Dibut Masterlist

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)
Name of Municipality: ________________________

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011
Name of Child
(Surname, First,
MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Sto. Domingo, Rebecca
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Francisco, Jim Andrei
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl
*Use Fill Color to identify reported children within the reporting month
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
JUNE
Summary:
Yellow
Blue
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
MARIA JESUSA A. MARZAN, RN
NDP
No. of Vaccinated Neonate/Infant f

MALE
Sex (M/F)
Date of Birth*
Age in
Months
Age Group
M
F
F
F
M
M
F
M
M
M
F
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015
27
22
22
19
15
6
6
6
4
3
2
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
eporting month
1380
1380
1380
1380
1380
0
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above
inated Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
(Mun., Name of Mother (Surname, First,
Prov.)
MI.)
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Sto. Domingo, Leslie
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Abragon, Regine Rose
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen
Date of Completion: __________________
Detailed Address in Purok

including Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
1
1
1
1
1
1
1
1
1
1
1
Purok
Barangay
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
ROGELYNE P. TAMAYO, RN
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
NHTS (Yes/No)
yes
No
yes
No
No
yes
yes
No
No
No
No
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
0720-0320-3183
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
Place 1 if vaccine has been given*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROSALILIA C. TANGSON, MD
MHO
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
een given*
FIC*
1
1
CIC*
1
1
1
Immunized
Immunized
Immunized
Immunized
Immunized
TT5
Partially
Partially
Partially
Partially
Partially
TT4
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT2
Card Check
TT1
Place 1 if mother recall TT doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
Status
Age
TI-Trans In
TOGroup
Location (Brgy,
CPAB*
Trans Out
VGiven
1: 6-11
Mun, Prov.), Name
(Yes/No)
Visitor
P(Date) mos 2:
of Pediatrician,
Private Pedia
12-23
Reason for refusal
R-Refused
mos
Remarks
adopted by Vilma Ritual
Date of
Completion
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
Name of Child
(Surname, First,
MI.)
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Sindac, Princess Banalee
Abragon, Lea Mae S.
Orena, Queen Althea Joy
Sindac, Jayven Roy
Bernabe, Eduardo jr.
Nadiajan, Jake Lee
10
11
12
13
14
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
Sex (M/F)
Date of Birth*
Age in
Months
Age Group
F
F
F
F
F
F
M
M
M
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
24
24
21
18
15
17
10
9
7
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
eporting month
1380
1380
1380
1380
1380
0
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
Prov.)
MI.)
San Luis, Aurora

Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Abragon, Marmelyn S.
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel

including Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
3
3
2
3
3
3
2
2
2
Purok
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
3
3
2
3
3
3
2
2
2
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS (Yes/No)
No
yes
no
no
yes
No
No
No
No
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
No
No
no
no
yes
No
No
No
Yes
No
Yes
No
No
No
No
No
Yes
Yes
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
Place 1 if vaccine has been
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
MMR
1
1
1
1
1
1
1
1
1
1
1
1
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
AMV
vaccine has been given*
1
1
1
1
1
1
Card Check
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
CIC*
TT2
FIC*
TT1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT5
Vitamin A*
TT4
her recall TT doses*
1
1
Status
Age
TI-Trans In
TOGroup
CPAB*
Trans Out
VGiven
1: 6-11
(Yes/No)
Visitor
P(Date) mos 2:
Private Pedia
12-23
R-Refused
mos
Status
Location (Brgy,
Mun, Prov.), Name
of Pediatrician,
Reason for refusal
Remarks
Date of
Completion
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115083011
Name of Child
(Surname, First,
MI.)
Abragon, Jhon Carl

Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Salinel, Lovelyn Mae
Andrada, Lance Aeron
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
OLIT, GINMAR
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
Sex (M/F)
Date of Birth*
Age in
Months
Age Group
M
M
F
M
F
F
M
F
M
F
M
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
7/25/2015
12/14/2014
31
27
20
19
12
14
18
10
10
4
11
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
eporting month
1380
1380
1380
1380
1380
0
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
Prov.)
MI.)
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
OLIT, DALIA

including Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
4
4
4
4
4
4
4
4
4
4
4
Purok
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
4
4
4
4
4
4
4
4
4
4
4
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS (Yes/No)
no
No
No
No
No
yes
no
yes
No
yes
NO
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
no
No
No
No
No
yes
No
07-2009137042
No
no
NO
No
No
No
No
No
No
No
Yes
No
No
YES
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
MMR
1
1
1
1
1
1
1
1
1
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
AMV
1
1
1
1
1
Card Check
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
CIC*
TT2
FIC*
TT1
Place 1 if mother recall TT do
1
1
1
1
Vitamin A*
TT5
TT4
Status
Age
TI-Trans In
TOGroup
CPAB*
Trans Out
VGiven
1: 6-11
(Yes/No)
Visitor
P(Date) mos 2:
Private Pedia
12-23
R-Refused
mos
TO
1
1
1
Status
Location (Brgy,
Mun, Prov.), Name
of Pediatrician,
Reason for refusal
REAL
Remarks
Date of
Completion
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
SANL0115084001
SANL0115084002
SANL0115084003
SANL0115084004
Name of Child
(Surname, First,
MI.)
Alling, Marvin
Magdato, Nadine
Novicio, Raico Jay
Pradillada, Clifford
10
11
12
13
14
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
Sex (M/F)
M
F
M
M
eporting month
Date of Birth*
Age in
Months
Age Group
5/7/2014
6/3/2014
4/15/2015
8/22/2015
19
18
8
4
12-23 mos
12-23 mos
0-11 mos
0-11 mos
1380
1380
1380
1380
1380
0
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
Prov.)
MI.)
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Pradillada, Reena

including Landmarks
Zone
Zone
Zone
Zone
5
5
5
5
Purok
zone
zone
zone
zone
5
5
5
5
Barangay
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
NHTS (Yes/No)
yes
no
No
No
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
yes
No
No
No
No
No
Yes
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
MMR
1
1
1
1
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
AMV
1
1
Card Check
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
CIC*
TT2
FIC*
TT1
Place 1 if mother recall TT dos
1
1
1
1
1
1
1
1
1
1
TT5
Vitamin A*
TT4
1
1
CPAB*
(Yes/No)
Age Group
1: 6-11
Given
mos 2: 12-23 mos
(Date)
Status
TI-Trans In
TOLocation (Brgy,
Trans Out
VMun, Prov.), Name
Visitor
Pof Pediatrician,
Private Pedia
Reason for refusal
R-Refused
Remarks
Date of
Completion
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
10
11
12
13
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115085013
Name of Child
(Surname, First,
MI.)
Natividad, Robin Jan

