Recording, Consolidation and Reporting of Family Health Care and Services

Chapter 4
Recording, Consolidation and Reporting

of Family Health Care and Services
The FHSIS records and reports the coverage of family health care and services of
individuals at various stages of the life cycle. Family Health Care and Services that
are tracked through the FHSIS encompass the following:
 Family Planning Services

 Maternal Care and Services: Prenatal, Intrapartum and Delivery Outcome,
Postpartum Care
 Adolescent Health Care and Services: these are integrated into the Family
Planning, Maternal Care, Child Care and Oral Health Care
 Newborn Care
 Infant Care
 Child Health Care and Services
 Management of Sick Children
 Oral Health
 Micronutrient Supplementation: Coverage of micronutrient supplementation
for pregnant women and post-partum women is integrated in Maternal Care
and supplementation of children below 5 years old is incorporated in Child
Care
 Deworming Services
 Screening for HIV, syphilis, and Hepatitis B for Pregnant Women
 Laboratory Services: Gestational Diabetes, Complete Blood Count
Given the above family health care and services, Chapter 4 is designed and
structured as follows:
Chapter 4.1 Family Planning Services
Chapter 4.2 Maternal Care and Services
Chapter 4.3 Child Care and Services
Chapter 4.4 Oral Health Care and Services
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Chapter 4.1
Family Planning Services
A. Introduction
The passage of the Responsible Parenthood and Reproductive Health Act of 2012
(RPRH Law) mandated the DOH to lead in crafting the Implementation Rules and
Regulations and to execute its provisions. Executive Order (EO) No. 12 issued in
January 9, 2017 required the monitoring and reporting on the status of its
implementation. In this regard, the DOH issued AO No. 2017-0005 to facilitate the
Achievement of Desired Family Size through Accelerated and Sustained Reduction in
Unmet Need for Modern Family Planning Methods."
The above issuances provide the definition of Unmet Need for Modern Family
Planning (MFP), which refers to couples and individuals who are fecund and sexually
active, and report not wanting any more children or wanting to delay the next
pregnancy but are not using any modern method of contraception. This also includes
traditional users of Family Planning method who desire to shift to modern method.
This resulted to the enhancement and expansion of FP indicators to be monitored

through the FHSIS as reflected in the following FP Metadata. Furthermore, the FP
Reporting System from Hospitals has been designed and pilot-tested. It is believed
that this can now be used nationwide in recording and reporting coverage of FP
services in the hospital setting.
1. New Indicators to be Monitored through the FHSIS

 Proportion of Women of Reproductive Age (WRA) with Unmet Need for
modern FP method
2. Disaggregation of FP Service Indicators
2.1 FP indicators are to be disaggregated by socio-economic status of the
WRA, particularly into NHTS and non-NHTS
2.2 FP service coverage will also be disaggregated into 15 to 19 years old,
and 20 to 49 years old. This is to allow analysis of adolescent health
covering 15-19 years old. It is expected that there may be adolescents
10-14 years old who would need FP services and must be recorded.
3. The 2018 FHSIS MOP provides specific Guidelines for special FP clients and
special circumstances – Section D.
4. The guidelines in recording, collection and reporting of FP service coverage in
hospitals is also introduced in Section G.
5. In the Target Client List of FP Services, the coverage of deworming services
for WRA 20-49 years old are also to be recorded.
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B. Metadata
The following table lists, defines and rationalizes the key indicators on Family Planning Services to be tracked through the FHSIS. The metadata also provides
the formula in computing the indicators, specify the data sources as well as the frequency of measurements.
Source Frequency of
Indicator Definition Formula Target Rationale
of Data Reporting
1. Proportion of Refers to the proportion of women Numerator: < 5.0% Master List of BHS to RHU/MHC: The indicator aims to
Women of of reproductive age 15-49 years Total No. of WRA WRA for FP Monthly show the gap between
Reproductive old who are fecund and sexually with unmet need Services women’s reproductive
Age with Unmet active but are not using any (UN) for modern FP RHU/MHC to P/CHO: intentions and their
Need for modern modern method of contraception. and traditional user TCL for FP Quarterly contraceptive behavior.
FP (MFP) Unmet WRA with unmet need for MFP (TU) Services It is also useful for
Need P/CHO to DOH-RO: tracking progress
includes the following:
Denominator: Quarterly towards achieving
Disaggregation: (1) WRA who decides to limit (who Total estimated no. of universal access to
 By socio- no longer wants to have WRA (Total Pop X DOH-RO to DOH-CO: reproductive health and
economic status another child) or space (who 25.854% WRA) Quarterly services.
- NHTS wants to have another child
- Non-NHTS later) their children but are not Multiplier: 100 For Hospital Report:
 By age group using any modern FP method Community / Municipal /
- 15-19 y/o but expressed their desire to City Hospitals owned by
- 20-49 y/o use modern FP method the city/municipality to
(2) WRA using traditional FP BHS/RHU:
method (rhythm method, Monthly
calendar method, withdrawal
method, herbal) who expressed District/Provincial
their desire to shift to modern Hospitals to PHO:
FP method Monthly
DOH-Retained Hospitals
and Medical Centers to
DOH-RO:
Monthly
Source Frequency of
of Data Reporting
2. Prevalence Rate Refers to the proportion of women Numerator: 2019: TCL for FP BHS to RHU/MHC: Indicates the extent of
for Modern of reproductive age (15-49 years No. of WRA who are 27% Services Monthly people’s conscious effort
Family Planning old) who are using or whose using (or whose and capabilities to
Method (mCPR) partner is using any modern FP partner is using a 2020: RHU/MHC to P/CHO: control their fertility, their
method at a given point in time. modern FP method at 28% Quarterly awareness of
OR a given point in time contraceptive methods,
Modern FP Method: include the 2021: P/CHO to DOH-RO:
29% accessibility and quality
% of WRA using following: Denominator: Quarterly
of RH services. It is
any modern FP 1. Bilateral Tubal Ligation (BTL) No. of WRA who are
2022: DOH-RO to DOH-CO: useful in measuring
Contraceptive or Female Sterilization/ BTL eligible to practice
Method (mCPR) contraception 30% Quarterly utilization of FP
2. Male Sterilization/ Vasectomy
3. intrauterine devices(IUD) (Total Population x methods. Clients’
Disaggregation: 2.1. IUD-interval 25.854%) For Hospital Report: preferences for methods
 By socio- 2.2. IUD-post partum Community / Municipal / and sources is also
economic status 4. Oral pills Multiplier: 100 City Hospitals owned by tracked and related to
- NHTS 4.1. Progestin-Only Pill (POP) the city/municipality to continuation and/or
- Non-NHTS 4.2. Combined Oral BHS/RHU: contraceptive failure
 By age group Contraceptive (COC) Monthly rates. It is a
- 15-19 y/o 5. Injectables complementary output
- 20-49 y/o 6. Implants District/Provincial
indicator to total fertility
7. NFP Methods Hospitals to PHO:
rate.
7.1 Cervical Mucus Method Monthly
(CCM)
7.2 Basal Body Temperature DOH-Retained Hospitals
(BBT) and Medical Centers to
7.3 Symptothermal Method DOH-RO:
(STM) Monthly
7.4 Standard Days Method
(SDM)
7.5 Lactational Amenorrhea
Method (LAM)
Women of Reproductive Age
(WRA): refers to all women aged
15-49 years old
Eligible Population: Refers to

WRA who are at risk of getting
pregnant
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Source Frequency of
of Data Reporting
 sexually active (women who have

