Beruflich Dokumente
Kultur Dokumente
IDENTIFYING DATA
Name of Patient: ____________________________________
Sex: _____ Age: _____ Birth date: ____________________
Place of residence: __________________________________
__________________________________________________
Place of birth: ______________________________________
Race: __________________ Religion: __________________
Number of admissions: _______________________________
Frequency
& Duration
of Intake
Compliance
I. Onset
Date of onset: ______________________________________
Manner of onset: ___ Gradual
___ Acute
Precipitating/Predisposing factors: ______________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
II. Characteristics
Character (Quantity, Quality, Consistency, Appearance):
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Location/Radiation: __________________________________
Intensity/Severity (Pain Scale): _________________________
Timing:
___ Continuous
___ Intermittent
___ Rhythmic
___ Remittent
Aggravating/Relieving Factors: _________________________
__________________________________________________
__________________________________________________
__________________________________________________
Associated Symptoms: _______________________________
__________________________________________________
__________________________________________________
__________________________________________________
III. Course since Onset
Incidence:
___ Single acute attack
___ Recurrent acute attack
___ Daily occurrences
___ Periodic occurrences
___ Continuous chronic episode
PAST HISTORY
I. Maternal & Birth History
Age of Mother: _____ y/o
OB Score: G ____ P ____
Known problems of the mother prior to pregnancy: ________
__________________________________________________
Drug intake during pregnancy: _________________________
__________________________________________________
__________________________________________________
Exposure to infection during pregnancy:
___ Fever
___ Rash
___ Other viral infections: _____________________
Exposure to radiation during pregnancy: Yes ___
No ___
Age of Gestation: _____ wks ___ Full-term ___ Pre-term
Manner of Delivery: ___ Natural spontaneous vaginal delivery
___ Caesarian section
___ Forceps delivery
___ Vacuum extraction
Place of Delivery: ___ Hospital
___ Lying-in
___ Home
Condition at birth:
APGAR Score: _____ 1st minute
_____ 5th minute
Birth weight: _____ kg/lbs.
1
Resuscitation: ______________________________________
Congenital Anomalies: _______________________________
__________________________________________________
Length of stay at the nursery: __________________________
Other problems surrounding birth: _____________________
__________________________________________________
__________________________________________________
Others:
______________
Tuberculin Test
V. Past Diseases
___ Measles
___ Mumps
___ Rubella
___ Varicella
___ Chickenpox
___ Typhoid fever
___ Dengue fever ___ URTIs
___ Tonsillitis
___ Pyoderma
___ Convulsions
___ TB
Others: ____________________________________________
Injuries: ___________________________________________
__________________________________________________
__________________________________________________
Previous Hospitalizations:
Date
Hospital
Surgeries:
Date
Number
of Doses
Diagnosis
Indication
Procedures
Done
Type of Operation
Result:
Grandparent
Age
Health Status
Cause of Death/
Age at Death
Parent
Age
Health Status
Cause of Death/
Age at Death
Adverse
Reactions
BCG
Hepatitis B
DPT
OPV
Measles
Rotavirus
HiB
Varicella
MMR
Rotavirus
2
Sibling
Sex
Age
Health Status
Cause of Death/
Age at Death
___ Hypertension
___ Cerebrovascular Disease
___ Cancer
___ Others: _____________
Occupation
NOTES