Natividad, Rappah Jan
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Del Monte, Bea Grace
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Novicio, Bb. Boy
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
Sex (M/F)
Date of Birth*
Age in
Months
Age Group
M
M
M
F
F
F
F
F
M
F
F
F
M
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/15/2015
32
19
29
28
28
27
22
21
20
34
23
19
8
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos
eporting month
1380
1380
1380
1380
1380
0
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
Prov.)
MI.)
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Loberiano, Evangeline
Del Monte, Bernadette
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Novicio, Daisy Rose

including Landmarks
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
6
6
6
6
Purok
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
6
6
6
6
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
none
NHTS (Yes/No)
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
IPV
PCV 3
PCV 2
PCV 1
1
1
1
1
1
1
1
1
1
1
1
1
ROTA 2
MMR
1
1
1
1
1
1
1
1
1
1
1
1
ROTA 1
AMV
1
1
1
1
1
1
1
1
1
1
1
Card Check
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
CIC*
TT2
FIC*
TT1
1
1
1
1
1
1
1
TT5
Vitamin A*
TT4
1
1
1
1
1
Status
Age
TI-Trans In
TOGroup
CPAB*
Trans Out
VGiven
1: 6-11
(Yes/No)
Visitor
P(Date) mos 2:
Private Pedia
12-23
R-Refused
mos
Yes
Status
Location (Brgy,
Mun, Prov.), Name
of Pediatrician,
Reason for refusal
Remarks
Date of
Completion
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
1
2
3
4
5
6
7
8
9
10
11
12
13
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
SANL0115086007
SANL0115086008
Name of Child
(Surname, First,
MI.)
Tindogan, Fea
Esplandor, Johnmarvin
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
Salcedo, Rafael
Casamis, Jamaica
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
Sex (M/F)
Date of Birth*
Age in
Months
Age Group
F
M
M
M
F
F
M
F
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
4/15/2015
4/24/2015
31
24
27
24
24
5
7
7
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
0-11 mos
0-11 mos
0-11 mos
eporting month

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
Prov.)
MI.)
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy

including Landmarks
zone
zone
zone
zone
zone
zone
zone
zone
7
7
7
7
7
7
7
7
Purok
zone
zone
zone
zone
zone
zone
zone
zone
7
7
7
7
7
7
7
7
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: ____________________________
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS (Yes/No)
No
No
no
No
No
No
No
No
PhilHealth (YesNBS
write the PHIC
done*
number/No)
(Yes/No)
No
No
no
No
No
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
MMR
1
1
1
1
1
1
1
1
1
1
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
AMV
Card Check
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
1
1
1
1
1
CIC*
TT2
FIC*
TT1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
TT5
TT4

CPAB*
(Yes/No)
1
1
Yes
Yes
Given (Date)
Age Group
1: 6-11 mos
2: 12-23 mos
Status
TI-Trans In
TO-Trans Out
Location (Brgy,
V-Visitor
Mun, Prov.), Name
P-Private Pedia
of Pediatrician,
RReason for refusal
Refused
Remarks
Date of
Completion
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015

Name of Municipality:SAN LUIS, AURORA
Name of MHO: _ROSALILIA C. TANGSON, MD
Name of PHN: ROGELYNE P. TAMAYO, RN
No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
Name of Child
(Surname, First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Sex (M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
F
M
F
F
M
F
M
F
M
M
M
F
F
F
F
F
M
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
MALE
0
0
0
0
2
2
0
2
0
2
1
2
0
No. of Vaccinated Neonate/In

FEMALE
1
1
0
2
5
9
1
3
5
5
3
3
4
Prepared by:
NDP
Date of Birth*
Age in Months
Age Group
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
17
12
12
9
5
14
14
11
8
5
7
21
18
10
9
2
4
8
0
8
7
21
8
18
17
17
16
11
10
9
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
23
12
8
21
14
17
14
14
ng month
ccinated Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
1
1
1
1
0
0
2
2
5
7
9
11
1
1
3
5
5
5
5
7
3
4
3
5
4
4
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
Birthplace
(Mun.,
Prov.)
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Date of Completion: _
Detailed Address in
Purok including
Landmarks
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
#83 DOH Street

In front of the church
At the back of Brgy. Hall
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
7
7
7
7
7
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Noted by:
PHN
pletion: _JANUARY 2015
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
yes
No
No
No
yes
no
no
yes
No
no
No
No
No
No
yes
no
yes
yes
no
No
No
No
yes
yes
no
no
yes
yes
PhilHealth (Yeswrite the PHIC

number/No)
NBS
done*
(Yes/No)
0720-0320-3183
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
Yes
No
Yes
No
No
No
No
No
No
No
No
No
No
0720-1046-1295
No
No
No
No
no
no
yes
No
no
No
No
No
No
yes
No
07-2009137042
yes
No
No
No
No
yes
yes
no
no
yes
yes
HepB BD
Contact No.
NHTS
(Yes/No)
BCG
Place 1 if v
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
yes
No
No
No
no
No
No
yes
yes
No
No
No
no
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROSALILIA C. TANGSON
MHO
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MMR
1
1
1
1
AMV
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
OPV 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
FIC* CIC*
OPV 2
OPV 1
Penta 2
Penta 3
Penta 1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
SALILIA C. TANGSON, MD
TT3
TT4
TT5
Completely Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT2
Card Check
TT1
Place 1 if mother recall TT

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/No)
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
Age Group
1: 6-11 mos
Given (Date)
2: 12-23 mos
Status
TI-Trans In
TO-Trans Out
V-Visitor
P-Private Pedia
R-Refused
Location (Brgy, Mun,

Prov.), Name of
Pediatrician, Reason for
refusal
Remarks
Date of
Completion
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
Name of Child
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Sex (M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
F
M
F
F
M
F
M
F
M
M
M
F
F
F
F
F
M
F
F
F
F
35
36
37
38
39
40
41
42
43
44
45
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP
No. of Vaccinated Neonate/Infant fro