had sexual intercourse within 30
days preceding the consultation.-
NDHS)
 fecund
 fertile
and excludes those women who
have undergone:
 hysterectomy
 bilateral salpingo oophorectomy
3. No. of New New Acceptor (NA) refers to the Sum of all WRA who NA TCL for FP BHS to RHU/MHC:
Acceptors ff: are new acceptors of Services Monthly
- client using a contraceptive FP method
Disaggregation: method for the first time or RHU/MHC to P/CHO:
 By type of MFP has never accepted any Quarterly
 By socio- Modern Family Planning
economic status Method OR P/CHO to DOH-RO:
- NHTS - client using FP method but Quarterly
- Non-NHTS was never recorded or has
 By age group never consulted in any health DOH-RO to DOH-CO:
- 15-19 y/o facility Quarterly
- 20-49 y/o
Note: For Hospital Report:
If there are 10-14 years old given Community / Municipal /
MFP with parental consent, these City Hospitals owned by
should be recorded but do not the city/municipality to
report. BHS/RHU:
Monthly
District/Provincial
Hospitals to PHO:
Monthly
DOH-RO:
Monthly
Source Frequency of
of Data Reporting
4. No. of Current Current Users (CU): Refers to Formula for CU at NA TCL for FP BHS to RHU/MHC:
Users FP clients who are presently using End of Month/ Services Monthly
any FP method. These are FP Quarter
clients who have been carried = CU of previous RHU/MHC to P/CHO:
over from the previous months month Quarterly
Disaggregation: after deducting the drop-outs of + New Acceptor of P/CHO to DOH-RO:
 By type of MFP current month and adding the new previous month Quarterly
 By socio- acceptors of the previous month + Other acceptors
economic status and adding the Other Acceptors of present month DOH-RO to DOH-CO:
- NHTS (OA) of the current month. - Drop-out of Quarterly
- Non-NHTS present month
 By age group Other Acceptors include: For Hospital Report:
- 15-19 y/o  Re-starter (RS) Community / Municipal /
- 20-49 y/o  Changing Method (CM) City Hospitals owned by
 Changing Clinic (CC) the city/municipality to
BHS/RHU:
Note: Monthly
To avoid duplication of data,
women who underwent BTL in District/Provincial
hospitals or whose partners Hospitals to PHO:
underwent NSV in hospitals Monthly
should only be reported by the
hospital who performed the DOH-Retained Hospitals
procedure. In the event that the and Medical Centers to
ligated/vasectomized patient visits DOH-RO:
the BHS/RHU for any complaints, Monthly
they shall not be reported by the
BHS/RHU as OA-Changing Clinic.
Only those who received
temporary MFP methods in
hospitals yet followed-up in
BHS/RHU can be reported as OA-
Changing Clinic.
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Source Frequency of
of Data Reporting
5. No. of Drop-outs Drop-outs refers to client who Sum of all MFP users Not TCL for FP BHS to RHU/MHC:
fails to return for the next service who dropped out Applic Services Monthly
Disaggregation: date or had other conditions (e.g. able RHU/MHC to P/CHO:
 By type of MFP BSO, Hysterectomy), she is Quarterly
considered a drop-out. The P/CHO to DOH-RO:
 By socio- Quarterly
service provider should
economic status DOH-RO to DOH-CO:
conduct validation prior to
- NHTS Quarterly
dropping out of the client.
- Non-NHTS
 By age group Note: For Hospital Report:

- 15-19 y/o Pregnant women are considered Community / Municipal /
- 20-49 y/o drop-out. City Hospitals owned by
the city/municipality to
BHS/RHU: Monthly
District/Provincial
Hospitals to PHO:
Monthly
DOH-RO:
Monthly
C. Recording of FP Data
C.1 Master Listing of WRA

Master listing of women of reproductive age (WRA) is an essential process in the
overall delivery of FP services. This will serve as the main reference of the health care
providers in prioritizing those to be visited in order to validate if they have unmet need
for modern FP method, thus to be given information and counselling and appropriate
FP method of their choice. The following are the steps in master listing the WRA.
1. Based on the completed HH Profiles in each barangay (discussed in Chapter

3), the BHS midwife with assistance from the BHWs/NDPs/other volunteer
workers shall summarize all women of reproductive age, 15-49 years old into
the Master List of WRA;
2. Transfer the following information from the accomplished HH Profiles into the
Master List of WRA;
Column 1 HOUSEHOLD (HH) NUMBER. Write the number assigned to a

particular household.
Column 2 NAME OF WRA. Write the first name, middle initial and family name
of the woman.
Column 3 ADDRESS. Write the complete address: Number of house, name of
street, barangay, municipality and province.
Column 4 AGE. Write the age of WRA at her last birthday on the sub- column
corresponding her age.
Column 5 BIRTHDAY. Write the date of birth of the WRA: Month, day and
year.
Column 6 SOCIO-ECONOMIC (SE) STATUS. Indicate under this Column if
the client is an NHTS or Non-NHTS member by writing the
corresponding code.
3. In coordination with POPCOM, the BHS midwife with assistance of the

Barangay Health Workers (BHWs) and other community volunteers including
the NDPs shall visit the WRA recorded in the Master List.
4. Validate if the particular WRA has unmet need for MFP.
5. Note that there are different approaches to establish whether WRA would
have unmet need for FP. However, the following questions are recommended
to validate unmet need for modern FP method:
Column 7 Do you plan to have more children? If the WRA answers “YES,”
ask if (7a) now or (7b) spacing, then check (√) the sub-column
based on the WRA’s answer. If she answers (7c) “NO” place a
check (√) under the column. If Col 7b or 7c is checked, proceed
to next question.
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Column 8 Are you currently using any FP method? This has three sub-
columns. Ask if WRA is currently using any FP method then write
the method used in the corresponding column. (e.g. IUD will be
under “Modern” column 8a, and withdrawal under “Traditional”
column 8b). Check (√) column 8c if not using any FP method. If
WRA is using Traditional (8b) or not using any FP method
(8c), proceed to the next question.
Column 9 Would you like to shift to Modern method? Ask WRA who is
using Traditional method or not using any FP method if she
would like to shift to Modern method then place a (√) under the
sub-column corresponding to the WRA’s answer.
Column 10 WRA with Modern FP (MFP) Unmet Need. Under this column,
classify if the WRA has FP unmet need for modern method by
checking if column 9a is checked
Column 11 Based on the Target Client List for FP, validate if the WRA
accepted a modern FP method or not. Place a check under
column 11a if the WRA did not accept any modern FP method. If
the WRA accepted modern FP method, specify under 11b specific
method and the date when WRA accepted modern FP method.
6. The BHS midwife shall maintain and file the Master List of Women with MFP
Unmet need and update this every quarter based on the HH Profiles also
updated on a quarterly basis.
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Master List of Women of Reproductive Age for Family Planning Services
For the Quarter/Year: _____________________
Barangay: ___________________________ Name of BHS Midwife: _________________________ Date Prepared: ______________
No. HH No. Name of WRA Address Age in Birthday SE Status Do you plan to have If col. 7b & 7c is √, are If col 7b or 7c is WRA Based on TCL on FP,
(FN, MI, LN) Years (MM/DD/YY) more children? you currently using √ and using col. with did WRA accept any
(Place a √) any FP method? 8b or 8c, would MFP modern FP method?
you like to shift Unmet
to Modern Need
method?
(Place a √)
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
15-19 20-49 1: NHTS If Yes, when? No If Yes, whatNot using Yes No (Put √ if No Yes
2: Non- type? any FP (9a) (9b) Col 9a is (11a) (11b)
NHTS Method checked) (Put
Now Spacing Limiting Modern Tradi- (Place a a √) Specify Date
(7a) (7b) (7c) tional √) modern when FP
(8a) (8b) (8c) FP method
Method accepted
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TOTAL
Recommended only for those who do not have their master list to identify WRA with unmet need for Modern Family Planning.
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C.2 Provision of FP Services in the BHS/HCs, RHUs/MHCs Using the FP
Service Record (Form 1)
As the WRA clients seek consult and avail of services from the health facility, they are
initially registered on the Individual Treatment Records (ITR) used by the health
facility in general containing the following basic information:
 Demographic Profile: Complete Name, Address, Age, Birthday, Sex, Religion,

Occupation
 Vital Signs: BP, RR, etc.
 Anthropometric Measurements: weight, height
 Chief Complaint
 Diagnosis, management and treatment
The clients are further assessed using the FP Service Record (Form 1), with a back-
to-back set of information to be obtained on the clients’ condition. Form 1 records the
demographic-socio-economic profile of the client, their medical, obstetrical history as
well as the presence of risks for sexually transmitted infections and violence against
women. It also records the results of physical examination undertaken. At the bottom
of the front page is a space for the signature of the client. The back-side is where the
service provider records the medical findings during each visit, the FP method
accepted and the date of follow-up with the name and signature of the service
provider. As a guide, the service provider shall:
(1) Administer the FP Service Record (Form 1) to every new client seeking
consult and availing services from the health facility;
(2) Ensure that all items in Form 1 are filled-up upon interview or screening
the client;
(3) Collate all accomplished Forms 1 at the end of each day as basis in
accomplishing the Target Client List for FP services;
(4) Maintain the accomplished Forms 1 and use the same to record the results
of the follow up visits of the client to the health facility;
(5) Once the client has been provided with FP services, check in the Master
List of WRA with MFP Unmet Need if she is listed. If Yes, indicate the date
when she consulted the health facility and specify the modern FP method
accepted under Column 11b. If she is not in the original list, include her
name and other information at the bottom of the Master List of WRA with
MFP unmet need.
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C.3 Recording FP Services Provided in the Target Client List
At the end of each day, it is important for the BHS/RHU midwife to transfer the
information to be reported to the next administrative level into the TCL for FP Services.
The Target Client List for FP Services includes all eligible women aged 15-49 years old
and those with spouses/partners who received any FP method from the reporting unit.
These include: (i) Female Sterilization/Bilateral Tubal Ligation (FSTR/BTL), (ii) Male
Sterilization/No-Scalpel Vasectomy, (iii) condom, (iv) pills (POP/COC), (v) injectables
(DMPA/CIC), (vi) Implants, (vii) Intra-Uterine Device (IUD, interval/postpartum), (viii)
NFP-Lactational Amenorrhea Method (NFP-LAM), (ix) NFP-Basal Body Temperature
(NFP-BBT), (x) NFP-Cervical Mucus Method (NFP-CMM), (xi) NFP-Symptothermal
Method (NFP-STM), and (xii) NFP-Standard Days Method (NFP-SDM). The Target
Client List is accomplished by FP Method and updated immediately after a client visits
the facility. There are 13 columns to be filled-up accordingly:
Column 1 DATE OF REGISTRATION. Indicate in this column the date (month,

