Bhs Rama Non Com Masterlist
Bhs Rama Non Com Masterlist
Bhs Rama Non Com Masterlist
SENIOR
PWD INDIGENT SCHEDULE OF
NAME AGE SEX ADDRESS CONTACT NUMBER DIAGNOSIS CITIZEN REMARKS
YES/NO YES/NO TREATMENT
YES/NO
9 A
10
11
12
13
14
15
16
17
18
19
20
BARANGAY MASTERLIST OF HYPERTENSIVE and DIABETIC PATIENTS
Put "1" on the corresponding column
MEDICATIONS TAKEN (for oral medications please indicate the number of tablets
SEX
taken per day)
Isophane Biphasic
DATE OF Insulin Insulin
BOTH (NPH) (70/30)
NAME OF LAST FIRST MIDDLE BIRTH PHILHEALTH Kindly Kindly
No. AGE ADDRESS HPN DM WITH HPN Amlodipine Amlodipine Losartan Simvastatin Metformin
FACILITY NAME NAME NAME M/F (mm/dd/ NUMBER AND DM indicate the indicate the Others Remarks
5mg 10 mg 50mg 20mg 500mg
yyyy) number of number of
vials vials
consumed consumed
in 1 quarter in 1 quarter
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL 0 0 0
BARANGAY MASTERLIST OF HYPERTENSIVE and DIABETIC PATIENTS
Put "1" on the corresponding column
MEDICATIONS TAKEN (for oral medications please indicate the number of tablets
SEX
taken per day)
Isophane Biphasic
DATE OF Insulin Insulin
BOTH (NPH) (70/30)
NAME OF LAST FIRST MIDDLE BIRTH PHILHEALTH Kindly Kindly
No. AGE ADDRESS HPN DM WITH HPN Amlodipine Amlodipine Losartan Simvastatin Metformin
FACILITY NAME NAME NAME M/F (mm/dd/ NUMBER AND DM indicate the indicate the Others Remarks
5mg 10 mg 50mg 20mg 500mg
yyyy) number of number of
vials vials
consumed consumed
in 1 quarter in 1 quarter
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL 0 0 0
BARANGAY MASTERLIST OF HYPERTENSIVE and DIABETIC PATIENTS
Put "1" on the corresponding column
MEDICATIONS TAKEN (for oral medications please indicate the number of tablets
SEX
taken per day)
Isophane Biphasic
DATE OF Insulin Insulin
BOTH (NPH) (70/30)
NAME OF LAST FIRST MIDDLE BIRTH PHILHEALTH Kindly Kindly
No. AGE ADDRESS HPN DM WITH HPN Amlodipine Amlodipine Losartan Simvastatin Metformin
FACILITY NAME NAME NAME M/F (mm/dd/ NUMBER AND DM indicate the indicate the Others Remarks
5mg 10 mg 50mg 20mg 500mg
yyyy) number of number of
vials vials
consumed consumed
in 1 quarter in 1 quarter
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
TOTAL 0 0 0