MALE
FEMALE
0
1
0
1
0
0
0
2
2
5
2
9
0
1
2
3
0
5
2
5
1
3
2
3
0
4
Date of
Birth*
Age in Months
Age Group
Birthplace
(Mun.,
Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/5/2013
18
13
13
10
6
15
15
12
8
6
8
22
18
11
10
3
5
9
1
9
8
22
9
19
18
18
17
12
11
10
24
13
9
22
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
24 mos above
12-23 mos
0-11 mos
12-23 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
11/9/2013
8/8/2013
11/23/2013
11/19/2013
15
18
15
15
12-23
12-23
12-23
12-23
porting month
ed Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
1
1
1
1
0
0
2
2
5
7
9
11
1
1
3
5
5
5
5
7
3
4
3
5
4
4
mos
mos
mos
mos
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Detailed Address
Name of Mother
in Purok including
Landmarks
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 7
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
zone
zone
zone
zone
7
7
7
7
Noted by:
PHN
Dibut
Dibut
Dibut
Dibut
ompletion: _JANUARY 2015
yes
No
yes
No
No
No
yes
no
no
yes
No
no
No
No
No
No
yes
no
yes
yes
no
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
NBS
done*
(Yes/No)
0720-0320-3183
No
No
No
No
No
No
Yes
No
No
No
No
No
No
No
No
No
No
No
Yes
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
0720-1046-1295
No
No
No
No
no
no
yes
No
no
No
No
No
No
yes
No
07-2009137042
yes
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
Penta 1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109

number/No)
HepB BD
Contact No.
NHTS
(Yes/No)
BCG
Place 1 if vaccine ha
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9068948109
9068948109
9068948109
9068948109
No
no
No
No
No
no
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
ROSALILIA C. TANGSON,
MHO
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR

FIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CIC
*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Card Check
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
LILIA C. TANGSON, MD
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT1
TT2
TT3
TT4
TT5
Place 1 if mother
recall TT doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
CPAB*
(Yes/No)
Given (Date)
Age Group
1: 6-11 mos
2: 12-23 mos
1
1
1
1
1
1
1
1
1
1
Status
TI-Trans In
TOLocation (Brgy, Mun,
Trans Out
VProv.), Name of
Visitor
PPediatrician, Reason
Private Pedia
for refusal
R-Refused
Remarks
Date of
Completion
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015
2/28/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
F
M
F
35
36
37
38
39
40
41
42
43
44
45
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP
No. of Vaccinated Neonate/Infant from

MALE
FEMALE
1
0
0
0
0
0
2
0
0
0
1
4
2
0
2
3
1
3
1
2
0
1
1
2
0
0
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun.,
Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
17
12
12
9
5
14
14
11
8
5
7
0
Err:502
21
18
10
9
2
4
8
0
0
8
7
21
8
18
17
17
16
11
10
9
23
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
Err:502
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
12
8
21
14
17
14
14
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
eporting month
d Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
1
0
0
0
0
0
2
0
0
4
5
0
2
3
5
3
4
2
3
1
1
2
3
0
0
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Detailed Address in
Purok including
Landmarks
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Noted by:
PHN
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Date of Completion: _JANUARY 2015
Barangay
Contact No.
NHTS
(Yes/No)
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no
yes
yes
yes

number/No)
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
yes
yes
yes
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
No
No
no
No
No
yes
No
No
No
no
No
No
OPV 3
AMV
MMR
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
PCV 2
OPV 2
1
1
1
1
1
1
1
1
1
1
1
PCV 1
OPV 1
1
1
1
1
1
1
1
1
1
1
1
1
ROTA 2
Penta 3
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROTA 1
Penta 2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Penta 1
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
No
HepB BD
NBS
done*
(Yes/No)
BCG
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT5
1
1
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT4
Card Check
TT3
CIC
*
TT2
FIC*
TT1
IPV
PCV 3

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TI-Trans
In
Location
TO(Brgy,
Vitamin A*
Status
Age
Trans
Mun,
Group
Out
Prov.),
CPAB*
Remark
1: 6-11 V-Visitor Name of
(Yes/No) Given (Date)
s
mos 2:
Pediatri
12-23
Pcian,
mos
Private Reason
Pedia
for
R- refusal
Refused
TO Real
Date of
Completion
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015
1/31/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
Name of Child
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Bernabe, Eduuardo jr.
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
F
M
F
35
36
37
38
39
40
41
42
43
44
45
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP
No. of Vaccinated Neonate/Infant fro

MALE
FEMALE
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Date of Birth*
Age in
Months
Age Group
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
20
15
15
12
8
17
17
14
11
8
10
3
2
24
20
13
12
5
7
11
3
3
11
10
24
11
21
20
20
19
14
13
12
26
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
15
11
24
17
20
17
17
12-23 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
eporting month
nated Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
(Mun.,
Prov.)
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Name of Mother (Surname,

First, MI.)
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Detailed Address in
Purok including
Landmarks
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 5
Zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Noted by:
PHN
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
mpletion: _JANUARY 2015
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
PhilHealth (Yes-write
(Yes/No) the PHIC number/No)
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no
yes
yes
yes
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
yes
yes
yes
NBS
done*
(Yes/No)
BCG
Place 1 if
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
No
No
no
No
No
yes
No
No
No
no
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
ROSALILIA C. TA
MHO
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR

FIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CIC
*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT4
TT5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT2
Card Check
TT1
Place 1 if mother
recall TT doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/No)
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
Given (Date)
Status
TI-Trans In
TOAge Group
1: Trans Out
V6-11 mos 2:
Visitor
P12-23 mos
Private Pedia
R-Refused
Status
Prov.), Name of
Pediatrician, Reason
for refusal
Remarks
Date of
Completion
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Bernabe, Eduuardo jr.
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
F
M
34
35
36
37
38
39
40
41
42
43
44
45
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
FEMALE
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Date of Birth*
Age in
Months
Age Group
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
20
15
15
12
8
17
17
14
11
8
10
3
2
24
20
13
12
5
7
11
3
3
11
10
24
11
21
20
20
19
14
13
12
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
26
15
11
24
17
20
17
17
24 mos above
12-23 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
ing month
ed Neonate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Birthplace
(Mun.,
Prov.)
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora

First, MI.)
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Detailed Address
in Purok including
Landmarks
zone
zone
zone
zone
zone
1
1
1
1
1
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
3
3
2
3
3
3
2
2
4
4
4
4
4
4
4
4
4
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
Noted by:
PHN
6
6
6
7
7
7
7
7
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
mpletion: _JANUARY 2015
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no
yes
yes

number/No)
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
yes
yes
NBS
done*
(Yes/No
)
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
BCG
Place
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
yes
No
No
No
no
No
No
yes
yes
No
No
No
no
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
ROSALILIA C. TANG
MHO
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
FIC* CIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT4
TT5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT2
Card Check
TT1