day and year) an eligible person made the first clinic visit. If client
fails to come back after a year, she must be registered again.
Column 2 FAMILY SERIAL NUMBER. Indicate in this column the number that
corresponds to the number of the family folder/envelope or ITR. This
will facilitate retrieval of client’s record.
Column 3 COMPLETE NAME. Write the first name, middle initial and family
name of the client.
Column 4 COMPLETE ADDRESS. Write the complete address: number of the
house, name of the street, barangay, municipality and province. This
column will help you monitor or follow-up the client.
Column 5 AGE/DATE OF BIRTH. Indicate in this column the age of the client
as of her last birthday. Indicate below the age the date of birth of the
client.
Column 6 SOCIO-ECONOMIC (SE) STATUS. Indicate under this Column if the
client is an NHTS or Non-NHTS member by writing the
corresponding code.
Column 7 TYPE OF CLIENT. Indicate in this column any of the applicable
categories:
Code Type of Client

NA New Acceptors – a client who has NEVER accepted any modern
FP method at any health facility before.
CU Current Users – current users carried over from last month’s Client
List. These also include Other Acceptors (OA) such as:
 Changing Method (CM) – a continuing user who is shifting to
another Method.
 Changing Clinic (CC) – a continuing user using the same
method; however the client is new to the clinic.
 Restarter (RS) – a client who has stopped FP practice for at
least 1 month and has resumed using the same method in the
same clinic.
NOTE: For clients who are changing methods/changing clinic, they

should be recorded as a DROP-OUT from their previous method and
indicate the reason as “CHANGING METHOD/CHANGING CLINIC”.
The client is still categorized as CURRENT USER.
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Column 8 SOURCE. Indicate if the source of FP method/commodities
were from public health facility or private source (e.g. private
hospitals, clinics, pharmacy, etc.)
Column 9 PREVIOUS METHOD. Indicate the type of the last FP method
used prior to accepting the new method. Using the following
codes, add code for NONE to cover “New to Program”.
Codes Methods
FSTR/BTL Female Sterilization/Bilateral Tubal Ligation
MSTR/NSV Male Sterilization/No-Scalpel Vasectomy
CON Condom
PILLS-POP Pills – Progestin Only Pill
PILLS-COC Pills – Combined Oral Contraceptive
INJ Depo-medroxy Progestone Acetate (DMPA) /
Combined Injectables Contraceptives (CIC)
IMP Implants
IUD-I Intra-Uterine Device - Interval
IUD-PP Intra-Uterine Device - Postpartum
NFP-LAM Lactational Amenorrhea Method
NFP-BBT Natural Family Planning-Basal Body Temperature
NFP-CMM Natural Family Planning-Cervical Mucus Method
NFP-STM Natural Family Planning-Symptothermal Method
NFP-SDM Natural Family Planning-Standard Days Method
Column 10 FOLLOW-UP VISITS. This column has twelve (12) sub-

columns representing each month of the year. Write in each
sub-column 2 entries; in the upper space is the scheduled date
of visit and at the lower space is the actual date of visit. A
client who is scheduled for a particular month and failed to
make the clinic visit will only have one date entered in that
particular month.
Column 11 DROP-OUT. Write the date client has been dropped from the
TCL based on the following method.
The following are the definitions for each method drop-out :
a. Pill A client is considered drop-out from the method if

she:
 fails to re-supply from the last 21 white pill up
to the last brown pill (if the pills have a set of
brown tablets/iron); or within seven (7) days
 gets supply or transfers to another provider or
clinic. in this case, the client is listed under the
Other Acceptor (“Changed Clinic”) in the clinic
where she transferred and a drop-out in her
former clinic.
 decides to stop the use of pills for any reason
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Note: The service provider should undertake a follow-
up visit of the client during the above period before
dropping her from the method.
b. Injectables A client is considered a drop-out if she:

 fails to visit the clinic on the scheduled date of
visit up to the last day of 4 weeks (for DMPA –
every 3 months) after the scheduled date of
visit
 fails to visit the clinic on the scheduled date of
visit up to the last day of 2 weeks (for NET-EN
– every 2 months) after the scheduled date of
visit
 gets supply or transfers to another provider.
The client is listed under the Other Acceptor
(“Changed Clinic”) in the clinic where she
transferred and a drop-out in her former clinic
 stops receiving injection for any reason
Note: the service provider should undertake a follow-
up visit within this above period before dropping her
from the method.
c. IUD A client is considered a drop-out if she:

 decides to have the IUD removed
 has expelled IUD that was not re-inserted
 did not return on the scheduled date of follow-
up visit within three (3) to six (6) weeks after
insertion
 If the client has not followed up for 2 years
after initial follow-up visit
Note: Follow-up of the client within the week of the
scheduled visit should be done before dropping her
out from the method
d. Condom A client is considered a drop-out if he/she:

 fails to return for re-supply on scheduled visit
 gets supply from another clinic (change clinic)
 decides not to use condom for any reason.
e. LAM A client is considered a drop-out if she does NOT

fulfill ANY of the following criteria:
 Mother has no menstruation or amenorrheic
within six months. Spotting or bleeding during
the last fifty-six (56) days postpartum is not
considered return of menses.
Fully/exclusive breastfeeding means
 No other liquid or solid except breast milk is
given to the infant,
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 Intervals should not exceed four (4) hours
during the day and six (6) hours at night.
 Baby is less than six (6) months
f. NFP For Standard Days Method – A client is considered a

drop-out if she:
 fails to return on the follow-up date to
check on the proper use of the method
 if the client fails to identify her own fertile and
infertile periods
 if the user has no indication of SDM use
through beads or no knowledge of first day of
menstruation or cycle length
 decides to stop the use of the method
Note: The service provider should undertake a follow-
up visit during the above period prior to dropping her
out from the method.
For BBT/Billing’s/ Symptothermal Method – A client is
considered a drop-out if client:
 fails to return on the follow-up date to check
on the correct charting and/or the proper use
of the method
 fails to identify her own fertile and infertile
periods
 decides to stop the method
Note: Client is given a period of time (2 months) as a
learning user to practice correct charting with
assistance before recording the client as a new
acceptor. A new acceptor is considered if the client
can identify and chart her fertile and infertile period
correctly.
An autonomous user can be considered a Current
User as these clients no longer need assistance in
charting from the health workers.
g. BTL A client is considered drop-out if she:

 reaches the age of 50 years
 reaches menopause
 underwent procedure like hysterectomy or
bilateral salpingo-oophorectomy
Note: The service provider should undertake a
follow-up visit during the above period prior to
dropping her out from the method.
h. Implants A client is considered a drop-out if she did not return

to the facility 3 years after the implant insertion for
removal and replacement of the implant rod.
Note: The service provider should undertake a
follow-up visit during the above period prior to
dropping her out from the method.
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Column 12 REMARKS / ACTIONS TAKEN. Indicate in this column the
date and reason for every referral MADE to other clinic and
referral RECEIVED from other clinic which can be due to
medical complications or unavailable family planning services
and other pertinent findings significant to client care.
Column 13 DEWORMING DRUGS GIVEN TO 20-49 YEARS OLD WRA.

