Post on 02-Jun-2018
8/11/2019 CHT Report Matrix
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BARANGAY MASAO
NO. HOUSEHOLD NO. BIRTHDAY RELATIONSH
Last Name First NameYears Months Day
NAMES
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SOURCE OF
WATER
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BARANGAY MASAO
NO. HOUSEHOLD NO. BIRTHDAY NAMES
Years
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RELATIONSHIP CCT
DATE
STARTED
JAN FEBMonths Day
CHT PARTNER
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MAR APR MAY JUN JUL AUG SEP OCT NOV DEC FP METHOD Reasons for not
using
CURRENT USERS PROBABLE USERS
Pregnant
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DROPOUTS
Single Separated
Spouse
working out
of town
Wish to have
a childTransfer-out DeceasedMenopause Widowed
With Health
Issues
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NO. HOUSEHOLD NO. BIRTHDAY NAMES Years
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RELATIONSHIP Facilit Home
NEWBORN HEALTH
Place ofNBS IBF BCG
Months Day CHT PARTNER
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1 2 3 1 2 3 1 2 1 2 3
INFANT HEALTH
ICPENTA OPV MCV ROTAHepa
B
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1 2 3 EBF CBF
DEWORMI
NG
CHILD HEALTH
BFFIC IRON VIT.A
PCV
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NO. HOUSEHOLD NO. BIRTHDAY NAMES Years
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RELATIONSHIP CCT 1stMonths Day CHT PARTNERLMP(DATE)
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2nd 3rd 4th 24HRS 1WK
PRENATAL VISITS (DATE) W/ 4 PNV
(DATE)TT IRON W/ 4 PNV
W/ PPV (DATE)
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BF FP NC
COUNSELLINGBIRTH
PLANVIT. A
IRON W/
FOLIC
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NO. HOUSEHOLD NO. BIRTHDAY NAMESYears
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RELATIONSHIP CCT
SPUTUM
EXAMXRAYMonths Day
CHT PARTNER
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