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
PHYSICAL EXAMINATION
I. General Survey
Sensorium: ___ Calm
___ Crying
___ Awake, alert, responsive
___ Consolable
___ Inability to feed
___ Irritable
___ Stuporous
___ Lethargic
___ Obtunded
___ Comatose
Signs of distress:
___ Cardiorespiratory distress
___ Anxiety
___ Pain
___ Depression
Apparent state of health: ___ Acutely ill
___ Chronically ill
Color: ___ Pinkish
___ Pallor
___ Acrocyanosis
___ Jaundice
___ Cyanosis
___ Redness/flushing
Activity: ___ Good
___ Poor
DESCRIPTION
BLOOD PRESSURE
Blood Pressure
Average Systolic and/or Diastolic BP
Category
for Age, Sex & Height
Normal
< 90th percentile
Prehypertensive
90th-95th percentile
Hypertensive
95th percentile
For 0-5 y/o:
z-score
Above 3
Above 2
Length/
Height for
Age
Very tall
Above 1
Median
Below 1
Below 2
Below 3
III. Anthropometrics
Weight = ________ kg/lbs
z-score: ________
Length/Height = ________cm/in
z-score: ________
Waterlow Classification: Wasting = _____%
Stunting = _____%
BMI = ________ kg/m2
Head circumference = ________ in/cm
Chest circumference = ________ in/cm
Abdominal circumference = ________ in/cm
Stunted
Severely
stunted
IV. Skin
Color: ___ Cutis marmorata
___ Hypopigmentation
___ Harlequin dyschromia
___ Hyperpigmentation
Moisture: ___ Dry
___ Wet/clammy
___ Oily
Turgor: ___ Good
___ Fair
___ Poor
___ Rash: Distribution __________________________________
____________________________________________
Color: ______________________________________
Pruritus: ____________________________________
Description: _________________________________
____________________________________________
Common skin conditions:
___ Vernix caseosa
___ Milia
___ Edema
___ Eyelid patch
___ Desquamation
___ Salmon patch
___ Miliaria rubra
___ Caf-au-lait spots
___ Erythema toxicum
___ Mongolian spots
___ Pustular melanosis
Lesions: ______________________________________________
Hemorrhages: ___ Petechiae
___ Hematoma
___ Ecchymoses
Above 2
Above 1
Median
Below 1
Below 2
Below 3
Moderately
stunted
Severely
stunted
GROWTH INDICATOR
Weight for
Weight for
Age
Length/
Height
Use weight
Obese
for length or
Overweight
BMI for age
charts
Possible risk
of
overweight
Underweight
Severely
underweight
Obese
Overweight
Possible risk
of
overweight
Wasted
Severely
wasted
GROWTH INDICATOR
Weight for
Weight for
Age
Length/
Height
Use weight
Morbidly
for length or
obese
BMI for age
Obese
charts
Overweight
Moderately
underweight
Severely
underweight
Wasted
Severely
wasted
Moderately
wasted
Severely
wasted
WASTING
Normal
Mild
Moderate
Severe
STUNTING
Normal
Mild
Moderate
Severe
Morbidly
obese
Obese
Overweight
Wasted
Severely
wasted
___ Loosening
___ Pitting
___ Dry
___ Coarse
___ Lesions
DESCRIPTION
V. Head
Fontanelles: ___ Soft, flat
___ Depressed
___ Tense and bulging
___ Pulsations
Diameter: Anterior ____ cm
Posterior ____ cm
Sutures: ___ Open, ridged
___ Mobile
___ Immobile
Scalp: ___ Clean
___ Dandruff
___ Parasites
___ Lesions
___ Dilatation of veins
Skull: ___ Symmetrical
___ Asymmetrical
___ Molding
___ Plagiocephaly
___ Caput succedaneum
___ Dolichocephaly
___ Cephalhematoma
___ Craniotabes
___ Craniosynostosis
___ Cranial bruit
___ Biparietal enlargement
___ Macewens Sign
Cranial Index: _____ cm (width) x 100/_____ cm (length)
Face: ___ Symmetrical
___ Asymmetrical
___ Micrognathia
___ Facies
___ Chovsteks sign
___ Mass
Cranial Index:
> 85 Brachycephalic (short head)
75-85 Mesocephalic (medium head)
< 75 Scapocephalic (long head)
VI. Eyes
Lids: ___ Symmetrical
___ Edema/swelling (R/L)
___ Ptosis (R/L)
___ Lesions
Periorbital region: ___ Edema
___ Discoloration
___ Sunken
___ Ecchymoses/hematoma
Conjunctiva: ___ Pinkish ___ Redness
___ Pale
___ Subconjunctival hemorrhages
___ Eye discharge: ___ Watery ___ Colored
Sclera: ___ Anicteric