Indicate the number of women of reproductive age 20-49 years
old who were given 2 doses of deworming tablet.
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NAME OF BARANGAY/RHU : ________________________

MUNICIPALITY : ________________________
PROVINCE/CITY : ________________________
REGION : ________________________
TARGET CLIENT LIST FOR FAMILY PLANNING SERVICES
No. Date of Family Serial No. Complete Name Complete Address Age/ Date of SE Status Type of Client* Source** Previous Method***
Registration (FN, MI, LN) Birth 1 - NHTS
(mm/dd/yy) 2 - Non-NHTS
(1) (2) (3) (4) (5) (6) (7) (8) (9)
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* Type of Client: *** Previous Method: **** Reas

NA = New Acceptors FSTR/BTL = Female Sterilization/Bilateral tubal ligation NFP-LAM = Lactational Amenorrhea Method A = Preg
CU = Current Users MSTR/NSV = Male Sterilization/No-Scalpel Vasectomy NFP-BBT = Basal Body Temperature B = Desi
OA = Other Acceptors CON = Condom NFP-CMM = Cervical Mucus Method C = Med
CU-CM = Changing Method Pills-POP = Progestin Only Pills NFP-STM = Symptothermal Method D = Fear
CU-CC = Changing Clinic Pills-COC = Combined Oral Contraceptives NFP-SDM = Standard Days Method E=
CU-RS = Restarter INJ = DMPA or CIC NONE or New Acceptor F = Husb
IMP = Single rod sub-thermal Implant G = Men
** Source: IUD-I = IUD Interval H = Lost
Public IUD-PP = IUD Postpartum
Private
55
56
TARGET CLIENT LIST FOR FAMILY PLANNING SERVICES

FOLLOW-UP VISITS DROP-OUT Remarks/ Deworming Drugs Given to 20-49 years
(Upper Space: Schedule Date of next visit / Lower Space: Actual Date of Visit) Actions Taken old WRA
(10) (11) (12) (13)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Date Reason**** Date 1st Date 2nd Status
dose given dose given Check (√) if
given 2 doses
**** Reasons:
A = Pregnant I = Failed to get supply For LAM:
B = Desire to become pregnant J = Change Method A - Mother has a menstruation or not amenorrheic within 6 months OR
C = Medical complications K = Underwent Hysterectomy B - No longer practicing fully/exclusively breastfeeding OR
D = Fear of side effects L = Underwent Bilateral Salpingo-oophorectomy C - Baby is more than six (6) months old
E = Changed Clinic M = No FP Commodity
F = Husband disapproves N = Unknown
G = Menopause O = Age out for BTL
H = Lost or moved out of the area or residence
D. Guidelines in Recording and Reporting Special FP Clients
D.1 Reporting Clients who are purchasing their own FP commodities
a. Follow - up the client. Clients should be encouraged to have at least one (1)
visit to the BHS/RHU or have at least one (1) check-up during home visit to
be reported. It is important that the BHS/RHU conduct an Informed Choice
and Voluntarism (ICV) assessment and administer the FP Service Record
(Form 1) as basis for reporting.
b. Since client was never recorded in any public facility, she should be
considered as New Acceptor (NA) after 1 month from the day of visit. RHU
midwife must follow-up if she continues to use the FP Method.
D.2 Reporting IUD Clients who obtained FP service outside catchment area
Reporting of FP services provided by other public health facilities outside the

catchment area of the midwife (e.g. IUD clients from another barangay was served by
a trained provider outside the catchment barangay).
a. The facility which provided the FP service should be the one reporting the
client as a new acceptor.
b. The facility who provided the service shall issue a referral to the BHS/RHU
where the client resides to ensure continuum of care.
c. The BHS/RHU where the client resides will record the client in the TCL but
will not be reported.
d. In the following reporting period however, the client will be dropped from the
health facility which provided the initial service and report the client as OA-
CC provided that the BHS/RHU has conducted a follow up visit and found
the IUD still intact.
D.3 Reporting FP clients 50 years old and above
If a woman 50 years old and above who has been assessed by a health service
provider is still regularly menstruating and decided to use any modern FP method
after counselling:
a. Provide her the FP method/commodities of choice
b. Record the client in the TCL for FP services but not as a Current User as she
is already outside the reproductive age.
57
c. Put this condition “above 49 years old” under the REMARKS Column in the
TCL for FP Services
D.4 Reporting FP clients less than 15 years old

a. Record in the FP TCL any FP client less than 15 years old. However, do not
include them in the report.
b. Place under the Remarks Column “less than 15 years old.”
D.5 Reporting FP male clients using condom or who have undergone

vasectomy
a. In recording FP services involving male clients, it is always the female spouse/

partner that are recorded in the TCL for FP Services. This is in the case of
condom users and those that have undergone vasectomy.
b. It is assumed that a male FP user (condom, vasectomy) has a partner,

whether married or not. The wife/partner will be the one recorded in the TCL
for FP Services.
c. If the male FP client has multiple partners, record the names of the female
partners in the TCL for FP Services of the particular barangay/s where each
resides. If they reside in the same barangay, then both should be recorded in
the TCL for FP Services of that particular barangay.
d. Write the name of the male partner under the REMARKS Column in the TCL
for FP Services.
D.6 Dropping female partners of vasectomy/condom-user clients
a. Follow the same criteria for dropping women who underwent BTL.
b. Consider the female partner of the male client who underwent vasectomy as
drop-out once she reaches the age of 50 as a drop-out.
c. Also consider the female FP clients as drop-out once she has undergone
surgical menopause or early menopause.
d. Woman whose husband/partner has undergone vasectomy or was using

condom but is already deceased, consider the woman as drop-out.
e. Place under the REMARKS Column the FP female as “more than 49 years
old” or “has underwent surgical menopause” or “had early menopause.”
58
D.7 Recording FP clients reached through NGOs/Civil Society Organization
in partnership with the DOH
a. The MOA between DOH and the NGO/CSO stipulates that FP commodities
will be given free but they should administer and fill up the FP Service Record
(Form 1);
b. The NGO/CSO shall give the accomplished FP Services Record (Form 1) to

the nearest RHU/BHS where the client resides;
c. The nearest BHS/RHU shall record the FP client in the TCL for FP Services;
but the NGO/CSO must submit a separate Monthly Report (M1) to the public
facility to distinguish private sector performance relative to RHU/HC
performance
d. Advise the FP client to have her follow-up check-up and resupply of FP

commodities from the BHS/RHU where the FP Form 1 has been forwarded.
D.8 Reporting LAM users

a. Get the number of LAM users from the TCL for FP Services rather than from
the TCL for Post-Partum Care.
b. Follow the given criteria for LAM users, as stated in Section C.3, Column 11 E.
E. Consolidating the FP Program Accomplishment/Service

Coverage in each Barangay
E.1 Using the Summary Table on FP services at the Barangay Level

The Summary Table on FP Program Accomplishment is intended to record FP data in
the facility to facilitate the capture and recall of data.
a. The first column lists the FP Program indicators being tracked in your health
facility;
b. Place under the second column. Target the targets of your health facility for
each indicator at the start of the year. Consult the supervising nurse for the
number to be entered under this column;
c. Under each succeeding monthly columns, record the number corresponding to

each indicator for the month;
d. Under each quarter columns, write the total number of each target rendered
with the services for the 3-month period.
59
E.2 Using the Monthly Consolidation Table (MCT) at the Municipal/City
Level
The supervising nurse/FHSIS Coordinator in the C/MHO records all FP data from all
barangays into the Monthly Consolidation Table (MCT). This becomes the source
document of the nurse in coming up with the quarterly report on FP at the
municipal/city level. The same MCT shall serve as the Output Table of the M/CHO as
it already contains the listing of all FP indicators by barangay.
a. The first column lists all the FP Program indicators being tracked by your LGU;
b. The rest of the columns are intended for each of the barangays covered by the
municipality/city. Write the name of each barangay per column;
c. On a monthly basis, transfer the data pertinent to each FP indicator by

barangay using the Barangay Summary Table as a source;
d. Use this to prepare the monthly and quarterly report to be submitted to the
next administrative level.
60
SUMMARY TABLE FOR BARANGAY FOR
FAMILY PLANNING SERVICES
NAME OF BARANGAY : ___________________
NAME OF BHS : ___________________
MUNICIPALITY : ___________________
PROVINCE/CITY : ___________________
REGION : ___________________
61
62
Jan Feb Mar 1st Qtr Apr May June 2nd Qtr July Aug Sep 3rd Qtr Oct Nov Dec 4th Qtr TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
1. No. of WRA with Unmet
Need for MFP - Total
NHTS
Non-NHTS
2. Current Users Beginning -
Total
► Female Sterilization (BTL)
- Total
NHTS
Non-NHTS
► Male Sterilization (NSV)
- Total
NHTS
Non-NHTS
► Condom – Total
NHTS
Non-NHTS
► Pills (POP & COC)- Total
NHTS
Non-NHTS
► Pills-POP - Total
NHTS
Non-NHTS
► Pills-COC - Total
NHTS
Non-NHTS
► Injectables (DMPA/CIC)
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
► IUD (I & PP)- Total
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
► NFP-BBT – Total
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
► NFP-STM – Total
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
3. Total New Acceptors -
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
63
64
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
4. Total Other Acceptors
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
65
66
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
5. Total Drop-outs
- Total
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
67
68
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
6. Total Current Users End
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
7. WRA, 20-49 years old
given 2 doses of
deworming drugs - Total
NHTS
Non-NHTS
69
70
MONTHLY CONSOLIDATION TABLE FOR

