the
PROFILED for the MONTH
Please note if DEATH occurred within El Salvador City or Outside for MATERNAL and CHILD Death (#3, #8)
MONTH
 Section D. Oral Care and Services
To be submitted Quarterly
Male Female Total Male Female Total
Remarks Indicators Remarks
Indicators
(Col. (Col. (Col. 5) (Col. 1) (Col. (Col. (Col. 5)
(Col. 4) (Col. 4)
2) 3) 2) 3)
1. Orally fit children 12-59 months old upon oral exam plus orally fit after
6a. Adolescents 10-14 years old who received BOHC - Total
rehab - Total
2. Clients 5 years old and above with cases of DMFT - Total 6b. Adolescents 15-19 years old who received BOHC - Total

3. Infants 0-11 months old who received BOHC - Total 7. Adults 20-59 years old who received BOHC - Total

4. Children 1-4 years old who received BOHC -Total 8. Senior citizens 60 years old and above who received BOHC - Total

5. Children 5-9 years old who received BOHC - Total

Indicators 10 11 12 13 14 15-19 20-49 Total Remarks

9. Pregnant women who received BOHC - Total

Section E. Infectious Disease Prevention and Control Services
Male Female Total Male Female Total
Indicators Remarks Indicators Remarks
(Col. (Col. (Col. (Col.
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
2) 3) 2) 3)
E1. Filariasis Prevention and Control (to be reported annually)
E2. Schistosomiasis Prevention and Control
1. No. of patients seen - Total 6. No. of confirmed chronic cases - Total
7. No. of confirmed cases (acute and chronic) -
2. No. of suspected cases seen - Total
Total
3. No. of acute clinically diagnosed cases - Total 8. No. of cases treated - Total

4. No. of confirmed acute cases - Total 9. No. of confirmed chronic cases referred to a hospital facility - Total

5. No. of chronic clinically diagnosed cases - Total E5. Tuberculosis Prevention and Control

E3. Soil Transmitted Helminthiasis Prevention and Control (other age groups reflected under Child Care and Maternal Care) 1. Number of notified TB cases, all forms - Total

1. No. of WRA, 20-49 years old, who completed 2 doses of 2. No. of registered bacteriologically confirmed drug resistant TB (RR/MDR-TB
deworming tablet - Total Cases) -Total

E4. HIV-AIDS/STI Prevention and Control (reflected under Maternal Care) 3. Number of TB, all forms that are cured and completely treated - Total

4. No. of registered bacteriology confirmed drug resistant TB Cases (RR/MDR-

TB) cured & completed treatment - Total
E6. Leprosy Prevention and Control E7. Rabies Prevention and Control

1. No. of Leprosy cases on treatment during eporting period - Total 1. No. of animal bites - Total

2. No. of newly detected cases during reporting period - Total 2.. No. of deaths due to Rabies - Total
 Section C. Child Care and Services
Indicators Male Female Total Male Female Total
Remarks Indicators Remarks
(Col. (Col. (Col. (Col.
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
2) 3) 2) 3)
C1. Immunization Services for Newborns, Infants and School-Aged Children/Adolescents
1. CPAB - Total 13. PCV 1 - Total