___ Icteric
___ Hemorrhages
Cornea & lens: ___ Clear ___ Cloudy
___ Opaque
Iris: ___ Coloboma
___ Brushfield spots
VII. Ears
External ear: ___ Normoset
___ Symmetrical
___ Low set
___ Asymmetrical
___ Ear tags
___ Cup ear
___ Ear pits
___ Loop ear
Ear canal: ___ Patent
___ Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
Tympanic membrane: ___ Dull, gray
___ Whitish
___ Redness
___ Distorted
___ Bulging
___ Perforated
___ Retracted
___ Thickened
___ Effusion
___ Lesions
___ Cone of light at R - _____
L - _____
VIII. Nose
Nasal Passages: ___ Patent (breathes with mouth closed)
___ Occluded
___ Foreign body
___ Nasal flaring
___ Nasal polyps
Septum: ___ Midline
___ Deviated
___ Perforation
Mucosa: ___ Pinkish
___ Pale
___ Reddish
Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
6
DESCRIPTION
XII. Breast
___ Midclavicular
___ Enlarged
___ Mass
___ Gynecomastia
___ Palpable/enlarged
___ Tender
Lymph Nodes:
___ Pre-auricular
___ Post-auricular
___ Tonsillar
___ Submandibular
___ Submental
___ Anterior cervical
___ Supraclavicular
___ Posterior cervical
___ Axillary
___ Epitrochlear
___ Inguinal
DESCRIPTION
XIV. Cardiovascular
Periorbital region: ___ Edema/Swelling
___ Sunken
Conjunctiva: ___ Pinkish ___ Pale
Lips: ___ Pallor
___ Cyanosis
___ Dry/Cracked
___ Lesions
Gums: ___ Pinkish
___ Pallor
___ Bleeding
___ Tenderness
Buccal mucosa: ___ Pinkish ___ Pale
Pharynx: ___ Pinkish
___ Reddish
___ Pale
Jugular venous pulse: ____ cm w/ head of bed elevated at ____
Precordium: ___ Flat
___ Adynamic
___ Bulging
___ Dynamic
___ Tenderness
___ Heaves
___ Thrills
PMI at: ______________________________________________
Heart Sounds: ___ Distinct
___ Faint
S1 _____ S2 at the base
S1 _____ S2 at the apex
Extra heart sounds: ___ S3
___ S4
___ Murmurs: Grade _____
Nails: ___ Cyanosis
___ Pallor
___ Clubbing
___ Spooning
Capillary refill time: _____ secs
___ Edema of the extremities: ___ Bilateral
___ Unilateral
___ Pitting
___ Non-pitting
Peripheral pulses: ___ Symmetrical
___ Regular
___ Asymmetrical
___ Irregular
___ Weak
___ Strong
___ Faint
___ Bounding
___ Absent
Grade: _________
Characteristics of murmur:
Location: ___________________________________________
Radiation: __________________________________________
Intensity: __________________________________________
Quality: ____________________________________________
Peripheral pulses:
Temporal __________________________________________
Brachial ___________________________________________
Femoral ___________________________________________
Posterior tibial ______________________________________
Dorsalis pedis _______________________________________
XV. Abdomen
Skin: ___Scars
___ Striae
___ Dilated veins
___ Rashes & lesions
Umbilical cord: ___ 2 arteries, 1 vein
___ Single umbilical artery
8
DESCRIPTION
LIVER:
Liver size: ________________ cm/in
Tenderness on percussion: ___ Yes
___ No
Tenderness on palpation: ___ Yes
___ No
___ Soft, sharp, regular edge with smooth surface
___ Firm/hard, blunt/rounding of edge, irregular contour
SPLEEN:
Dullness on percussion: ___ Yes
___ No
___ Splenic percussion sign
___ Non-palpable
___ Palpable
___ Non-tender
___ Tender
AORTA:
Aortic pulsations: ___ Yes
___ No
GROIN:
___ Symmetrical creases
___ Palpable pulses
XVI. Genitourinary
KIDNEYS:
___ Non-palpable
___ CVA tenderness
th
___ Palpable
BLADDER:
___ Non-palpable
___ Palpable
___ Non-tender
___ Tender
Dullness on percussion: ___ Yes
___ No
Male
Skin: ___ Redness
___ Discoloration
___ Papules
___ Pustules
___ Macules
___ Vesicles
___ Ulcers
___ Nodules
___ Plaques
___ Excoriations
___ Others: ______________________________________
Pubic Hair: Distribution: _________________________________
___ Nits
___ Lice
Prepuce: ___ Phimosis