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/No)
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
Status
TI-Trans In
Age Group
1: Trans Out
VProv.), Name of
Given (Date)
6-11 mos 2:
Visitor
12-23 mos
Private Pedia
for refusal
R-Refused
Remarks
Date of
Completion
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015
4/30/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
Name of Child
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
F
M
34
35
36
37
38
39
40
41
42
43
44
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
No. of Vaccinated Neonate/Infant from Mo

MALE
FEMALE
0
0
0
0
0
0
0
0
0
0
0
0
1
1
2
0
1
0
2
5
0
0
1
2
0
2
Prepared by:
NDP
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun.,
Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
22
17
17
14
10
19
19
16
13
10
12
5
4
26
22
15
14
7
9
13
5
5
13
12
26
13
23
22
22
21
16
15
14
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
0-11 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
28
17
13
26
19
22
19
19
24 mos above
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
reporting month

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
1
2
0
2
0
1
5
7
0
0
2
3
2
2
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Date of Completion:
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Detailed
Address in
Purok
including
Landmarks
zone
zone
zone
zone
zone
1
1
1
1
1
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
3
3
2
3
3
3
2
2
4
4
4
4
4
4
4
4
4
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
7
7
7
7
7
Noted by:
PHN
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
te of Completion: _JUNE 2015
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
yes
yes
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
Penta 2
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no
yes
yes
Penta 1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
HepB BD
PhilHealth
NBS
NHTS (Yes-write the
Contact No.
done*
(Yes/No)
PHIC
(Yes/No)
number/No)
BCG
Place 1 if vaccine has
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
yes
No
No
No
no
No
No
yes
yes
No
No
No
no
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
ce 1 if vaccine has been given*

FIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Card Check
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
NGSON, MD
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially Immunized
Partially Immunized
Partially Immunized
TT1
TT2
TT3
TT4
TT5

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
CPAB*
(Yes/No)
Given
(Date)
Age Group
1: 6-11 mos
2: 12-23 mos
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Status
TI-Trans In
TO-Trans Out
Location (Brgy,
V-Visitor
Mun, Prov.), Name
P-Private
of Pediatrician,
Pedia
R- Reason for refusal
Refused
Remarks
(D)
TO
REAL
Date of
Completion
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015
6/30/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
SANL0115082010
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Novicio, Laurence
Dela Torre, Jayron
Melencio, Jaymar
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Nadiahan, Jake Lee
Francisco, jim Andrei A
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Sex
(M/F)
M
F
F
F
M
M
M
M
F
F
F
F
F
F
M
M
M
M
M
M
F
M
F
F
M
F
M
F
M
F
M
M
M
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115085013
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Novicio, Rayco
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
F
F
F
F
F
M
F
F
F
M
F
M
M
M
F
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
No. of Vaccinated Neonate/Infant from M

MALE
FEMALE
4
3
2
1
0
0
0
0
0
0
0
0
0
0
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP
1
1
0
0
0
0
0
0
0
0
0
0
Date of
Birth*
Age in
Months
Age Group
Birthplace
(Mun., Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/11/2015
7/22/2015
8/3/2015
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
5/27/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
8/1/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
23
18
18
15
11
2
0
Err:502
20
20
17
14
11
13
6
5
3
2
27
24
16
15
8
10
14
6
6
Err:502
14
13
27
14
24
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
0-11 mos
Err:502
12-23 mos
12-23 mos
24 mos above
12-23 mos
24 mos above
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/15/2015
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
23
23
22
17
16
15
29
18
14
3
27
20
23
20
20
1
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
nate/Infant from Month 1-30, 2015

FEMALE
TOTAL
3
7
1
3
0
0
0
0
0
0
0
0
0
0
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
0
0
0
0
0
0
1
1
0
0
0
0

First, MI.)
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Novicio, Dolores
Dela Torre, Zepora
Melencio, Mica
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Detailed Address in
Purok including
Landmarks
ZONE 1
ZONE 1
ZONE 1
ZONE 1
ZONE 1
ZONE 1
ZONE 1
ZONE 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
Zone 2
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
ZONE 5
ZONE 5
zone 6
zone 6
zone 6
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Novicio, Daisyree
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
1
7
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
1
7
7
7
7
7
7
Noted by:
PHN
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
yes
yes
No
No
yes
no
no
yes
No
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
yes
no
No
No
No
PhilHealth
(Yes-write the NBS done*
PHIC
(Yes/No)
number/No)
0720-0320-3183
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
no
no
yes
No
No
No
Yes
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
No
Yes
No
No
No
Yes
No
No
No
BCG
Date of Completion: JULY 2015
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
none
9068948109
9068948109
9068948109
9068948109
9068948109
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROSALILIA C. TANG
MHO
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR

FIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT5
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT4
Partially Immunized
Partially Immunized
TT3
1
1
Card Check
TT2
CIC*
TT1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Vitamin A*
CPAB*
(Yes/No)
Given (Date)
Age Group
1: 6-11 mos
2: 12-23 mos
Status
TI-Trans In
TOTrans Out
VVisitor
PPrivate Pedia
R-Refused
TO
TO
Yes
Yes
Status
Prov.), Name of
Pediatrician, Reason
for refusal
Remarks
Benguet
(D)
REAL
Date of
Completion
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015
7/31/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115083011
SANL0115084001
SANL0115084002
SANL0115084003
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Nadiajan, Jake Lee
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
OLIT, GINMAR
Alling, Marvin
Magdato, Nadine
Novicio, Raico Jay
Sex
(M/F)
M
F
F
F
M
M
F
M
M
M
F
F
F
F
F
F
F
M
M
M
M
M
F
M
F
F
M
F
M
F
M
M
F
M
35
36
37
38
39
40
41
42
43
44
45
46
47
49
50
51
52
53
54
55
56
SANL0115084004
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
SANL0115086007
SANL0115086008
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
Salcedo, Rafael
Casamis, Jamaica
M
M
M
M
F
F
F
F
F
M
F
F
F
F
M
M
M
F
F
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
FEMALE
0
0
0
0
2
0
0
0
0
0
0
0
2
2
2
1
0
0
0
0
3
8
0
0
0
0
Date of
Birth*
Age in
Months
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
7/25/2015
12/14/2014
5/7/2014
6/3/2014
4/15/2015
24
19
19
16
12
3
3
3
1
0
Err:502
21
21
18
15
12
14
7
6
4
28
25
17
16
9
11
15
7
7
1
8
15
14
4
Age Group
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
Birthplace
(Mun., Prov.)
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
8/22/2015
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
4/15/2015
4/24/2015
0
28
15
25
24
24
23
18
17
16
30
19
15
28
21
24
21
21
2
4
4
0-11 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
24 mos above
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
ate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
0
0
0
0
2
0
0
0
0
0
0
2
4
1
3
0
0
0
0
8
11
0
0
0
0