2. BCG - Total 14. PCV 2 - Total

3. HepB, within 24 hours. - Total 15. PCV 3 - Total

4. DPT-HiB-HepB 1 - Total 16. MCV 1 - Total

5. DPT-HiB-HepB 2 - Total 17. MCV 2 - Total

6. DPT-HiB-HepB 3 - Total 18. FIC - Total

7. OPV 1 - Total 19. CIC - Total

8. OPV 2 - Total 20. Td, Grade 1 (November) - Total

9. OPV 3 - Total 21. MR, Grade 1 (November) - Total

10. IPV 1 - Total 22. Td, Grade 7 (November) - Total

11. IPV 2 (routine)- Total 23. MR, Grade 7 (November) - Total

12. IPV 2 (catch-up)- Total 24. HPV, Grade 4 (9-14 years old) - Total

C2. Nutrition Services for Infants and Children

Indicators Male Female Total Remarks Indicators Male Female Total Remarks
(Col. (Col. (Col. (Col.
(Col. 1) (Col. 4) (Col. 5) (Col. 1) (Col. 4) (Col. 5)
2) 3) 2) 3)
24. Newborns initiated on breastfeeding imme-diately after birth lasting to 90 33. Stunted - Total
mins - Total
25. Preterm/LBW infants given iron supplementation - Total 34. Wasted - Total
26. Infants exclusively breastfed until 5th month and 29 days - Total 34.a. MAM - Total
27. Infants 6 mos. old initiated to complementary feeding with continued 34.a.1. MAM-admitted in SFT - Total
breastfeeding - Total
28. Infants 6 mos. old initiated to complementary feeding but no longer or 34.a.2. MAM-cured in SFT - Total
never been breastfed - Total
29. Infants 6-11 mos. given 1 dose of Vitamin A 100,000 I.U. - Total 34.a.3. MAM-defaulted in SFT - Total

30. Children 12-59 mos. old given 2 doses of Vitamin A 200,000 I.U. - Total 34.a.4. MAM-died in SFT - Total
31. Infant 6-11 months old who completed MNP supplementation - Total 34 b. SAM - Total
32. Children 12-23 mos. who completed MNP supplementation - Total 34.b.1. SAM-admitted in OTC - Total

C3. Deworming Services for Infants, Children and Adolescents 34.b.2. SAM-cured in OTC - Total

37. 1-19 y/o given 2 doses of deworming drug - 34.b.3. SAM-defaulted in OTC - Total
Total
a. PSAC, 1-4 y/o dewormed (2 doses) - Total 34.b.4. SAM-died in OTC - Total
b. SAC, 5-9 y/o dewormed (2 doses) - Total 35. Overweight and Obese - Total
c. Adolescents, 10-19 y/o dewormed (2 doses) - Total 36. Normal - Total
C4. Management of Sick Infants and Children
38. Sick Infants 6-11 mos. old seen - Total 42. Diarrhea cases 0-59 months old seen - Total
39. Sick Infants 6-11 mos. old received Vitamin A - Total 43. Diarrhea cases 0-59 months old received ORS - Total

40. Sick Children 12-59 mos. old seen - Total 44. Diarrhea cases 0-59 mos. received ORS w/ zinc - Total

41. Sick Children 12-59 mos. old received Vitamin A - Total 45. Pneumonia cases 0-59 mos. old seen - Total
 B2. Intrapartum Care and Delivery Outcome

15-19 20-49 15-19 20-49

10 11 12 13 14 Total REMARKS 10 11 12 13 14 Total REMARKS

Names of Mother who delivered… 20. No. of deliveries attended by skilled

18. No. of deliveries – Total health professionals - Total
a. No. of deliveries attended by a doctor -
4 ANC
Total
No. of deliveries b. No. of deliveries attended by a nurse –
w/in EL SAL/LYING IN Total
c. No. of deliveries attended by midwives -
4 ANC
Total
HOME LIVE BIRTH within EL SALVADOR
4 ANC Birth Within EL SLVADOR 10 11 12 13 14 15-19 20A TOTAL
Outside EL SAL Lying-in (LIMC)
4 ANC Home Delivery/Transit
19. No. of live births – Total Mothers who COMPLETED 4 ANC
a. No. of live births with
Lying-in (LIMC) NOTE: 4ANC and 2PP will be based
normal birth weight - Total
on TOTAL DELIVERIES (within and
b. No. of live births with low
Home Delivery/Transit outside EL SALVADOR)
birth weight - Total
c. No. of live births with
Mothers who COMPLETED 2PP
unknown birth weight-Total
Lying-in (LIMC)

Home Delivery/Transit
Indicators Age Total Remarks Age
(Col. 1) (Col. 2) (Col. 3) (Col. 4) Indicators (Col. 2)
15- (Col. 1) 15-
10 11 12 13 14
19
20-49 10 11 12 13 14 19 20-49 TOTAL
21. No. of health facility-based 23a. No. of vaginal deliveries – Total
deliveries - Total
a. No. of deliveries in public health 23b. No. of deliveries by cesarean section –
facility-Total Total
b. No. of deliveries in private 24a. No. of full-term births – Total
health facility-Tot.
22. No. of non-facility-based 24b. No. of pre-term births – Total
deliveries - Total
24c. No. of fetal deaths - Total