___ Paraphimosis
___ Smegma
Penis: ___ Discharge
___ Tenderness
___ Ulcers
___ Scars
___ Swelling
___ Nodules
___ Induration
Urethral Meatus: ___ Hypospadia ___ Epispadia
Scrotum: ___ Equal
___ Unequal
___ Edema at R/L
___ Enlargement at R/L
___ Tenderness
___ Undescended at R/L
___ Rashes
___ Nodules
___ Veins
___ Lumps
___ Epidermoid Cysts
___ Bulging
Prostate: ___ Smooth
___ Firm
___ Rubbery
___ Non-tender
___ Swelling
___ Tender
___ Bogginess
___ Warm
___ Nodules
Others: ___ Ambiguous genitalia
___ Cremasteric reflex
Tanner Stage: __________________________________
DESCRIPTION
Female
Mons Pubis: ___ Excoriations
___ Itchiness
___ Redness
___ Papules
___ Macules
___ Pustules
___ Plaques
___ Vesicles
___ Ulcers
___ Nodules
___ Others: ________________________________
Pubic Hair: Distribution: _________________________________
___ Nits
___ Lice
Clitoris: ___ Enlargement
Urethral Meatus: ___ Caruncle
___ Prolapse
Labia: ___ Symmetrical
___ Asymmetrical
___ Tenderness
___ Discoloration
___ Redness
___ Edema/Swelling
___ Adhesions
Hymen: ___ Intact
___ Imperforated
___ Hymenal tag
Vaginal Introitus: ___ Inflammation
___ Swelling
___ Vesicles
___ Pustules
___ Ulcerations
___ Nodules
___ Others: ____________________________
___ Discharge: ___Serous
___ Purulent
___ Mucoid
___ Foul-smelling
___ Whitish, curd-like
___ Bleeding
Others: ___ Ambiguous genitalia
Tanner Stage: ___________
XVII. Musculoskeletal
Posture, gait, motor activity:
___ Coordinated
___ Unable to walk alone
___ Uncoordinated
___ Walks w/ assistive devices
10
DESCRIPTION
Location
___ Temporomandibular joints (TMJ)
___ Shoulder girdle (sternoclavicular,
acromioclavicular, glenohumeral joints)
___ Wrist joints (radiocarpal, distal
radioulnar, intercarpal joints)
___ Hand joints (MCPs, PIPs, DIPs)
___ Anatomical snuffbox
___ Spinous processes
___ Facet joints
___ Sacroiliac joints
___ Knee joints (tibiofemoral, patellofemoral joints)
___ Suprapatellar pouch
___ Ankle joints (tibiotalar, subtalar joints)
___ Transverse tarsal & metatarsophalangeal joints
___ Bursae (Indicate: _______________________)
___ Biceps tendon
___ Patellar tendon
___ Achilles tendon
Decreased ROM on:
___ Flexion
___ Abduction
___ Internal rotation
___ Pronation
___ Opposition
___ Inversion
XVIII. Neurologic
Cranial Nerves
CN I (Olfactory): ___ Intact
___ Anosmia (unilateral/bilateral)
CN II (Optic):
Visual acuity:
VA (w/correction)
OD ________
OS ________
(w/out correction) OD ________
OS ________
___ Counting fingers at _____ ft
___ Hand movement at ___ RUQ
___ LUQ
___ RLQ
___ LLQ
___ R temporal ___ L temporal
___ R nasal
___ L nasal
___ Light projection at _________________ quadrant/s
___ Light perception: ___ Vague
___ Erratic
Laterality
___ Extension
___ Adduction
___ External rotation
___ Supination
___ Lateral bending
___ Eversion
VISUAL MILESTONES
Birth
Blinks, may regard face
1 month
Fixes on objects
1 - 2 months
Coordinated eye movements
3 months
Eyes converge, baby reaches
12 months
Acuity around 20/50
3 months
Eyes converge, baby reaches
12 months
~20/200
Less than 4 years
20/40
4 years and older
20/30
th
DESCRIPTION
Confrontation Field Diagram:
T
LE
RE
th
Motor Function
Involuntary movements: ___ Tics
___ Choreoathetosis
___ Myoclonus ___ Tremors
Strength: _____/5 located at (see column 2 Muscle Groups)
___ Tenderness
___ Pronator drift
___ Gowers Sign
Tone: ___ Normal
___ Scarf Sign
___ Inverted U-shape on horizontal position
___ Slipping through armpit on vertical suspension
___ Head lag on pull-to-sit
___ Opisthotonus
___ Fisting
___ Scissors legs on vertical suspension
Bulk: ___ Atrophy
___ Hypertrophy
___ Pseudohypertrophy
DESCRIPTION
Muscle Groups
___ Muscles of mastication (masseter,
temporal, pterygoid ms.)