First, MI.)
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
OLIT, DALIA
Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Detailed Address in
Purok including
Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
1
1
1
1
1
1
1
1
1
1
1
3
3
2
3
3
3
2
2
2
4
4
4
4
4
4
4
4
4
4
4
5
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 5
Pradillada, Reena
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
Manarpiis, Mercy
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy
Zone 5
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
zone 7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
5
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
Noted by:
PHN
Date of Completion: AUGUST 2015
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
yes
yes
No
No
No
No
No
yes
no
no
yes
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
NO
yes
no
No
PhilHealth
(Yes-write the NBS done*
PHIC
(Yes/No)
number/No)
0720-0320-3183
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
No
no
no
yes
No
No
No
Yes
no
No
No
No
No
yes
No
07-2009137042
No
no
NO
yes
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
Yes
No
No
YES
No
Yes
No
BCG
Place
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
#VALUE!
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
ROSALILIA C. TANG
MHO
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR

FIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT4
TT5
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
TT2
Card Check
TT1

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/No)
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
Partially Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Yes
Yes
Vitamin A*
Given (Date)
Age Group
1: 6-11 mos
2: 12-23 mos
Status
TI-Trans In
Trans Out
VProv.), Name of
Visitor
Private Pedia
for refusal
R-Refused
TO
REAL
TI
Umiray
Remarks
DEAD
Date of
Completion
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015
8/31/2015

Name of Municipality: SAN LUIS, AURORA
Name of MHO: ROSALILIA C. TANGSON, MD
No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115083011
SANL0115084001
SANL0115084002
SANL0115084003
Name of Child
(Surname, First,
MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Nadiajan, Jake Lee
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
OLIT, GINMAR
Alling, Marvin
Magdato, Nadine
Novicio, Raico Jay
Sex
(M/F)
M
F
F
F
M
M
F
M
M
M
F
F
F
F
F
F
F
M
M
M
M
M
F
M
F
F
M
F
M
F
M
M
F
M
35
36
37
38
39
40
41
42
43
44
45
46
47
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
SANL0115084004
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
SANL0115086007
SANL0115086008
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
Salcedo, Rafael
Casamis, Jamaica
M
M
M
M
F
F
F
F
F
M
F
F
F
F
M
M
M
F
F
M
F
84
85
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
FEMALE
2
1
0
1
2
S
4
1
0
1
0
2
1
0
2
0
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun., Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
7/25/2015
12/14/2014
5/7/2014
6/3/2014
4/15/2015
25
20
20
17
13
4
4
4
2
1
0
22
22
19
16
13
15
8
7
5
29
25
18
17
10
12
16
8
8
2
9
16
15
5
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
0-11 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
8/22/2015
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
4/15/2015
4/24/2015
1
29
16
26
25
25
24
19
18
17
31
20
16
29
22
25
22
22
3
5
5
0-11 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
24 mos above
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora

FEMALE
TOTAL
1
3
1
1
0
2
1
0
2
0
0
0
0
0
2
3
5
1
2
1
0
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
OLIT, DALIA
Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Detailed Address in
Purok including
Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
1
1
1
1
1
1
1
1
1
1
1
3
3
2
3
3
3
2
2
2
4
4
4
4
4
4
4
4
4
4
4
5
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 5
Pradillada, Reena
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
Manarpiis, Mercy
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy
Zone 5
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
5
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
7
Noted by:
_ROGELYNE P. TAMAYO, RN
PHN
Date of Completion: SEPTEMBER 2015
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
yes
yes
No
No
No
No
No
yes
no
no
yes
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
NO
yes
no
No

number/No)
NBS
done*
(Yes/No)
0720-0320-3183
No
No
No
No
No
No
No
No
No
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
No
no
no
yes
No
No
No
Yes
no
No
No
No
No
yes
No
07-2009137042
No
no
NO
yes
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
Yes
No
No
YES
No
Yes
No
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
yes
No
No
no
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB
BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
CIC*
IPV
PCV 3
PCV 2
FIC*
PCV 1
ROTA 2
ROTA 1
een given*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT3
TT4
TT5
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT2
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT1
Card Check
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/N
o)
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Yes
Yes
Vitamin A*
Status
TI-Trans In
Location (Brgy,
Age Group
TO-Trans Out
Mun, Prov.),
1: 6-11 mos
Given (Date)
V-Visitor
Name of
2: 12-23 mos
P-Private Pedia
Pediatrician,
R-Refused Reason for refusal
TO
TI
REAL
TI
Remarks
Date of
Completion
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015
9/30/2015

Name of Municipality: SAN LUIS, AURORA
Name of MHO: ROSALILIA C. TANGSON
Name of PHN: ROGELYN P. TAMAYO
No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115083011
SANL0115084001
SANL0115084002
SANL0115084003
Name of Child
(Surname, First,
MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Nadiajan, Jake Lee
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
OLIT, GINMAR
Alling, Marvin
Magdato, Nadine
Novicio, Raico Jay
Sex
(M/F)
M
F
F
F
M
M
F
M
M
M
F
F
F
F
F
F
F
M
M
M
M
M
F
M
F
F
M
F
M
F
M
M
F
M
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
SANL0115084004
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115085013
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
SANL0115086007
SANL0115086008
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Novicio, Bb. Boy
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
Salcedo, Rafael
Casamis, Jamaica
M
M
M
M
F
F
F
F
F
M
F
F
F
M
F
M
M
M
F
F
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1

MALE
FEMALE
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
CATHERINE M. ERTO, RN
NDP
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun., Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
7/25/2015
12/14/2014
5/7/2014
6/3/2014
4/15/2015
29
24
24
21
17
8
8
8
6
5
4
26
26
23
20
17
19
12
11
9
33
30
22
21
14
16
20
12
12
6
13
20
19
9
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
8/22/2015
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/15/2015
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
4/15/2015
4/24/2015
5
33
20
30
29
29
28
23
22
21
35
24
20
9
33
26
29
26
26
7
9
9
0-11 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
24 mos above
24 mos above
12-23 mos
0-11 mos
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
0-11 mos
0-11 mos
0-11 mos
onate/Infant from Month 1-30, 2015