24d. No. of abortion/miscarriage - Total

B3. Postpartum and Newborn Care
25. No. of postpartum women 27. No. of postpartum women with
together with their Vitamin A supplementation – Total
newborn
who completed at least 2
postpartum check-ups -
Total
26. No. of postpartum women
who completed iron with
folic acid supplementation -
Total
 Section A2. Deworming for Women of Reproductive Age
20-49 yrs old
No. of WRA given one dose of
deworming tablet
No. of WRA given two doses of
deworming tablet

Section B. Maternal Care and Services

Indicators Age Remarks Indicators Age Remarks
(Col. 1) (Col. 2) Total (Col. 4) (Col. 2) Total (Col. 4)
15- (Col. 3) (Col. 1) 15- (Col. 3)
10 11 12 13 14 20-49 10 11 12 13 14 20-49
19 19
B1. Prenatal Care
1. No. of pregnant women who 6. No. of pregnant women who completed
gave birth (w/in and outside) doses of calcium carbonate supplementation -
with at least 4 prenatal check- Total
ups - Total
2. No. of pregnant women 7. No. of pregnant women given iodine
assessed of their nutritional capsules – Total
status during the 1st tri. -Total

a. Number of pregnant women 8. No. of pregnant women given one dose of

seen in the first trimester who deworming tablet - Total
have normal BMI - Total
9. No. of pregnant women screened for
b. No. of pregnant women
syphilis - Total
seen in the first trimester who
have low BMI - Total

c. No. of pregnant women seen 10. No. of pregnant women tested positive
for syphilis - Total
in the first trimester who have
high BMI-Total
11. No. of pregnant women screened for
3. No. of pregnant women for
Hepatitis B - Total
the first time given at least 2
doses of Td vaccination-Total
12. No. of pregnant women tested positive
4. No. of pregnant women for
for Hepatitis B - Total
the 2nd or more times given at
least 3 doses of Td vaccination
(Td2 Plus) - Total

5. No. of pregnant women who 13. No. of pregnant women screened for
completed the dose of iron HIV - Total
with folic acid supplementation
- Total
14. No. of pregnant women tested for CBC
or Hgb & Hct count - Total

15. No. of pregnant women tested for CBC

or Hgb & Hct count diagnosed with anemia -
Total
16. No. of pregnant women screened for
gestational diabetes – Total

17. No. of pregnant women tested positive

for gestational diabetes – Total
 FHSIS REPORT for the MONTH: _________________________ YEAR: 2024

M1
Name of Barangay: _______________________________
Name of BHS: _______________________________ Please reproduce copies
Name of Municipality/City:
Name of Province:
_______________________________
_______________________________
for your barangay. POBLACION
Projected Population of the Year: _______________________________ Thank you!
For submission to RHU/MHC
Section A1. Family Planning Services
A1.a. Modern FP Unmet Need Age Total for WRA
(Col. 1) (Col. 2) (Col. 3) Remarks
10-14 y/o 15-19 y/o 20-49 y/o (Col. 4)
1. No. of WRA with unmet need for modern FP - Total
A1.b. Use of FP Method Current Users Acceptors Drop-outs
(Beginning Month) New Other (Present Month) (Present Month) New Acceptors
Current Users
(Previous Month) Restarter (RS), Changing Method (CM), (Col. 6) (End of Month)
Changing Clinic (CC) (+)
(Col. 7)
(Col. 3) (Col. 4) (Col. 5)
(Col. 1) (Col. 2)
15- 20- 15- 20- 15- 20- 15- 20- 15- 20- 15- 20-
10 11 12 13 14 19 49 Total 10 11 12 13 14 19 49 Total 10 11 12 13 14 19 49 Total 10 11 12 13 14 19 49 Total 10 11 12 13 14 19 49 Total 10 11 12 13 14 19 49 Total

a. BTL - Total

b. NSV - Total

c. Condom - Total

d. Pills - Total

d.1 Pills-POP - Total

d.2 Pills-COC - Total

e. Injectables (DMPA/POI)-Tot.

f. Implant - Total

g. IUD (IUD-I and IUD-PP)-Tot.

g.1 IUD-I- Total

g.2 IUD-PP - Total

h. NFP-LAM - Total

i. NFP-BBT - Total

j. NFP-CMM - Total

k. NFP-STM - Total

l. NFP-SDM - Total

m. Total Current Users