___ Axioscapular group (trapezius, rhomboids,
serratus anterior, levator scapulae)
___ Axiohumeral group (pectoralis major &
minor, latissimus dorsi)
___ Scapulohumeral/SITS ms.
___ Biceps ms.
___ Triceps ms.
___ Thenar ms.
___ Hypothenar ms.
___ Paravertebral ms.
___ Iliopsoas ms.
___ Gluteal ms.
___ Quadriceps femoris
___ Hamstring ms.
___ Gastrocnemius ms.
___ Soleus ms.
___ Plantar and dorsiflexor ms.
Sensory function
Crude
Touch: ___ Intact & symmetrical
___ Impaired at _____________________________
Pain: ___ Intact & symmetrical
___ Impaired at ______________________________
Temperature: ___ Intact & symmetrical
___ Impaired at ______________________
Vibration: ___ Intact & symmetrical
___ Impaired at __________________________
Joint position sense: ___ Intact & symmetrical
___ Impaired at _________________
Rombergs Test: ___ Positive
___ Negative
Cortical
Graphesthesia: ___ Intact
___ Impaired at R/L palm
Stereognosis: ___ Intact
___ Impaired at R/L hand
Two-point discrimination: R _____ cm L _____ cm
Bilateral simultaneous stimulation: ___ Intact
___ Extinction at R/L
Point localization: ___ Intact
___ Extinction at R/L side
Cerebellar
***Coordination: ___ Intact
___ Dysmetria
___ Dysdiadochokinesia
___ Nystagmus
___ Tremors (at rest/intention)
Stance: ___ Wide base
Feet _____ cm apart
**Gait: ___ Staggering
___ Shuffling
___ Cerebellar ataxia ___ Waddling
___ Drunken/Reeling ___ Toppling
___ Sensory ataxia
___ Frontal lobe disorder
___ Steppage/Equine ___ Parkinsonian gait
___ Marche a petit pas ___ Hemiplegic/Paraplegia
___ Hysterical
___ Choreoathetotic/Dystonic
Reflexes
Superficial/Primitive Reflexes:
___ Snout
___ Moro/startle
___ Tonic neck
___ Righting
___ Palmar grasp
___ Plantar grasp
___ Rooting
___ Sucking
___ Abdominal
___ Beevors Sign
___ Anal
___ Cross-adductor
___ Placing/stepping
___ Babinski
___ Buttress response
___ Parachute response
___ Trunk incurvation
___ Positive support
___ Landau
Deep Tendon Reflexes (grade using diagram on column 2):
Biceps
Triceps
Brachioradialis
Knee
Ankle jerk
___ Hoffmans
___ Clonus
Meninges: ___ Kernigs Sign
Laterality
4+
3+
2+
1+
0
APPENDIX
BCG
DTwP-HiB-HepB
OPV
VACCINE
ROUTE
d.
e.
f.
Measles
MMR
Rotavirus vaccine
1st DOSE
g.
h.
2nd DOSE
Other Recommended Vaccines are vaccines outside the pink box. These vaccines are not
part of the Philippine EPI but because of merit are advocated by the Philippine Pediatric
Society (PPS), Pediatric Infectious Disease Society of the Philippines (PIDSP), and the
Philippine Foundation for Vaccination (PFV). Other Recommended Vaccines include:
PCV
Td
a.
b.
c.
3rd DOSE
DTaP
Tdap/Td
IPV
ADDL DOSE/S
d.
e.
f.
MMRV
Varicella
Hepatitis A
g.
h.
Influenza
Human Papillomavirus Vaccine (HPV)
NOTES
For healthy infants and children > 2 mos. who are not given
BCG at birth, PPD prior to BCG vaccination is not necessary.
Earliest possible age after birth
(preferably within the 1st 2 months of life)
BCG
Intradermal
(ID)
0.05 ml for
< 12 months of age
0.1 ml for
> 12 months of age
Diphtheria,
Tetanus &
Pertussis (DTP)
Hepatitis B
Vaccine
Intramuscular
(IM)
Intramuscular
(IM)
6 weeks
10 weeks
6 weeks
14 weeks
10 weeks
May be given as
early as 12
months of age
provided there is
a minimum
interval of
6 months from
the 3rd dose
14 weeks
The 5th dose may not be given if the 4th dose was administered
at age 4 yrs or older.