FEMALE
TOTAL
0
0
0
0
0
0
0
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
0
0
0
0
0
0
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
OLIT, DALIA
Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Detailed Address in
Purok including
Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
1
1
1
1
1
1
1
1
1
1
1
3
3
2
3
3
3
2
2
2
4
4
4
4
4
4
4
4
4
4
4
5
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 5
Pradillada, Reena
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Novicio, Daisy Rose
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy
Zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 7
zone 7
zone 7
zone 7
zone 7
zone 7
zone 7
zone 7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
5
6
6
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
Noted by:
PHN
Date of Completion: JANUARY 2016
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
yes
yes
No
No
No
No
No
yes
no
no
yes
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
NO
yes
no
No

number/No)
NBS
done*
(Yes/No)
0720-0320-3183
No
No
No
No
No
No
No
No
No
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
No
no
no
yes
No
No
No
Yes
no
No
No
No
No
yes
No
07-2009137042
No
no
NO
yes
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
Yes
No
No
YES
No
Yes
No
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
none
9068948109
9068948109
9068948109
9068948109
9068948109
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
No
No
No
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
MHO
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
een given*
FIC*
CIC*
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TT4
TT5
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT2
Card Check
TT1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/N
o)
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Yes
Yes
Yes
Vitamin A*
Status
TI-Trans In
Location (Brgy,
Age Group
TO-Trans Out
Mun, Prov.),
1: 6-11 mos
Given (Date)
V-Visitor
Name of
2: 12-23 mos
P-Private Pedia
Pediatrician,
TO
REAL
Remarks
Date of
Completion
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016

2
SANL0115081002 Bihasa, Lyca joyce
3
SANL0115081003 Caldosa, Allyna
4
SANL0115081004 Sto. Domingo, Rebecca
5
SANL0115081005 Avenilla, Daiton
14
SANL0115082003 Mila, Irish Jade
15
SANL0115082004 Sindac, Princess Banalee
16
SANL0115082005 Abragon, Lea Mae S.
17
SANL0115082006 Orena, Queen Althea Joy
23
SANL0115083003 Loberiano, Clarisse
24
SANL0115083004 Udarbe, Yodi
25
SANL0115083005 Gonzales, Micaela
26
SANL0115083006 Salinel, Lovelyn Mae
27
SANL0115083007 Andrada, Lance Aeron
32
SANL0115084001 Alling, Marvin
33
SANL0115084002 Magdato, Nadine
37
SANL0115085002 Natividad, Rappah Jan
42
SANL0115085007 Molina, Fairy Mae
43
SANL0115085008 Angara, Glory Joy
44
SANL0115085009 Baynosa, Benedict
46
SANL0115085011 Manarpiis, Jenny
47
SANL0115085012 De Leon, Irish
F
F
F
M
F
F
F
F
F
M
F
F
M
M
F
M
F
F
M
F
F
1/6/2014
1/11/2014
4/11/2014
8/2/2014
2/19/2014
5/30/2014
8/14/2014
6/10/2014
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
5/7/2014
6/3/2014
5/14/2014
2/19/2014
3/2/2014
4/17/2014
1/8/2014
5/2/2014
22
22
19
15
21
18
15
17
20
19
12
14
18
18
17
18
21
20
19
22
18
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
12-23
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Manarpiis, Mercy
De Leon, Aileen
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
1
1
1
1
2
3
3
3
4
4
4
4
4
5
5
zone
zone
zone
zone
Zone 2
Zone 3
Zone 3
Zone 3
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
1
1
1
1
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
No
yes
No
No
no
no
yes
No
No
No
No
yes
no
yes
no
No
no
yes
yes
yes
No
No
0720-1046-1295
No
No
no
no
yes
No
No
No
No
yes
No
yes
No
No
no
yes
yes
yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Yes
No
No
No
No
No
No
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TO
REAL
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015
11/30/2015

Name of MHO: ______________________________
Name of PHN: _______________________________
No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115081006
SANL0115081007
SANL0115081008
SANL0115081009
SANL0115081010
SANL0115081011
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115082009
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115083010
SANL0115083011
SANL0115084001
SANL0115084002
SANL0115084003
Name of Child
(Surname, First,
MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Novicio, Laurence
Gambito, Faith
Dela Torre, Jayron
Melencio, Jaymar
Aldama, Bb. Girl
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Nadiajan, Jake Lee
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Salinel, Lea Mae
OLIT, GINMAR
Alling, Marvin
Magdato, Nadine
Novicio, Raico Jay
Sex
(M/F)
M
F
F
F
M
M
F
M
M
M
F
F
F
F
F
F
F
M
M
M
M
M
F
M
F
F
M
F
M
F
M
M
F
M
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
SANL0115084004
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115085013
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
SANL0115086006
SANL0115086007
SANL0115086008
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Novicio, Bb. Boy
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
Eslera, Elerie
Salcedo, Rafael
Casamis, Jamaica
M
M
M
M
F
F
F
F
F
M
F
F
F
M
F
M
M
M
F
F
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
FEMALE
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun., Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
5/3/2015
5/11/2015
5/27/2015
7/22/2015
8/3/2015
9/1/2015
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
7/25/2015
12/14/2014
5/7/2014
6/3/2014
4/15/2015
28
23
23
20
16
7
7
7
5
4
3
25
25
22
19
16
18
11
10
8
32
29
21
20
13
15
19
11
11
5
12
19
18
8
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
0-11 mos
0-11 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
8/22/2015
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/15/2015
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
6/2/2015
4/15/2015
4/24/2015
4
32
19
29
28
28
27
22
21
20
34
23
19
8
32
25
28
25
25
6
8
8
1380
1380
1380
1380
1380
0
0-11 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
12-23 mos
0-11 mos
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
0-11 mos
0-11 mos
0-11 mos
24
24
24
24
24
mos
mos
mos
mos
mos
above
above
above
above
above
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora

