template for national cht reporting
DESCRIPTION
CHTTRANSCRIPT
Municipality of: ______________________
TARGET (Q1) TRAINED DEPLOYED% of Trained
Teams
% of Deployed
Teams TARGET (Q1) TRAINED DEPLOYED
% of Trained
CHT Members
% of Deployed
CHT MembersTARGET TRAINED DEPLOYED
% of Trained
RNHEALS
% of Deployed
RNHEALS
1) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
2) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
3) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
4) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
OVERALL TOTAL #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
NOTED BY: APPROVED BY:
Republic of the Philippines
Department of Health
Regional Office III
Form 1 : COMMUNITY HEALTH TEAMS COVERAGE & MATERNAL & NEONATAL DEATHS CONSOLIDATED REPORT
AS OF October 30, 2014
Barangays
NO. OF
MATERNAL
DEATHS
NO. OF
NEONATA
L DEATHSNHTS (Q1 ) VISITED
COMMUNITY HEALTH TEAMS
% of Household
Visited
NO. OF HOUSEHOLDS
NO. OF TEAMS NDPNO. OF MEMBERS
Republic of the Philippines
Department of Health
Regional Office III
Form 1 : COMMUNITY HEALTH TEAMS COVERAGE & MATERNAL & NEONATAL DEATHS CONSOLIDATED REPORT
AS OF October 30, 2014
NO. OF
INFANT
DEATHS
Municipality of: _________________________
MALARIA NCD
1)
2)
3)
4)
OVERALL TOTAL
.
NOTED BY: APPROVED BY:
NEWBORNUNDER-5
CHILDREN
NO. OF SEEN & REFERREDCURRENT MODERN
FP USERSWITH RISK FACTORS FOR:
WITH ACCESS
TO SAFE H20OthersPHIC
MEMBERS
FP WITH
UNMET
NEEDS
% of PHIC
Members
% of HH WITH
ACCESS TO
SAFE H20
% of HH WITH
SANITARY
TOILET
Republic of the Philippines
Department of Health
Regional Office III
SENIOR
CITIZENSPWDs MEN WOMEN TB
FORM 2: CHTs HOME VISIT CONSOLIDATED REPORT
BarangaysHOUSEHOLD
VISITED
NO. OF HOUSEHOLDS
AS OF OCTOBER 30, 2014
WITH
SANITARY
TOILETPREGNANT
WOMEN
WITH RISK FACTORS FOR:
Republic of the Philippines
Department of Health
Regional Office III
FORM 2: CHTs HOME VISIT CONSOLIDATED REPORT
NO. OF HOUSEHOLDS
AS OF OCTOBER 30, 2014
TOTAL