The pertussis component may either be an acellular or whole
cell formulation.
VACCINE
Hepatitis B
Vaccine
ROUTE
Intramuscular
(IM)
Haemophilus
Influenza Type
B Conjugate
Vaccine (HiB)
Intramuscular
(IM)
Measles
Vaccine
Subcutaneous
(SC)
Measles,
Mumps, Rubella
(MMR)
Subcutaneous
(SC)
1st DOSE
6 weeks
2nd DOSE
3rd DOSE
ADDL DOSE/S
6 weeks
10 weeks
14 weeks
10 weeks
14 weeks
Booster dose:
between 12-15
months of age,
with an interval
of 6 months from
the 3rd dose
9 months
12 months
4-6 years
May be administered at an earlier age (16 months)
provided the interval between the 1st and 2nd dose
is at least 4 weeks
NOTES
If the mother is HBsAg (+), administer HBV and HBIG (0.5 ml)
within 12 hrs of life. If HBsAg status is unknown, administer
HBV within 12 hrs of birth and determine mothers HBsAg as
soon as possible. If HBsAg (+) administer HBIG no later than 7
days of age.
In the EPI schedule, HBV is given as monovalent hepatitis B
vaccine at birth then subsequent doses are given at 6, 10, 14
weeks of age as combination vaccines containing DTwP-HepBHiB.
If the 1st dose was given between 7-11 months of age, the 2nd
dose should be given at least 4 weeks later, and the 3rd dose at
least 8 weeks from the 2nd dose.
One dose of the HiB vaccine should be considered for
unimmunized children aged 5 yrs or older who have sickle cell
disease, leukemia, HIV infection or who had splenectomy.
May be given as early as 6 months of age in cases of outbreaks
as declared by public health officials.
Two doses of MMR are recommended.
Children below 12 months of age given any measles containing
vaccine (measles, MR, MMR) should be given 2 additional
doses of MMR. The 1st dose is given at age 12-15 months and
should be separated by at least 4 weeks from measles
containing vaccine. The 2nd dose is administered at age 4-6 yrs,
but may be given at an earlier age provided the interval
between the 1st and 2nd dose is at least 4 weeks.
In the Philippine EPI, a 2nd dose of MMR is given to high school
students (Grades 7-10) enrolled in public schools in selected
cities and provinces.
In the Philippine EPI, OPV is administered together with DwTPHepB-HiB vaccines at 6, 10 and 14 weeks of age.
Poliovirus
Vaccine
(OPV/IPV)
Per orem
(PO)
or
Intramuscular
(IM)
6 weeks
10 weeks
14 weeks
VACCINE
ROUTE
1st DOSE
2nd DOSE
3rd DOSE
ADDL DOSE/S
NOTES
*In children who are fully immunized, Td booster should be
given every 10 yrs. A single dose of Tdap can be given in place
of the due Td dose, and can be administered regardless of the
interval since the last tetanus and diphtheria toxoid containing
vaccine.
Children aged 7 through 18 yrs who are not fully immunized
with DPT vaccine should receive Tdap as the 1st dose in the
catch-up series. If additional doses are needed use Td vaccine.
Tetanus and
Diphtheria
Toxoid
(Td)/Tetanus
and Diphtheria
Toxoid and
Acellular
Pertussis
Vaccine (Tdap)
Intramuscular
(IM)
10 years
Hepatitis A
Vaccine
Intramuscular
(IM)
> 12 months
Rotavirus
Vaccine (RV)
Per orem
(PO)
6 weeks
At least 4 weeks
after the
1st dose
VACCINE
Varicella
Vaccine
ROUTE
Subcutaneous
(SC)
1st DOSE
12 15 months
2nd DOSE
3rd DOSE
ADDL DOSE/S
NOTES
Two doses of varicella vaccine are recommended.
A 2nd dose of the vaccine is recommended for children,
adolescents and adults who previously received only one dose
of the vaccine. For children below 13 yrs, the recommended
minimum interval between doses is 3 months. However, if the
2nd dose was administered at least 4 weeks after the 1st dose, it
can be considered as valid.
All individuals aged > 13 yrs and without immunity should
receive 2 doses of varicella vaccine given at least 4 weeks
apart.
