Beruflich Dokumente
Kultur Dokumente
Noted by:
PHILIPPINE HEALTH AGENDA
RECORDING FORM
PHYSICAL
SEX WEIGHT HEIGHT
# NAME EXAM
M/F DATE kg cm
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
FORM
1B
NEWBORN 0 - 28 DAYS
PHYSICAL
SEX WEIGHT HEIGHT
# NAME EXAM
M/F DATE kg cm
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
FORM
1C
CHILD (1-4 years old)
PHYSICAL
SEX WEIGHT HEIGHT
# NAME EXAM
M/F DATE kg cm
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
/
/
FORM
1D
CHILD (5-9 years old)
F
# Name M post non
pregnant
partum pregnant
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
BLOOD BLOOD
PHYSICAL EXAM WEIGHT HEIGHT CBC
PRESSURE TYPING
DATE kg cm Y/N Y/N Y/N
FASTING STOOL FAMILY PLANNING EYE
URINALYSIS
BLOOD SUGAR EXAM w/ unmet EXAM
counseling commodities
Y/N Y/N Y/N need DATE
/
/
/
FORM
1E
10 - 19 years old
EAR ORAL
EXAM EXAM SIGNIFICANT FINDINGS REMARKS/ACTIONS TAKEN
DATE DATE
PHILIPPINE HEALTH AGENDA
RECORDING FORM
PHYSICAL
SEX WEIGHT HEIGHT
# NAME EXAM
M/F DATE kg cm
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
FORM
1E
MEN (10-19 years old)
DRUG REHABILITATION
SIGNIFICANT FINDINGS REMARKS/ACTIONS TAKEN
Y/N
PHILIPPINE HEALTH AGENDA - FIRST 100 DAYS
RECORDING FORM
F
# Name M post non
pregnant
partum pregnant
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
BLOOD BLOOD
PHYSICAL EXAM WEIGHT HEIGHT CBC URINALYSIS
PRESSURE TYPING
DATE kg cm Y/N Y/N Y/N Y/N
FASTING STOOL FAMILY PLANNING EYE EAR ORAL
BLOOD SUGAR EXAM w/ unmet EXAM EXAM EXAM
counseling commodities
Y/N Y/N need Y/N Y/N Y/N
FORM
1F
20 - 49 years old
PHYSICAL BLOOD
SEX WEIGHT HEIGHT
# NAME EXAM PRESSUE
M/F DATE kg cm Y/N
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
FORM
1G
50 - 59 years old
PHYSICAL BLOOD
SEX WEIGHT HEIGHT
# NAME EXAM PRESSUE
M/F DATE kg cm Y/N
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
COMPLETE BLOOD STOOL EYE EAR ORAL
URINALYSIS
BLOOD COUNT TYPING EXAM EXAM EXAM SERVICES
Y/N Y/N Y/N Y/N Y/N Y/N Y/N
FORM
1H
60 years and above