FAMILY PLANNING SERVICES
NAME OF RHU / HEALTH CENTER : _________________

MUNICIPALITY OF : _________________
PROVINCE / CITY : _________________
REGION : _________________
Brgy 1 Brgy 2 Brgy 3 Brgy 4 Brgy 5 Brgy 6 Brgy 7 Brgy 8 Brgy 9 Brgy 10 Brgy 11 Brgy 12 Brgy 13 Brgy 14 Brgy 15 Brgy n TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
1. No. of WRA with Unmet
Need for MFP - Total
NHTS
Non-NHTS
2. Current Users Beginning -
Total
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
71
72
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
3. Total New Acceptors -
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
73
74
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
4. Total Other Acceptors
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
5. Total Drop-outs
- Total
NHTS
Non-NHTS
75
76
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
6. Total Current Users End
- Total
NHTS
Non-NHTS
- Total
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
NHTS
Non-NHTS
77
78
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
TOTAL
INDICATORS TARGET
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
15-19
20-49
- Total
NHTS
Non-NHTS
► Implant - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► IUD-I - Total
NHTS
Non-NHTS
► IUD-PP - Total
NHTS
Non-NHTS
► NFP-LAM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-CMM - Total
NHTS
Non-NHTS
NHTS
Non-NHTS
► NFP-SDM - Total
NHTS
Non-NHTS
7. WRA, 20-49 years old
given 2 doses of
deworming drugs - Total
NHTS
Non-NHTS
F. Reporting Service Coverage
F.1 Monthly FP Program Accomplishment Report (M1)
The Monthly Program Accomplishment Report is prepared by the midwife at the

barangay level. The midwife fills up the Form to report the FP Program
accomplishments from the first day to the last day of the month. She submits this to
the nurse at the RHU/MHC for consolidation. The Form is divided into three sections
with corresponding set of indicators to be reported:
Section A1. Modern FP Unmet Need
This Section contains the report on FP unmet need, categorized by age 15-19 and
20-49 years old as well as by socio-economic status (SES).
Column 1 Lists the indicator to be tracked and reported which is the Proportion of
WRA with modern FP Unmet Need
Column 2 Indicate the number of WRA with FP unmet need according to age group:
(15-19 years old or 20-49 years old) and socio-economic status (either
NHTS or Non-NHTS).
Column 3 Provide a total of both NHTS and non-NHTS women age 15-19 years old
and 20-49 years old who have unmet need for modern FP.
Section A2. Use of FP Method
Column 1 Listed in this column are the different FP Methods

Column 2 Current Users (Beginning Month). Write on the space provided the
total number of FP clients who have been carried over from previous
month.
Column 3 New Acceptors of previous month. Write on the space provided the
number of new acceptors from previous month.
Column 4 Other Acceptors of present month. Write on the space provided the
number of clients who had Changed Method, Changed Clinic and
Restart.
Column 5 Drop-outs of present month. Write on the space provided the number
of clients who dropped-out during the month.
Column 6 Current Users (End of Month). Write on the space provided the total
number of FP clients who have been carried over from the previous
month after deducting the drop-outs of the present month, adding the
new acceptors of the previous month and adding the other acceptors
(RS, CC, CM). This consists of CU for pills, IUD, injectables, condom,
NFP (BBT, CMM, STM, SDM and LAM), female sterilization/BTL, male
sterilization/NSV and implants.
79
Note: In preparing the monthly report for this portion, the midwife in the
BHS/Barangay will prepare the monthly data only.
Calculation sample for Month of February Report:
Current users from the previous month (Jan 2019) 29

+ New Acceptors previous month (Jan 2019) +6
+ Other Acceptors of the present month (Feb 2019) +4
- Drop-outs present month (Feb 2019) - 2
= Current Users ending month of Feb 2019 = 37
Calculation of the Current Users
 Current Users Beginning Month (ex. February)

Formula: Just carry over the CU End data of previous month (January)
 New Acceptors (ex. February)

Formula: Count Total No. of New Acceptors for the month of January
in the TCL/Summary Tables
 Other Acceptors (ex. February)

Formula: Count Total No. of Other Acceptors for the Month of
February in the TCL/Summary Tables
 Current Users Ending Month (ex. February)
Calculation:
Current users from the previous month (Jan)
+ New Acceptors (previous month) (Jan)
+ Other Acceptor (current month) (Feb)
- Drop-outs (current month) (Feb)
= Current User of ending month (Feb)
Example. Calculation for the Month of January to March
Given: New Acceptors for the Month of December = 8

Month CU Beg Month New Other Drop-outs CU
Acceptors Acceptors End. Month
January 15 6 7 1 29= (15+8+7-1)
February 29 3 4 2 37= (29+6+4-2)
March 37 8 9 5 44= (37+3+9-5)
Column 7 New Acceptors of the present month. Using a family planning method
for the first time or a client who has never accepted any modern family
planning method at any clinics before (new to the program). It includes
new acceptors for pills, IUD, injectables, condom, NFP (BBT, CMM,
STM, and SDM), LAM, implants, Female Sterilization/BTL and Male
Sterilization/NSV.
80
Section A3. Deworming Services
Column 1 Listed in this Column is the indicator – number of women 20-49 years old
given 2 doses of deworming drugs.
Column 2 Write under this Column the number of WRA 20-49 years old given 2
doses of deworming drugs who are members of the NHTS HHs and
those who are not NHTS.
Column 3 Provide a total of both NHTS and non-NHTS women 20-49 years old who
were given deworming drugs.
F.2 Quarterly Program Accomplishment Report (Q1)
The Quarterly Form is the official health report of the municipality/city for the quarter.
It contains the consolidated three-month reports from all the BHSs and RHU/MHC
during the quarter. The PHN forwards this report to the Provincial/City FHSIS
Coordinator at the PHO/CHO every third week of the first month of the succeeding
quarter for provincial/city consolidation. The municipality/city prepares only one
quarterly report. In case there is more than one RHU/MHC in the municipality/city,
the MHO/CHO shall be responsible for directing the consolidation of all the quarterly
data from different RHUs/MHCs and the preparation of one Quarterly Form for the
municipality/city. The FP Program Accomplishment Report for the quarter has three
sections.
Section A1. Modern FP Unmet Need
Column 1 Listed in this column is the indicator on unmet need for modern FP.
Column 2 Indicate the number/percent of WRA with modern FP unmet need
(Indicator 1) by age group: 15-19 years old OR 20-49 years old and by
socio-economic status – NHTS or non-NHTS.
Column 3 Provide the total of WRA 15-19 years old and 20-49 identified with unmet
need for modern FP and the estimated number of WRA.
Column 4 Write your analysis/interpretation of the data on this space.
Column 5 Write any recommendation or actions that need to be undertaken under
this Column.
81
Section 2. Use of FP Method
Column 1 Listed in this column are the different FP Methods

Column 2 Current Users (Beginning of Quarter). Write on the space provided the
total no. of FP clients who have been carried over from previous quarter.
Column 3 New Acceptors (End of Quarter). Write on the space provided the
number of new acceptors for the end of the quarter.
Column 4 Other Acceptors (End of Quarter). Write on the space provided the
number of clients who had Changed Method (CM), Changed Clinic (CC)
and the Restarters (RS).
Column 5 Drop-outs (Present Quarter). Write on the space provided the number
of clients who dropped-out during the quarter.
Column 6 Current Users (End of Quarter). Write on the space provided the total
number of FP clients who have been carried over from the previous
quarter after deducting the drop-outs of the present quarter, adding the
new acceptors and other acceptors (RS, CC, CM) of the present quarter.
This consists of CU for pills, IUD, injectables, condom, NFP (BBT, CM,
STM, SDM and LAM), female sterilization, male sterilization and implants.
 Current Users Beginning Quarter (ex. First Quarter)

Formula: Just carry over the CU data at the start of the First
Quarter (January)
 New Acceptors (ex. First Quarter)

Formula: Count Total No. of New Acceptors for the First Quarter
(December Previous Year to February Current year) from the
TCL/Summary Tables
 Other Acceptors (ex. February)

Formula: Count Total No. of Other Acceptors for the First Quarter
(January to March) in the TCL/Summary Tables
 Drop-outs (ex. February)

Formula: Count Total No. of Drop-outs for the First Quarter
(January to March) in the TCL/Summary Tables
 Current Users End of Quarter (ex. First Quarter)

Formula: Carry over the CU end of the month data from the last
month of the Quarter (March) for First Quarter
82
ILLUSTRATIVE TABLE:
SAMPLE REPORTING CURRENT NEW OTHER DROP- CURRENT NEW

COMPUTATION PERIOD USERS END ACCEPTORS ACCEPTORS OUT USERS ACCEPTOR
S FOR THE M1S OF OF PREVIOUS OF OF END OF S OF
AND Q1S PREVIOUS MONTH CURRENT CURRE CURRENT CURRENT
MONTH MONTH NT MONTH MONTH
(BEGINNIN MONTH
G OF
CURRENT
MONTH)
Dec-2018 100 10 15 5 120 12
M1 for Jan Jan-2019 120 12 (NA of Dec) 20 7 145 15