FEMALE
TOTAL
0
0
0
0
0
0
0
0
0
0
0
0
0
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Novicio, Dolores
Gambito, Mica
Dela Torre, Zepora
Melencio, Mica
Aldama, Gretchen
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Nadiahan, Jaycel
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Salinel, LAILA
OLIT, DALIA
Alling, Maritess
Magdato, Wendra
Novicio, Daisyree
Detailed Address in
Purok including
Landmarks
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
Zone
1
1
1
1
1
1
1
1
1
1
1
3
3
2
3
3
3
2
2
2
4
4
4
4
4
4
4
4
4
4
4
5
5
5
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 1
Zone 1
Zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 5
Pradillada, Reena
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Novicio, Daisy Rose
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
Eslera, Elsie
Salcedo, Odette
Casamis, Joy
Zone 5
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
5
6
6
6
6
6
6
6
6
6
6
6
6
6
7
7
7
7
7
7
7
7
Noted by:
PHN
Date of Completion: _DECEMBER 2015
Barangay
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Contact No.
9068948109
9068948109
9068948109
9068948109
9068948109
none
none
none
none
none
none
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
NHTS
(Yes/No)
yes
No
yes
No
No
yes
yes
No
No
No
No
No
yes
no
no
yes
No
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
NO
yes
no
No

number/No)
NBS
done*
(Yes/No)
0720-0320-3183
No
No
No
No
No
No
No
No
No
No
0720-1046-1295
No
No
Yes
Yes
No
No
No
No
no
no
yes
No
No
No
Yes
no
No
No
No
No
yes
No
07-2009137042
No
no
NO
yes
No
No
No
Yes
No
No
No
No
No
Yes
Yes
No
No
No
No
No
No
No
Yes
No
No
YES
No
Yes
No
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
none
9068948109
9068948109
9068948109
9068948109
9068948109
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
No
No
No
No
Yes
No
No
No
No
yes
yes
no
no
yes
yes
yes
yes
No
No
No
No
no
No
No
No
No
No
364658
475765
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
BCG
HepB BD
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
AMV
MMR
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
MHO
IPV
PCV 3
PCV 2
PCV 1
ROTA 2
ROTA 1
een given*
FIC*
CIC*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TT4
TT5
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT3
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT2
Card Check
TT1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
CPAB*
(Yes/N
o)
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Yes
Yes
Yes
Vitamin A*
Status
TI-Trans In
Location (Brgy,
Age Group
TO-Trans Out
Mun, Prov.),
1: 6-11 mos
Given (Date)
V-Visitor
Name of
2: 12-23 mos
P-Private Pedia
Pediatrician,
TO
REAL
TO
V
R
P
Brgy. 1, Baler,
Aurora
Makati City, Manila
Religious belief
Dr. Mangaba
Remarks
Date of
Completion
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015
12/31/2015

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
32
33
34
35
36
37
38
39
40
41
42
43
44
45
SANL0115085008
SANL0115085009
SANL0115085010
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Angara, Glory Joy

Baynosa, Benedict
Novicio, Jeralyn
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
M
F
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC

MALE
FEMALE
1
0
0
0
0
0
2
0
0
0
1
4
2
0
2
3
1
3
1
2
0
1
1
2
0
0
Prepared by:
NDP
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun.,
Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
29
24
24
21
17
26
26
23
20
17
19
12
11
33
30
22
21
14
16
20
12
12
20
19
33
20
30
29
29
28
23
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
0-11 mos
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
3/2/2014
4/17/2014
2/2/2013
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
22
21
35
24
20
33
26
29
26
26
12-23 mos
12-23 mos
24 mos above
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
porting month

FEMALE
TOTAL
0
1
0
0
0
0
0
2
0
0
4
5
0
2
3
5
3
4
2
3
1
1
2
3
0
0
San
San
San
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Detailed Address in
Purok including
Landmarks
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
7
7
7
7
7
zone
zone
zone
zone
zone
zone
zone
zone
zone
zone
6
6
6
6
6
7
7
7
7
7
Noted by:
PHN
Barangay
Contact No.
NHTS
(Yes/No)
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no

number/No)
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
yes
yes
yes
No
No
No
no
No
No
yes
yes
yes
yes
No
No
No
no
No
No
OPV 3
AMV
MMR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PCV 2
OPV 2
0
0
0
0
0
0
0
0
0
0
0
PCV 1
OPV 1
0
0
0
0
0
0
0
0
0
0
0
0
ROTA 2
Penta 3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ROTA 1
Penta 2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Penta 1
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
HepB BD
NBS
done*
(Yes/No)
BCG
No
No
No
No
No
No
No
No
No
No
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
MHO
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT5
0
0
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT4
Card Check
TT3
CIC
*
TT2
FIC*
TT1
IPV
PCV 3

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TI-Trans Location
In Status
(Brgy,
Vitamin A*
Age
TO-Trans
Mun,
Group
Out
Prov.),
CPAB*
1: 6-11 V-Visitor Name of Remarks
mos 2:
P- Pediatric
12-23
Private
ian,
mos
Pedia
Reason
Rfor
Refused refusal
TO Real
Date of
Completion
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016
1/31/2016

No.
REP Code
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
SANL0115081001
SANL0115081002
SANL0115081003
SANL0115081004
SANL0115081005
SANL0115082001
SANL0115082002
SANL0115082003
SANL0115082004
SANL0115082005
SANL0115082006
SANL0115082007
SANL0115082008
SANL0115083001
SANL0115083002
SANL0115083003
SANL0115083004
SANL0115083005
SANL0115083006
SANL0115083007
SANL0115083008
SANL0115083009
SANL0115084001
SANL0115084002
SANL0115085001
SANL0115085002
SANL0115085003
SANL0115085004
SANL0115085005
SANL0115085006
SANL0115085007
SANL0115085008
SANL0115085009
SANL0115085010
Name of Child
(Surname,
First, MI.)
Novicio, Jhonny
Bihasa, Lyca joyce
Caldosa, Allyna
Avenilla, Daiton
Lopez, Rhianne
Alojado, Janelle
Mila, Irish Jade
Abragon, Lea Mae S.
Sindac, Jayven Roy
Abragon, Jhon Carl
Aldama, James Marky
Loberiano, Clarisse
Udarbe, Yodi
Gonzales, Micaela
Tanael, Jean Aira
Lopez, Mark Angel
Alling, Marvin
Magdato, Nadine
Aldama, Rommel
Angara, Khayla
Loberiano, Gilyn
Molina, Fairy Mae
Angara, Glory Joy
Baynosa, Benedict
Novicio, Jeralyn
Sex
(M/F)
M
F
F
F
M
F
F
F
F
F
F
M
M
M
M
F
M
F
F
M
F
M
M
F
M
M
M
F
F
F
F
F
M
F
35
36
37
38
39
40
41
42
43
44
45
SANL0115085011
SANL0115085012
SANL0115086001
SANL0115086002
SANL0115086003
SANL0115086004
SANL0115086005
Manarpiis, Jenny
De Leon, Irish
Tindogan, Fea
Bihasa, Arjie
Sollegue, Yuki
Orca, Princess
F
F
F
M
M
M
F
JANUARY
Light Blue
FEBRUARY
Red
MARCH
Green
APRIL
Purple
MAY
Yellow
JUNE
Blue
Summary:
Antigen
BCG
Hep B (w/i 24 hrs)
Hep B (> 24 hrs)
Penta 1
Penta 2
Penta 3
OPV 1
OPV 2
OPV 3
MCV 1
MCV 2
FIC
CIC
Prepared by:
NDP