Measles,
Mumps,
Rubella,
Varicella
(MMRV)
Human
Papillomavirus
Vaccine (HPV)
Subcutaneous
(SC)
Intramuscular
(IM)
12 months 12 yrs
9 yrs
At least 3 months
after the 1st dose
At least 1 month
after the 1st dose
Influenza
Vaccine
Intramuscular
(IM)
or
Subcutaneous
(SC)
6 months 8 yrs
At least 4 weeks
after the 1st dose
9 18 yrs of age:
Revaccination every year
VACCINE
Pneumococcal
Vaccines
(PCV/PPV)
ROUTE
1st DOSE
2nd DOSE
3rd DOSE
ADDL DOSE/S
NOTES
Primary vaccination of PCV consists of 3 doses with an interval
of at least 4 weeks between doses, plus a booster at 6 months
after the 3rd dose.
Intramuscular
(IM)
6 weeks
10 weeks
14 weeks
Booster Dose:
6 months after
the 3rd dose
ROUTE
1st DOSE
2nd DOSE
3rd DOSE
MCV4:
Intramuscular
(IM)
Meningococcal
Vaccine
At least 9 months
MPSV4:
Subcutaneous
(SC)
ADDL DOSE/S
If the person
remains at
increased risk:
Initial booster
dose of MCV4
3 years after
completing the
primary series
Continued
boosters at 5year intervals
after the initial
booster dose
Typhoid Vaccine
Rabies Vaccine
Intramuscular
(IM)
As early as 2 yrs
Intramuscular
(IM)
PVRV 0.5 ml or
PCECV 1 ml
Day 0
Day 21 or 28
NOTES
MCV4: Tetravalent meningococcal (ACYW-135)
conjugate vaccine
MPSV4: Tetravalent meningococcal polysaccharide vaccine
Two doses of MCV4 given 2 months apart should be given to
children aged 9 months and above at high risk for invasive
disease (persistent complement component deficiencies,
anatomic/functional asplenia, HIV, travelers to or residents of
area where meningococcal disease is hyperendemic or
epidemic, or belonging to a defined risk group during a
community or institutional meningococcal outbreak).
If MPSV4 is used for high-risk individuals as the 1st dose, a 2nd
dose using MCV4 should be given 2 months later.
Additional booster doses of polysaccharide vaccines are not
recommended.
Recommended for travelers to areas where there is risk of
exposure to S. typhi and for outbreak situations as declared by
public health officials.
The Anti-rabies Act of 2007 recommends routine rabies preexposure prophylaxis (PrEP) for children ages 5-14 yrs in areas
where there is high incidence of rabies and animal bites
(defined as more than twice the national average).
VACCINE
ROUTE
1st DOSE
2nd DOSE
3rd DOSE
ADDL DOSE/S
NOTES
A repeat dose should be given if vaccine is inadvertently given
subcutaneously.
Rabies vaccine should never be given in the gluteal area since
the absorption is unpredictable.
Rabies Vaccine
Intradermal
(ID)
PVRV or
PCECV 0.1 ml
Day 0
Day 7
Day 21 or 28
24 71 months
If 3 doses of any PCV were given previously:
Single dose of PCV13
24 71 months
If less than 3 doses
of any PCV were
previously given:
1st dose of PCV13
Pneumococcal
Vaccines
(PCV/PPV)
6 18 yrs
If no previous doses of PCV given:
Single dose of PCV13
Intramuscular
(IM)
2 18 yrs with
underlying medical
conditions* should
receive PPV at least
8 weeks after PCV
Clinical Sign
Heart Rate
Respiratory
Effort
Muscle Tone
Reflex
Irritability*
Color
Blue, pale
Active
movement
Crying
vigorously,
sneeze, or
cough
Pink all over
04
2
> 100
Good; strong
Severe depression,
requiring immediate
resuscitation
Anterior
Posterior
FONTANELLES
4 6 cm, closes between 4 26 mos.
1 2 cm, closes at 2 mos.
Percentile
< 10th
10 90th
> 90th
EXPECTED WEIGHT
Age
Weight in grams
Infants < 6 months Age in months x 600 + BW
6 12 months Age in months x 500 + BW
2 yrs and up Age in years x 2 + 8
*Average BW of Filipinos is 3, 000 grams (3 kg)
Birth
1 year
6 years
THORACIC INDEX
1
1.25
1.35
th
Age
*Continuation: Blood Pressure Level for Boys by Height and Age Percentile
*Continuation: Blood Pressure Level for Girls by Height and Age Percentile