M1 for Feb Feb-2019 145 15 (NA of Jan) 15 10 165 20
M1 for March Mar-2019 165 20 (NA of Feb) 17 8 194 17
Q1 for 1st Q1 120 47 52 25 194
Quarter
FPCU end of March 2019:

= FPCU end of Dec 2018/or Beginning of Jan 2019 + NA (previous month) + OA – DO
= 120 + 47 + 52 – 25 = 194 FPCU end of March 2019
Note that your end of March report is equivalent to your end of 1st quarter report in the case of
FP Current Users reporting, given that FPCU is a “status” indicator, implying that those that we
are reporting are active FP current users
Column 7 New Acceptors of the Last Month of the Present Quarter. Women
using FP method for the first time or a client who has never accepted any
modern FP method at any clinics before (new to the program). It includes
new acceptors for pills, IUD, injectables, condom, NFP (BBT, CM, STM,
and SDM), LAM, implants, Female Sterilization/BTL and Male
Sterilization/NSV.
Note that the NA is being reported a month after. New acceptors of the
present quarter is equal to the new acceptors of the past three months,
thus, if we are computing for the:
 NA of the 1st Quarter of 2019 = NA of Dec 2018+ NA of Jan 2019

+ NA of Feb 2019
 NA of 2nd Quarter of 2019 = NA of March 2019 + NA of April 2019
+ NA of May 2019
 NA of 3rd Quarter of 2019 = NA of June 2019 + NA of July 2019 +
NA of August 2019
 NA of 4th Quarter of 2019 = NA of September 2019 + NA of
October 2019 + NA of November 2019
Column 8 CPR. This is computed by dividing the Current Users End of Quarter
(Column 6) by the Total Population x 25.854%
Column 9 Interpretation. Write your analysis/interpretation of the data on this
space.
Column 10 Recommendations/Actions to be Taken. Write any recommendation or
actions that need to be undertaken on this space.
83
Section 3. Deworming Services
Column 1 Listed in this column is the indicator of the number and proportion of
women 20-49 years old given 2 doses of deworming drugs and estimated
number of WRA 20-49 years old
Column 2 Disaggregate the number of WRA 20-49 years old given 2 doses of
deworming drug by their socio-economic status, NHTS or Non-NHTS
Column 3 Provide the totals for 20-49 years old, NHTS and Non-NHTS
Column 4 Write your analysis/interpretation of the data under this Column
Column 5 Write any recommendation or actions that need to be undertaken under
this Column.
Note that the M1 and Q1 Reports on Family Planning and

Deworming for Women of Reproductive Age (Section A) will
be submitted by the Health Facility FHSIS Staff together with
the other M1 and Q1 Reports on other Public Health Programs
84
FHSIS REPORT for the MONTH: _______________
YEAR: ________
Name of Barangay:
Name of BHS:
Name of Municipality/City:
BRGY
Name of Province:
Projected Population of the Year: ______________________________
For submission to RHU/MHC
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total A3. Deworming Services SES Total
(Col. 1) (Col. 2) (Col. 3) (Col. 1) (Col. 2) (Col. 3)

Non-
15-19 20-49 NHTS
NHTS
1. No. of WRA with unmet 1. No. of women 20-49 years old given 2 doses of
need for modern FP - Total deworming drugs - Total
• NHTS
• Non-NHTS
A2. Use of FP Method Current User Acceptors Dropout Current User New Acceptors
(Beginning Month) New Acceptors Other Acceptors (Present Month) (End of Month) of the present
(Previous Month) (Present Month) Month
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) (Col. 7)
15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total
a. Female Sterilization/ BTL -
Total
• NHTS
• Non-NHTS
b. Male Sterilization/ NSV-Total
• NHTS
• Non-NHTS
c. Condom - Total
• NHTS
• Non-NHTS
d. Pills - Total
• NHTS
• Non-NHTS
85
86
d.1 Pills-POP - Total
• NHTS
• Non-NHTS
d.2 Pills-COC - Total
• NHTS
• Non-NHTS
e. Injectables (DMPA/ POI) -
Total
• NHTS
• Non-NHTS
f. Implant - Total
• NHTS
• Non-NHTS
g. IUD (IUD-I and IUD-PP) -
Total
• NHTS
• Non-NHTS
g.1 IUD-I- Total
• NHTS
• Non-NHTS
g.2 IUD-PP - Total
• NHTS
• Non-NHTS
h. NFP-LAM - Total
• NHTS
• Non-NHTS
i. NFP-BBT - Total
• NHTS
• Non-NHTS
j. NFP-CMM - Total
• NHTS
• Non-NHTS
k. NFP-STM - Total
• NHTS
• Non-NHTS
l. NFP-SDM - Total
• NHTS
• Non-NHTS
m. Total Current Users
• NHTS
• Non-NHTS
87
88
Q1
FHSIS REPORT for the QUARTER ________ YEAR: _______
Name of Municipality/City:
Name of Province:
RHU
Projected Population of the Year: _________________________________
For submission to PHO/CHO
Section A. Family Planning Services and Deworming for Women of Reproductive Age
A1. Modern FP Unmet Need Age Total Interpretation Recommendation / Action Taken
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5)
15-19 20-49
1. Proportion of WRA with unmet need for modern FP

(No.1.1/No.1.2 X 100)
• NHTS
• Non-NHTS
1.1 Number of WRA with unmet need for MFP
• NHTS p
• Non-NHTS
1.2 Total No. of Estimated WRA
(Total Population X 25.854%)
• NHTS
• Non-NHTS
A2. Family Planning Method Current Users Acceptors Drop-outs Current Users New Acceptors CPR Interpretation Recommenda
(Beginning of Qtr) New (end of Qtr) Other (end of Qtr) (Present Quarter) (End of Quarter) (Last Month of Col. 6/TP x 25.854% tions/Actions
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) (Col. 9) to(Col.
be Taken
10)
15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total 15-19 20-49 Total
a. Female Sterilization/ BTL
-Total
• NHTS
• Non-NHTS
b. Male Sterilization/ NSV-Total
• NHTS
• Non-NHTS
c. Condom - Total
• NHTS
• Non-NHTS
d. Pills - Total
• NHTS
• Non-NHTS
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) (Col. 9) (Col. 10)
d.1 Pills-POP - Total
• NHTS
• Non-NHTS
d.2 Pills-COC - Total
• NHTS
• Non-NHTS
e. Injectables (DMPA/ POI)
- Total
• NHTS
• Non-NHTS
f. Implant - Total
• NHTS
• Non-NHTS
g. IUD (IUD-I and IUD-PP) -
Total
• NHTS
• Non-NHTS
g.1 IUD-I- Total
• NHTS
• Non-NHTS
g.2 IUD-PP - Total
• NHTS
• Non-NHTS
h. NFP-LAM - Total
• NHTS
• Non-NHTS
i. NFP-BBT - Total
• NHTS
• Non-NHTS
j. NFP-CMM - Total
• NHTS
• Non-NHTS
k. NFP-STM - Total
• NHTS
• Non-NHTS
89
90
(Col. 1) (Col. 2) (Col. 3) (Col. 4) (Col. 5) (Col. 6) Present Qtr) (Col. 7) (Col. 8) (Col. 9) (Col. 10)
l. NFP-SDM - Total
• NHTS
• Non-NHTS
2. Total Current Users
• NHTS
• Non-NHTS
A3. Deworming Services
Recommendations /
Deworming Services NHTS Non-NHTS Total Interpretation
Actions to be Taken
1. Number of WRA 20 – 49 years
old given 2 doses of deworming
drugs - Total
1.1. Total Population X 20.914%
2. Proportion of WRA 20-49 years
old given 2 doses of deworming
tablet
(No. 1/No. 1.1)
G. Family Planning Service Coverage in Hospitals
G.1 Family Planning Performance Reporting in the Hospital
The Department of Health (DOH) recognizes the need to strengthen the provision of
family planning (FP) services in all public and private hospitals to ensuresuccessful
implementation of the Responsible Parenthood/Reproductive Health Law. This
approach supports the effective operationalization of Executive Order No. 12, entitled
“Attaining And Sustaining “Zero Unmet Need For Modern Family Planning” Through
The Strict Implementation Of The Responsible Parenthood And Reproductive Health
Act, Providing Funds Therefor, And For Other Purposes.”
Given the increasing number of clients seeking FP services from hospitals, the DOH
establishes the recording and reporting system to systematically captureand tracktheir
FP performance in line with the provisions of DOH Memo 2014-0312 and the
guidelines of the Field Health Services Information System. Facilitating the systematic
recording and reporting of FP performance of hospitals through the use of the Guide
will help the health sector in properly accounting for the overall contribution of
hospitals in achieving zero unmet need for modern family planning. To date, forty
public hospitals have been using the Guide as reference and have found it useful in
recording FP performance and in producing the required reports.
G.2 Recording of FP Services in the Hospital
Recording Tools:
1. LIST OF POTENTIAL FP CLIENTS. Different hospital departments may