MALE
FEMALE
1
0
0
0
0
0
2
0
0
0
1
4
2
0
2
3
1
3
1
2
0
1
1
2
0
0
Date of Birth*
Age in
Months
Age Group
Birthplace
(Mun.,
Prov.)
8/28/2013
1/6/2014
1/11/2014
4/11/2014
8/2/2014
11/6/2013
11/7/2013
2/19/2014
5/30/2014
8/14/2014
6/10/2014
1/25/2015
2/5/2015
4/12/2013
7/31/2013
3/15/2014
4/8/2014
11/13/2014
9/13/2014
5/16/2014
1/22/2015
1/3/2015
5/7/2014
6/3/2014
4/23/2013
5/14/2014
7/5/2013
8/9/2013
8/9/2013
9/27/2013
2/19/2014
3/2/2014
4/17/2014
2/2/2013
31
26
26
23
19
28
28
25
22
19
21
14
13
35
32
24
23
16
18
22
14
14
22
21
35
22
32
31
31
30
25
24
23
37
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
24 mos above
24 mos above
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
12-23 mos
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
12-23 mos
24 mos above
San Luis, Aurora

San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
Baler, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
San Luis, Aurora
1/8/2014
5/2/2014
4/5/2013
11/9/2013
8/8/2013
11/23/2013
11/19/2013
26
22
35
28
31
28
28
24 mos above
12-23 mos
24 mos above
24 mos above
24 mos above
24 mos above
24 mos above
porting month

FEMALE
TOTAL
0
1
0
0
0
0
0
2
0
0
4
5
0
2
3
5
3
4
2
3
1
1
2
3
0
0
San
San
San
San
San
San
San
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Luis,
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Aurora
Name of Mother
Novicio, Dolores
Bihasa, liezel
Caldosa, Lerma
Avenilla, Daisyrose
Lopez, Normelyn
Alojado, Fatima
Mila, Jemelie
Sindac, Marjorie
Orena, Kwinie
Trinidad, Michelle
Bernabe, Ginalyn
Abragon, Jonalyn
Aldama, Josephine
Loberiano, Maria
Udarbe, April
Gonzales, Carmen
Salinel, Luz
Andrada, Ronalyn
Tanael, Aurora
Lumbaga, Mary Rose
Alling, Maritess
Magdato, Wendra
Natividad, Abigail
Natividad, Abigail
Aldama, Gretchen
Angara, Rachelle
Molina, Rose May
Angara,Irene
Baynosa, Marvy
Novicio, Elsie
Detailed Address in
Purok including
Landmarks
Purok
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
Zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 1
zone 1
zone 1
zone 1
zone 1
Zone 3
Zone 3
Zone 2
Zone 3
Zone 3
Zone 3
Zone 2
Zone 2
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 4
zone 5
zone 5
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
zone 6
Manarpiis, Mercy
De Leon, Aileen
Tindogan, Razell
Esplandor, maricel
Bihasa, Elena
Sollegue, Lyn
Orca, Rachelle
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Noted by:
PHN
zone
zone
zone
zone
zone
zone
zone
6
6
7
7
7
7
7
Barangay
Contact No.
NHTS
(Yes/No)
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
yes
No
No
No
yes
no
no
yes
No
No
No
no
No
No
No
No
yes
no
yes
No
yes
no
No
No
No
yes
yes
no
no
yes
yes
yes

number/No)
0720-0320-3183
No
0720-1046-1295
No
No
No
No
no
no
yes
No
No
No
no
No
No
No
No
yes
No
07-2009137042
No
yes
No
No
No
No
yes
yes
no
no
yes
yes
yes
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
Dibut
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
9068948109
yes
No
No
No
no
No
No
yes
No
No
No
no
No
No
OPV 3
AMV
MMR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PCV 2
OPV 2
0
0
0
0
0
0
0
0
0
0
0
PCV 1
OPV 1
0
0
0
0
0
0
0
0
0
0
0
0
ROTA 2
Penta 3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ROTA 1
Penta 2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Penta 1
No
No
No
No
No
No
Yes
No
No
No
No
No
Yes
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No
No
No
No
No
No
No
No
No
HepB BD
NBS
done*
(Yes/No)
BCG
No
No
No
No
No
No
No
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
MHO
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
TT5
0
0
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
TT4
Card Check
TT3
CIC
*
TT2
FIC*
TT1
IPV
PCV 3

doses*
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
0
0
0
0
0
0
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Partially
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
Immunized
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
TI-Trans Location
In Status
(Brgy,
Vitamin A*
Age
TO-Trans
Mun,
Group
Out
Prov.),
CPAB*
1: 6-11 V-Visitor Name of Remarks
mos 2:
P- Pediatric
12-23
Private
ian,
mos
Pedia
Reason
Rfor
Refused refusal
TO Real
Date of
Completion
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016
3/31/2016

Dibut Masterlist

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Dibut Masterlist

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Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

Name of Municipality: ________________________

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been given*

Place 1 if mother recall TT doses*

adopted by Vilma Ritual

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

San Luis, Aurora

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been

vaccine has been given*

Place 1 if mother recall TT doses*

her recall TT doses*

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

Abragon, Jhon Carl

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

San Luis, Aurora

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been

vaccine has been given*

Place 1 if mother recall TT do

her recall TT doses*

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been

vaccine has been given*

Place 1 if mother recall TT dos

her recall TT doses*

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

Natividad, Robin Jan

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been

vaccine has been given*

Place 1 if mother recall TT doses*

her recall TT doses*

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

No. of Vaccinated Neonate/Infant f

inated Neonate/Infant from Month 1-30, 2015

Date of Completion: __________________

Detailed Address in Purok

Place 1 if vaccine has been

vaccine has been given*

Place 1 if mother recall TT doses*

her recall TT doses*

Form 2: MASTERLIST OF CHILDREN (0-23 MONTHS OLD)

No. of Vaccinated Neonate/In

ccinated Neonate/Infant from Month 1-30, 2015

San Luis, Aurora

#83 DOH Street