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    Mama Files

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    iluminadocorros
    This document contains a registration form for Marittes B. Arciga, a barangay health worker in Dinginan, Roxas City, Capiz. The form provides her personal details such as name, address, date of birth, civil status, and educational attainment. It also lists her service record as a health worker since 2000, the trainings she has attended, and her membership in national health organizations. The form is certified by her technical supervisor and the barangay captain to verify her registration as the official health worker for the area.

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    Mama Files

    Uploaded by

    iluminadocorros
    28 views3 pages
    This document contains a registration form for Marittes B. Arciga, a barangay health worker in Dinginan, Roxas City, Capiz. The form provides her personal details such as name, address, date of birth, civil status, and educational attainment. It also lists her service record as a health worker since 2000, the trainings she has attended, and her membership in national health organizations. The form is certified by her technical supervisor and the barangay captain to verify her registration as the official health worker for the area.

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    This document contains a registration form for Marittes B. Arciga, a barangay health worker in Dinginan, Roxas City, Capiz. The form provides her personal details such as name, address, date of birth, civil status, and educational attainment. It also lists her service record as a health worker since 2000, the trainings she has attended, and her membership in national health organizations. The form is certified by her technical supervisor and the barangay captain to verify her registration as the official health worker for the area.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    28 views3 pages

    Mama Files

    Uploaded by

    iluminadocorros
    This document contains a registration form for Marittes B. Arciga, a barangay health worker in Dinginan, Roxas City, Capiz. The form provides her personal details such as name, address, date of birth, civil status, and educational attainment. It also lists her service record as a health worker since 2000, the trainings she has attended, and her membership in national health organizations. The form is certified by her technical supervisor and the barangay captain to verify her registration as the official health worker for the area.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 3

    BARANGAY HEALTH WORKERS REGISTRATION FORM

    Form 01-2024
    A. IDENTIFICATION
    Region VI
    Municipality ROXAS CITY
    BARANGAY DINGINAN
    Registration Number
    Date of Registration 2004
    Place of Registration CHO
    Accreditation Number
    Date of Accreditation
    Place of Accreditation
    B. BHW PROFILE
    NAME OF BHW: ARCIGA MARITTES BILLONES
    LAST FIRST MIDDLE
    COMPLETE ADDRESS: CENTRO DINGINAN ROXAS CITY CAPIZ
    Number Street Barangay Municipality Province
    DATE OF BIRTH DEC. 15, 1967 AGE 56 SEX FEMALE CIVIL STATUS M RELIGION CATHOLIC
    NAME OF SPOUSE ROBERTO L. ARCIGA AGE 62 OCCUPATION LABORER
    DEPENDENTS TOTAL NUMBER DEPENDENTS
    NAME OF EDUCATIONAL
    RELATIONSHIP DATE OF BIRTH OCCUPATION
    DEPENDENTS ATTAINMENT
    REGINA B. ARCIGA DAUGHTER MAY 20, 1987 COLLEGE GRAD. FINANCE STAFF
    AMELITA A. BILLONES MOTHER APRIL 2, 1942

    C. SERVICE RECORD
    INCLUSIVE DATES
    STATION/PLACE OF ASSIGNMENT
    FROM TO
    MONTH DAY YEAR MONTH DAY YEAR
    JANUARY 6 2000 February 6 2024 CENTRO DINGINAN

    Number of Household Presently Covered______61_____


    Status of Service: (Please Check)
    LGU Appointment LHB Registered/Accredited Volunteer
    Received Honorarium: YES NO HOW MUCH: P 400.00/MONTH Source: BARANGAY
    Technical Supervisor: Name Position
    D. TRAINING ATTENDED
    TITTLE TRAINING DATE CONDUCTED BY:
    Basic Training for Community
    MARCH 15-22, 2004 CHO
    Volunteer Health Workers
    GAD RELATED LAWS NOVEMBER 27, 2015 CHO
    GENDER SENSITIVITY TRAINING OCTOBER 20- 21, 2016 CHO
    TRAINING OF BHW/ BSW ON
    NOVEMBER 28, 2018 PHO
    PRIMARY HEALTH CARE

    E. OTHER INFORMATION
    HIGHEST EDUCATIONAL ATTAINMENT HIGH SCHOOL GRADUATE
    BLOOD TYPE: A+ B+ AB+ O+
    Are you a member of the National Confederation of Barangay Health Workers of the Philippines Inc.? YES NO
    IF YES, year started Certificate of Membership No. ID No. RX- 421
    Insurance membership Phil.Health No.:112009140649 GSIS No. SSS No. Other

    CERTIFIED BY: RAQUEL A. LAAB_________ MARITTES B. ARCIGA


    PRINTED NAME AND SIGNATURE (BHW)

    NOTED BY:_MA. FE S. SALGADO________ Date Accomplished: _DECEMBER 5,2023__________________________


    ________________________________________

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