encounter potential FP clients in their daily provision of services. Each
Department (including, among others, the OPD, OB Ward, and Pedia) will
identify and maintain a daily list of potential FP clients which will be forwarded
to the FP point person every afternoon for consolidation. The list will include
clients who may have expressed intention to use an FP method but have not
yet been provided with either information or services, and clients who may
have been provided with initial information through group information-giving
but have not yet been provided with actual FP services. This Potential FP
Client List contains the following information: Name of Client, Age, Sex,
Gravida/Para or G/P (for female clients), address and contact number. This list
is vital in capturing all potential FP clients who should be scheduled for one-
on-one counseling bythe FP point person either immediately or before the
patients’ discharge.
2. FP FORM 1(Version 3.0). Once the client has undergone one-on-one

counseling and has accepted a method, the provider will generate critical
information and fill out FP Form 1. For FP the FP Form 1 or FP Record shall
serve as the Individual Treatment Record (ITR). This is a two-page form with
the front page divided into five sections, namely, medical history, obstetrical
history, assessment of risk for STI, assessment of risk for violence against
women (VAW), and physical examination. It likewise includes socio-
demographic information (client’s personal data, type of acceptor and FP
method used) and an acknowledgment section with the client’s signature
signifying that the client has been counseled). This record will be maintained
by the hospital for all FP acceptors seen.
3. PARENTAL CONSENT– To ensure compliance with Sections 4.06 and 4.07

of the Implementing Rules and Regulations of the Responsible
91
Parenthood/Reproductive Health (RP/RH) Law, clients below 18 years old
must secure a written consent from their parents/guardians prior to availing of
any FP method from the hospital.
4. HOME-BASEDFP CLIENT CARD (Reference: DOH Department Memo

2014-0312 on FP in Hospital). After filling out the FP Form 1, the client will be
issued an FP Client Card. This card serves as the FP service card of the
client, which s/he will need to bring every time s/he seeks any FP service from
any facility. It contains the following information: client’s name, client’s ID
number, age, client contact number, date of client visit, FP service provided,
date of expected follow-up or next service date, name of the facility which
rendered the service and name/signature of the service provider. It likewise
includes the client’s G/P and indicates whether or not the client belongs to a
priority household as identified using the National Household Targeting
System (NHTS). It also contains the name and address of the hospital that
issued the card.
5. HOSPITAL FP CLIENT RECORD (Patterned after the FHSIS FP-TCL). The

HFPCR serves many uses. First, it helps the FP Point Person or the FP
service provider to record, plan, and provide patient care and FP services
(including FP counseling provided to patients). This makes the job of the FP
Point Person/Team or the supporting midwives/nurses in the hospital’s FP
clinic easier in monitoring service delivery to clients in general. The primary
advantage of maintaining the HFPCR is that the FP Point Person/Team need
not have to keep referring to the ITRs/or FP Form 1 to review individual
patient information to monitor and track overall data on patient treatment or
services to beneficiaries. It already provides the consolidated information per
FP client. The HFPCR will allow the FP Point Person/Team to systematically
organize, plan and document FP service performance monthly, quarterly and
annually. It serves as the source document for the official FHSIS reports that
need to be submitted by the hospital to either the DOHRO (in the case of
regional hospitals) or the PHO/CHO (in the case of provincial/city hospitals,
district hospitals or community hospitals).
Given the new role of the hospitals in FP service provision, the HFPCR is
expected to facilitate the monitoring and supervision of FP service delivery
activities in the hospitals and to accurately report services delivered in the
hospitals or during mobile outreach service provision. The HFPCR will contain
the following information:
• Date of Registration
• Name of the Client
• Address
• Classification of the Client as NHTS or non-NHTS
• Age/ Birthdate
• Sex
• Gravida/Para (G/P)
• Date of FP Counseling Prior to Final Acceptance
• Classification for the Type of Client
• Previous Method used
• Follow-up Visits
• Drop-outs
• Remarks/ Action Taken
92
Important Considerations in Recording and Reporting Clients in the HFPCR:
In the use of the patient FP Client Card and the HFPCR, it is important to clarify how
the recording and reporting will proceed for clients who permanently or temporarily
seek services and acquire commodities from a different facility or hospital. Three
types of clients would normally be provided services by the hospital (and must be
clearly determined by the FP Point Person/Team)
Type 1 Clients: These are new FP clients who decided to secure and regularly seek
FP services from the hospital and will be continuously recorded and reported by the
hospital under the HFPCR:
 These clients will be continuously recorded by the hospital as current users in

the HFPCR unless they drop-out, decide to transfer, or reach the age of 50
and above.
 These clients will initially be recorded in the HFPCR as either OTHER
ACCEPTORS (if they already used a previous method) or NEW ACCEPTORS
(NA) if they received FP services for the first time and will be accounted for as
FP CURRENT USER (continuing user) during the next reporting month.
 Clients aged 49 and below that were provided with BTL services by the
hospital shall be continuously recorded as a BTL current user unless they’ve
reached the age of 50.
 Other commodity-based clients (Pills, IUD, PSI, injectable, condom, SDM)
who have decided to regularly seek services/resupply from the hospital
(oftentimes, those living near the hospitals) shall likewise be recorded as
continuing FP current users of the hospital.
Type 2 Clients: These are clients who initially decided to seek services from the
hospital but later went back to their respective municipalities/cities to avail of
needed services from their rural health units/health centers (RHUs/HCs); they will
be recorded initially as NA or Other Acceptors (Changed Method, Changed Clinic,
Restart) by the hospital but will be marked as drop-outs by the hospital upon
seeking services from the other facility (RHU or HC).
 These are clients who were provided with FP services/commodities only once
(or for a limited period of time) at the hospitals but were referred back to
RHUs/HCs for follow-up FP services/supply of commodities and future
recording and reporting.
 In this case, upon referral to the other facility and transfer of responsibility, the
hospital will need to record these clients as DROP-OUTS and subsequently
deleted from the HFPCR, while the receiving facility, e.g., RHU/HC (which
ideally should be part of a referral network/SDN) will record these clients as
OTHER ACCEPTORS (part of current users or CU) in the TCL. They will be
continuously recorded by the RHU/HC as CU in the TCL unless they drop-out,
decide to transfer, or reach the age of 50 and above.
Type 3 Clients: These are clients who initially seek FP services from the
RHUs/HCs but opt to seek services or change their source of service from
RHUs/HC to the hospital.
 These are clients who initially seek regular FP services/commodities from

RHUs/HCs but later on decide to regularly obtain services from the hospital for
different reasons (e.g., change of residence);
 They will be recorded initially as NA or Other Acceptors (Changed Method,
Changed Clinic, Restart) by the RHUs/HCs but upon referral and transfer of
responsibility to the hospital, the RHU/HC will need to record these clients as
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DROP-OUTS and subsequently delete them from the TCL, while the receiving
facility, i.e., the hospital (which ideally should be part of a referral
network/SDN) will record the clients as OTHER ACCEPTORs in the HFPCR.
They will continuously be recorded as current users by the hospital in the
HFPCR unless they drop-out, decide to transfer, or reach the age of 50 and
above.
In dropping out FP clients by method, hospitals shall follow the existing DOH
FHSIS guidelines to ensure synchronized FP recording and reporting by all public
health facilities
Recording Tools
1. MONTHLY FORM 1 or M1 FOR FP. The Monthly Form 1 for FP contains

indicators related to accounting and tracking FP current users and new acceptors
by FP method. It will help the hospital’s FP Point Person/Team to capture the
monthly data and make it easier to consolidate and prepare the quarterly report
for submission to the PHO/CHO or the DOHRO. A copy of the M1 form is shown
in Annex 1.
Submission of M1 Reports.
1. M1s of DOH-retained hospitals and medical centers will be submitted to
the concerned DOH-RO.
2. M1s of district and provincial hospitals owned and managed by the
provincial government will be submitted to the PHO. The Provincial FHSIS
Coordinator shall prepare the FP Quarterly Report ( to be submitted to the
next level based on their own FP-TCL; and then add the FP coverage from
the hospitals directly into the M1.
3. M1s of community/municipal/city hospitals managed by the component
municipalities/cities will be submitted to the MHO/CHO. The LGU FHSIS
Coordinator shall prepare the Monthly FP Report (M1) to be submitted to
the next level based on their own FP-TCL; and then add the FP coverage
from the hospitals directly into the M1.
4. M1s of city hospitals managed by the chartered city will be submitted to
the CHO. The Chartered City FHSIS Coordinator shall prepare the M1 to
be submitted to the next level based on their own FP-TCL; and then add
the FP coverage from the hospitals directly into the M1.
5. M1s of private hospitals will be submitted to the health office/BHS/RHU
where they are located.
Schedule of Submission:
 Consistent with the FHSIS reporting schedule, all hospitals need to submit
their M1 reports 15 days after the month being reported.
Important: M1s must be submitted in duplicate copies. Original copies must be

submitted to the PHO/CHO/DOHRO while the duplicate must be retained at the
hospital for reference.
Monthly Reports (M1s) will be submitted by LGU hospitals to the

