HOUSEHOLD NO.

NAME AGE SEX EDUCATION ETHNICITY

1 AUNIL 20 Male grade2 Bisaya
2 JIMBRYAN 25 Male high school Bisaya
CHRIS MARIN 1yr 9 month Male none Bisaya
3 MINA BIBBAS 42 Male high school Bisaya
4 XIAN JARPES NERI 5 Male Kinder Bisaya
WJE YAN JUSAYAN 11 Male elementary Bisaya
5 RICASE 28 Male high school Bisaya
GUIA MAURICE 5 Female none Bisaya
RHENA MAYENT 10 month Female None Bisaya
RELIGION OCCUPATION MARITAL
Catholic labarar single
Catholic Vulcanishiny married
Catholic None None
Catholic Business married
Catholic student None
Catholic student None
Catholic student married
Catholic None None
Catholic none None
HOUSEHOLD NO. MONTHLY INCOME REFRIGERATOR/FREEZER TV AIRCON ELECTRIC FAN
1 none 1 None 1
2 10,000 and below none 1 None 1
3 10,000 and below none 1 None 1
4 10,000 and below 1 1 1 1
5 10,000 and below None 1 none 1
RADIO/AUDIO EQUIPMENT HOUSE SOURCE OF ELECTRIC TOILET KIND OF TOILET WALK
1 rented Davao Light Shared Flush
none Owned Davao Light Own Flush
none rented Davao Light Own Flush
none Owned Davao Light Own Flush
none rented Davao light own Flush
MOTORCYCLE TRICYCLE JEEP BUS CAR WOOD
1
1
1
1
1
HOUSEHOLD NO DOCTOR (KMS) HOSPITAL NAME DIST HEALTH CENTRE
1 6to7 cukman general hospital 1
2 none Calman General Hospital none
3 7 to 8 Calman General Hospital 2
4 5 to 6 Calman General Hospital 1.5
5
CHECKUPS FREE MEDS IMMUNIZATIONS FAMILY PLANNING NAME AGE1 YEAR1
1 1 1 1 shaney kin 8 2
1 none none none emily 29 2016
2 1 1 1 mizzy 6 N/A
1 1 1 1 none 2 2
DIAGNOSIS1 TREATMENT1 ATTENDING PHYSICIAN1 NAME AGE2 DIAGNOSIS2
fever paracetamol 2 2 2 2
asthma salbutamol 2 2 2 2
fever paracetamol 2 mark jacob 4 fever
2 2 2 2 2 2
YEAR2 TREATMENT2ATTENDING PHYSICIAN2
2 2 2
2 2 2
2 paracetamol 2
2 2 2
HOUSEHOLD NO. MENOPAUSE HYSTERECTOMY CURRENTLY PREGNANT
5 2 2 1
6 2 2 2
7 2 2 2
8 1 2 2
ANY MORE CHILDREN CURRENTLY USING FP CURRENT FP LOCATIO SMOKING HOW MANY
1 2 2 2 2
1 2 2 2 2
2 DMPA 2 2 2
2 2 2 2 2
DRINKING ALCHOHOL HOW MANY GAMBLING HOW MANY ILLEGAL DRUG HOW MANY
2 2 2 2 2 2
2 2 2 2 2 2
2 2 2 2 2 2
2 2 2 2 2 2
HOW MANY
HOUSEHOLD NO SOURCE OF WATER YARD WASTE FOOD WASTE PAPER WASTE
1 piped level 3 bury bury bury
2 piped level 3 Bury burn throw in vacant lot
3 piped level 3 burn Burn Burn
4 piped level3 burn Burn Burn
5 piped level 3 burn burn burn
PLASTIC WARE METAL WASTE GLASS BOTTLES
bury Recycle Recycle
Recycle Recycle Recycle
Recycle Recycle Recycle
Recycle Recycle Recycle
recycle Recycle recycle
HOUSEHOLD NO. NAME OF WOMAN OBSCORE1 YEAR OF PREGNANCY 1 OUTCOME1
5 genevosa G2P2 2008 Live Birth
6 emily G1P1 2 Live Birth
7 remelyn G3P3 2012 Live Birth
8 maddlyn G3P2 2006 Live Birth
YR. OF PREG. 2 OUTCOME 2 YEAR OF PREGNANCY 3 OUTCOME3 Prenatal care if yes,when
2010 Live Birth 2 2 2 2
2 Live Birth 2 2 2 2
2014 Live Birth 2019 Live Birth 1 1st trimester
2008 Live Birth 2019 Live Birth 2 2
FREQUENCY Tetanus toxoid Any signs Which symtpoms Where delivered Who asissted
2 2 2 2 2 2
2 2 2 2 2 2
2 1 2 2 Birthing Home Midwife
2 2 2 2 2 2
How was baby delivered Visit after birth Breastfed Why not?
2 2 2 2
2 2 2 2
NSVD 2 1 2
2 2 2 2
HOUSEHOLD NO BREAKFAST LUNCH DINNER SNACKS AM SNACKS PM
5 rice,milk,vegetables Rice,vegetable Rice, vegetable pan banana
6 rice,noodles ricecorned beefRice,vegetable 2 banana
7 rice,milk,fish rice,fried fish Rice,vegetable 2 2
8 rice,egg Rice,vegetable Rice,vegetable banana bread
HOUSEHOLDNO. BARANGAY DIST. CITY HALL DIST. GOVT. POSITION NAME/RELATION VOTING
5 1to 5 6to7 2 None 1
6 2 2 1 None 1
7 2.5 7to8 2 none 1
8 1.5 5to6 2 None 1
WHY NOT?
None
None
None
None
HOUSEHOLD NO. NEAREST PLACE OF WORSHIP PICNIC BEACH SPORTS VIDEOKE GAMBLING
1 4km 2 2 2 2 2
2 2 2 2 2 2 2
3 1.5 2 2 2 2 2
4 1 2 2 2 2 2
TV SOCIAL MEDIA NONE FIESTA SPORTS TOURNAMENTS DANCE CONTESTS GAMBLING
1 2 2 2 2 2 2 2
2 2 2 1 2 2 1 2
1 1 2 1 2 1 1 2
1 2 2 2 2 2 2 2
OTHERS NONE
2 2
2 2
2 2
2 2
HOUSEHOLD NO. REGULAR CHECKUP IF YES,WHERE ? NAME 1 AGE1 WEIGHT HEIGHT
5 1 2 ACHTEY 10 2 2
6 2 2 AIVEE 6 2 2
7 1 2 MIZZY 6 13.8 96
8 2 2 2 2 2 2
REGULAR CHECKUP WHR? NUTRITION STATUS FEEDING VIT A1 OTHERS
2 2 2 2 2 2
2 2 2 2 2 2
2 2 2 1 1 2
2 2 2 2 2 2
SOURCE OF VACCINATION HEALTH CARDS? BCG DPT1 DPT2 DPT3 OPV1 OPV2
2 1 1 1 1 1 1 1
2 1 1 1 2 2 2 2
2 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2
OPV3 MEASLES HEP B OTHERS
1 1 1
2 2 2
1 1 1
2 2 2