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FAMILY PROFILE and CHILD RECORD Format

This document provides a family profile for a household in Brgy. Poblacion. It includes information about the head of household, spouse, children, occupation, health details, housing, family planning methods, and child health records for children under 5 years old.

Uploaded by

joy terante
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
72 views

FAMILY PROFILE and CHILD RECORD Format

This document provides a family profile for a household in Brgy. Poblacion. It includes information about the head of household, spouse, children, occupation, health details, housing, family planning methods, and child health records for children under 5 years old.

Uploaded by

joy terante
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BRGY.

POBLACI
ONFAMI
LYPROFI
LE

HeadofFami
l
y:_
___
___
___
___
___
___
___
___
_ Bi
rt
hday
:__
___
___
___
___
___

Addr
ess:
___
___
___
___
___
___
___
___
___
___
__ Occupat
ion:
___
___
___
___
___

Spouse:
___
___
___
___
___
___
___
___
___
___
___ Bi
rt
hday
:__
___
___
___
___
___
_

Occupat
ion:
___
___
___
___
___
___
___
___
___
__ Phi
l
.Heal
th#:
___
___
___
___
__

NHTS#:
___
___
___
___
___
___
___
___
___
___
___ Cont
actNumber
:__
___
___
___
__

()4PS ()NHTS ()LGUSponsor


ed ()MCCT ()DepEd ()OFW ()
Non-
PHIC

Mar
it
al Rel.tothe
Chi
ldr
en’
sName Bi
rt
hday Sex Headoft he Tr
ibe
St
atus famil
y

Ty
peoft
oil
etused()Wat
erseal
ed ()Openpi
tpr
ivy
Sour
ceofWat
er:
___
___
___
___
___
___
___
___
___
___
___
_

Gar
bageDi
sposal
()compost
ing()bur
ning ()bur
ying

Backy
ardGar
deni
ng()y
es ()no

Ty
peofHousi
ng:
___
___
___
___
___
___
___
___
___
___
___
__

Fami
l
yPl
anni
ngused: ()BDM/
Nat
ural ()Pi
l
ls ()I
UD
()DMPA

()I
mpl
ant ()BTL ()Vasect
omy
()LAM

Munici
pali
tyofLakeSebu
BarangayPoblaci
on

CHI
LDRECORD
Chi
l
dRecor
d(Chi
l
dren0-
5year
sol
d)

Name: __
_____
_____
_____
_____
_____
_____
___ Dat
eofBir
t _
h:______
_________Sex:_
_____
___
Address:__
_____
_____
_____
_____
_____
_____
___
___
___
___
____
_____
______
____
______
_____
___
Mother’
sName: _____
_____
_____
_____
_____
___
___
___
___
___Occupati
on:__
______
_____
_____
__

PASTHISTORYOFTHECHI LD
1.Deli
ver
y ()Normal ()Abnormal,
pls.st
ate__ _
____
______
____
2.Bir
thOrder Number _
____
____
_ ()Single ()Mul ti
ple
3.Deli
ver
edby ()Mi dwif
e ()Hi l
ot ()Phy si
cian ()Ot her
,
___
____
____
4.PastDi
seases__
___
_____
____
____
_____
___
___
____
______
____
_ _
______
______
____
_____

Tobef
il
leduponl
yforl
esst
han2y
ear
sol
dorwi
thabnor
mal
i
ty

5.Agest
art
edteethi
ng___
_____
_____ 7.St
andwi thoutsuppor
t__
___
___
___
___
___
_
6.Si
twit
hsupport__
___
_____
_____
__ 8.Walk1ststep_____
___
___
___
___
___
___
___

I
MMUNI
ZATI
ONHI
STORY
RECOMMENDEDAGE
VACCI
NE AT 1½ 2½ 3½ 12
9MONTHS
BI
RTH MONTHS MONTHS MONTHS MONTHS
BCG

HEPATI
TISB

PENTAVALENT
ORALPOLI
O
VACCI
NE(OPV)
I
NACTIVATEDPOLIO
VACCINE(I
PV)
PNEUMOCOCCAL
CONJUGATEVACCINE
(PCV)
MEASLES,MUMPS,
RUBELLA(MMR)

Dat
e Compl
aint
s/Fi
ndi
ngs/Di
agnosi
s Tr
eat
ment
NBSdat
eandr
esul
t:
Bi
rt
hWei
ght
:
Lengt
h/Hei
ght
:
Vi
tami
nK:

Dat
e Compl
aint
s/Fi
ndi
ngs/Di
agnosi
s Tr
eat
ment

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