CHO/MHO/PHO/DOHRO (depending on their specific categories) through the FP
coordinator and will be forwarded to the FHSIS Coordinator for final consolidation and
integration into the overall report, based on the following schedule:
• M1 Report for January 2019: deadline is Feb 15, 2019

• M1 Report for February 2019: deadline is March 15, 2019
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• M1 Report for March 2019: deadline is April 15, 2019 (in the case of FP Current
Users and Contraceptive Prevalence Rate (CPR) data, the M1 report for the end
of March, end of June, end of September and end of December are equivalent to
end of quarter report; the PHO/CHO can generate the quarterly report)
M1s should likewise reflect the age disaggregation of the FP current users to identify
adolescent clients provided with FP services.
M1 PREPARATION: AN ILLUSTRATION
STEPS IN PREPARING THE

MONTHLY FORM (M1):
1. Determine the Current Users

for Beginning of April (2019)
[This is equivalent to Current
Users as of previous month:
March 2019]
2. Add the Total New

Acceptors of the previous
Month (March 2019)
3. Add the Total Other

Acceptors (April 2019)
4. Deduct the Drop-outs for the

Current Month (April 2019)
Example:
FPCU (as of end of April

2019) =
Current Users for Beginning of
April (Equal to End of Month of
March) = 189
+ Total New Acceptors of the

Previous Month = 33
+ Total Other Acceptors for the

Current Month = 13
- Drop-outs = 5
Thus FPCU end of April 2019

= 230
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2. ANNUAL FORM OR A1 FOR FP - (reference FHSIS Annual Report)
Submission of A1 Reports. The A1 of LGU hospitals will be submitted to the

CHO/MHO/PHO (depending on category) while A1 reports of DOH Regional
Hospitals and Medical Centers will be submitted to their respective DOHRO.
Consistent with the FHSIS reporting schedule, all hospitals will need to submit A1
reports three weeks after the year being reported.
For DOH-retained and medical centers, submit report to the DOH-RO.

For provincial and district hospitals owned by the province, submit to the PHO.
For municipal/city/community hospitals owned by the city/municipality, submit to the
CHO/MHO.
For private hospitals, submit the reports to health office where the hospital is located.
Important: The A1 must be submitted in duplicate copies. Original copies must be

submitted to the PHO/CHO/DOH-RO while the duplicate must be retained at the
hospital for reference.
IMPORTANT CHANGES FOR FHSIS REPORTING WITH HOSPITAL REPORTING

AS A STAND-ALONE UNIT:
 RHUs/HCs should no longer take and report the hospital performance as part
of their performance to avoid duplication. As stipulated in the guide, the
hospital will now become a stand-alone reporting unit, reflecting its own
performance on reducing unmet needs for FP
 Clients who have been provided with complete BTL services by the hospital
will now be reported only by the hospital. Previous clients that have been
earlier recorded by the RHUs/HCs will remain to be part of the RHU/HC report
until the client reach the age of 50.
 Outreach services will be recorded and reported as part of the LGU FP
performance and will enter their respective Target Client List (TCLs); the
hospital team, in this case, serves as a support team to the LGU in the
provision of FP services
 The Hospital FP point person (or his/her designee) shall ensure that all clients
that received FP services from the OR/DR have corresponding FP form 1, and
are all recorded in the FP client record and are issued with the FP client card.
PREPARATION OF A1 REPORT
Data reported in M1s will be entered in the Annual Consolidation Table to support the
preparation of the hospital’s A1 Report. Below is an illustrative example of the Annual
Consolidation Report to be used for the final computation of A1 Report on FPCU.
96
97
Annex 1: M1 Report
98
Annex 2: A1 Report
FHSIS REPORT for end of YEAR____________

Name of Hospital ___________________________________
Address _________________________________________ Age Disaggregation
FP Point Person ____________________________________ of Current Users
Province: _________________________________________ (end of Year)
Region __________________________________________
Acceptors
Other
New Acceptors
Acceptors
Current User
Current User (NA for the Drop-Out New
(End of
(Beginning month of (January - Acceptors of 14 and
FAMILY PLANNING METHOD December 15-19 20-49
January Current December of December of December Below
(January - Current Year) Current
Year) Previous Year Currrent Year)
December of Year)
+ NA of
Current Year)
January-
November of
Current Year)
(Add) (Add) (Deduct)

a. Female Sterilization/BTL
b. Male Sterilization/Vasectomy
c1. Pills -POP
c2. Pills-COC
d1. IIUD (Interval IUD)
d2. PP- IUD (Post-partum IUD)
e1. Injectables- POI
e2. Injectables -CIC
f. NFP-CM (Cervical Mucus)
g. NFP-BBT (Basal Body Temperature)

h. NFP-STM (Symptothermal Method)
i. NFP-SDM (Standard Days Method)
j. NFP-LAM (Lactational Amenorrhea Method)
k. Condom
l. Progestin-only Subdermal Implant
Total
Prepared by: _____________________________________________

(Name and Signature)
Position _____________________________________________
Date _____________________________________________
Approved by: _____________________________________________

(Name and Signature)
Position _____________________________________________
Date _____________________________________________
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Chapter 4

Recording, Consolidation and Reporting

 Family Planning Services

Chapter 4.2 Maternal Care and Services

Chapter 4.3 Child Care and Services

Chapter 4.4 Oral Health Care and Services

This resulted to the enhancement and expansion of FP indicators to be monitored

1. New Indicators to be Monitored through the FHSIS

Eligible Population: Refers to

 sexually active (women who have

 By age group Note: For Hospital Report:

C.1 Master Listing of WRA

1. Based on the completed HH Profiles in each barangay (discussed in Chapter

Column 1 HOUSEHOLD (HH) NUMBER. Write the number assigned to a

3. In coordination with POPCOM, the BHS midwife with assistance of the

4. Validate if the particular WRA has unmet need for MFP.

 Demographic Profile: Complete Name, Address, Age, Birthday, Sex, Religion,

Column 1 DATE OF REGISTRATION. Indicate in this column the date (month,

Code Type of Client

NOTE: For clients who are changing methods/changing clinic, they

Column 10 FOLLOW-UP VISITS. This column has twelve (12) sub-

The following are the definitions for each method drop-out :

a. Pill A client is considered drop-out from the method if

b. Injectables A client is considered a drop-out if she:

c. IUD A client is considered a drop-out if she:

d. Condom A client is considered a drop-out if he/she:

e. LAM A client is considered a drop-out if she does NOT

f. NFP For Standard Days Method – A client is considered a

g. BTL A client is considered drop-out if she:

h. Implants A client is considered a drop-out if she did not return

Column 13 DEWORMING DRUGS GIVEN TO 20-49 YEARS OLD WRA.

NAME OF BARANGAY/RHU : ________________________

(1) (2) (3) (4) (5) (6) (7) (8) (9)

* Type of Client: *** Previous Method: **** Reas

TARGET CLIENT LIST FOR FAMILY PLANNING SERVICES

D.1 Reporting Clients who are purchasing their own FP commodities

Reporting of FP services provided by other public health facilities outside the

D.3 Reporting FP clients 50 years old and above

a. Provide her the FP method/commodities of choice

D.4 Reporting FP clients less than 15 years old

b. Place under the Remarks Column “less than 15 years old.”

D.5 Reporting FP male clients using condom or who have undergone

a. In recording FP services involving male clients, it is always the female spouse/

b. It is assumed that a male FP user (condom, vasectomy) has a partner,

D.6 Dropping female partners of vasectomy/condom-user clients

d. Woman whose husband/partner has undergone vasectomy or was using

b. The NGO/CSO shall give the accomplished FP Services Record (Form 1) to

d. Advise the FP client to have her follow-up check-up and resupply of FP

D.8 Reporting LAM users

E. Consolidating the FP Program Accomplishment/Service

E.1 Using the Summary Table on FP services at the Barangay Level

c. Under each succeeding monthly columns, record the number corresponding to

c. On a monthly basis, transfer the data pertinent to each FP indicator by

MONTHLY CONSOLIDATION TABLE FOR

NAME OF RHU / HEALTH CENTER : _________________

The Monthly Program Accomplishment Report is prepared by the midwife at the

Section A1. Modern FP Unmet Need

Section A2. Use of FP Method

Column 1 Listed in this column are the different FP Methods

Calculation sample for Month of February Report:

Current users from the previous month (Jan 2019) 29

Calculation of the Current Users

 Current Users Beginning Month (ex. February)

* Type of Client: * Previous Method: ** Reas