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    UBRA

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    osias blanca

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    © All Rights Reserved
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    UBRA

    Uploaded by

    osias blanca
    67 views2 pages

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    67 views2 pages

    UBRA

    Uploaded by

    osias blanca

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    BADAC DATA CAPTURE FORM 4

    UNIFIED BARANGAY REPORT ON REFERRAL ACTION (UBRA)

    Data provided herein are those recorded within the months of: January to June ( √ ) July to December (√ ) Year(YYYY)
    2023
    INDICATOR NO. OF SURRENDERERS INDICATO NO. OF SURRENDERERS
    MALE FEMALE TOT R MALE FEMALE TOTAL
    AL
    Submission of Updated BELOW 18 ABOVE BELOW ABOVE Submission BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
    18 18 18
    Number of Residents who of Updated
    surrendered
    0 0 0 0 0 Number of
    0 0 0 0 0
    Referred
    surrenderer
    s
    INDICATOR STATU NO. OF SURRENDERERS INDICAT STATUS/ NO. OF SURRENDERERS
    S/ MALE FEMALE TOTA OR LEVEL MALE FEMALE TOTAL
    LEVEL L OF RISK
    OF BELOW ABOVE BELOW 18 ABOVE BELOW ABOVE BELOW ABOVE
    RISK 18 18 18 18 18 18 18
    Submission of Low 0 0 0 0 0 Submission Low 0 0 0 0 0
    Updated Mild 0 0 0 0 0 of Updated Mild 0 0 0 0 0
    Number of Moderate 0 0 0 0 0 Number of Moderate 0 0 0 0 0
    Assessed Severe Enrolled
    0 0 0 0 Severe 0 0 0 0 0
    Surrendere
    Surrenderers
    rs

    INDICATOR NO. OF SURRENDERERS WHO


    COMPLETED WELLNESS & The purpose of this form is to determine the number of surrenderers per semester (January-
    RECOVERY INTERVENTIONS June, July-December), and monitor the number of who, among those surrenderers, have been
    MALE FEMALE TOT referred, assessed, and who have completed any Wellness and Recovery Program

    Barangay Bagong Silang, Mabuhay, Zamboanga Sibugay


    AL interventions within the 6-month time frame. Counting shall restart at the onset of the new
    BELOW 18 ABOVE BELOW ABOVE semester, meaning, the data on those who surrendered in the previous semester shall no
    Submission of Updated
    18 18 18 longer be accounted in the next, regardless they have been referred or assessed in the
    Number of Surrenderers following semester.
    Who Completed Wellness
    0 0 0 0 0
    and Recovery
    Interventions

    Barangay Bagong Silang, Mabuhay, Zamboanga Sibugay

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