BHW Monthly Report
BHW Monthly Report
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2
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5
V. Name of Malnourished Children Follow
Age in Mos. Action Taken
Up/Reffered
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2
3
4
VI. Name of Sick Children Followed-Up Age Case Outcome
1
2
3
4
VII. Name of Live Birth Sex Date of Birth Referred for NBS Outcome
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2
3
4
5
Total
VIII. Name of Women Referred for Family Age Method Counselled Outcome
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4
IX. Name of Children Referred Dental Care (12-71 mos old) Age Sex Outcome
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4
5
X. Name of TB Patients Follow-up Age Action Taken Outcome
Sputom-Follow-Up Treatment
1
2
3
4
5
Total
XI. Name of Leprosy Patient Follow-Up Age Sex Follow-Up Treatment Outcome
1
2
Total
XII. Name of Malaria Suspect/Patient Age Sex For Malaria Smear Treatment Outcome
1
2
3
4
5
Total
XIII. Name of Schistoosomiasis/Patient Follow- Age Sex Case Finding (+) Case forTreatment
1
2
3
4
5
XV. Name of Household Toilet Facility Inspected Outcome Action Taken
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4
5
XVI. Name of Household Owner Nearest to the Water Source Disinfect Chlorine use in Grams Date Inspected
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XVII. Health Promotions Number Number of Participants
* Households Teaching Conducted
* Mother's Class Conducted
* BHW Meeting Attended
* Barangay Assembly Conducted
* Meeting Conducted to CHT Families
XVIII. Other DOH Programs Number
* Assist in Garantisadong Pambata Children are Give Vac
* Operation Timbang
* Deworming
* Others
XIX. Deaths
Date of Status registration
Name Age Sex Cause
Death Yes No
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XX. Dates of Duties in Health Facility Dates
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