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Top 5 Health Condition

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Top 5 Referral Facility
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Assistance Needed from DOH
Medicines Units
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Assistive Devices Units
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CHD4A-FamilyProfile-Form2.Rev0
Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032/Direct Line: (02) 440.3551/440.3372
Email Add: chd4a_doh_calabarzon@yahoo.com

HEALTH CONDITION/PROBLEM AND INTERVENTIONS

Municipality/City:
Family Name Sex Address Date Profiled Interventions/Assistance Needed** Actions Taken
Age Barangay Health Condition/Problem*
(Surname, First Name, Middle Name) (M,F) (House No., Street, Purok) (mm/dd/yyyy) from RHU/CHO from Other HF-Name*** from Other HF-Intervention from CHD c/o RHU/CHO/NDP c/o Other HF-Name*** c/o Other HF-Action Taken
HPN; submandibular swelling (L) for two consultation due to submandibular walker/wheelchair to assist in referred for consultation on
*dela Cruz, Juan Castillo 70 M 25 Lakandula St. Brgy. Poblacion II 6/9/2019 Mount Grace Hospital consultation with ENT
days, with pain (4/10) swelling, left ambulation (date)
dental services
maintenance meds for HPN
maintenance meds for HPN Management for fever (38.7 C) -
*dela Cruz, Juana Rosario 64 F 4-a Lot 2 Phase 1 Brgy. As-Isan 6/9/2019 HPN; fever for 2 days
(losartan + HCTZ) TSB and paracetamol

referred to the RHU if fever


persists after a day

*Health condition/problem is not always a disease/diagnosis, but also consider what the client has been complaining for a time period.
**Do not limit interventions/assistances based on the current health condition/problem, but also from other observations that may be noted during profiling. Interventions/assistances may be health education/advocacies, referrals, VS takings, commodities, among .others
***Indicate the name of health facility, intervention needed and actions taken.
Municipality/City:
Family Name Sex
Age
(Surname, First Name, Middle Name) (M,F)
Date
Address
Profiled
(House No., Street, Barangay
(mm/dd/yy
Purok)
yy)
Republic of the Phi
Department of H
CENTER FOR HEALTH D
CaLaBaRZo
QMMC Compound, Project 4
Trunkline: (02)990.4032/Direct Line: (
Email Add: chd4a_doh_calabar

HEALTH CONDITION/PROBLEM

Health Condition/Problem*
from RHU/CHO
Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032/Direct Line: (02) 440.3551/440.3372
Email Add: chd4a_doh_calabarzon@yahoo.com

ONDITION/PROBLEM AND INTERVENTIONS

Interventions/Assistances Needed**
from Other HF-Name*** from Other HF-Intervention
Actions Tak
from CHD c/o RHU/CHO/NDP
CHD4A-FamilyProfile-Form2.Rev0

Actions Taken
c/o Other HF-Name*** c/o Other HF-Action Taken
Municipality/City:
Family Name Age Sex
(Surname, First Name, Middle Name) (M,F)

TAŇANG, BIENVENIDO PEREZ 71 M

VELASCO, VICENTE PINDEL 90 M

VELASCO, JULIET JARINA 27 F

CRUZ, KYRAN DAVE JARINA 7M

JARINA,ADELAIDA PEREZ 70 F

PEREZ, ROGELIO ROBLES 74 M

BAJETA, FLORDELIZA PEREZ 79 F


RAMOS, CRESENCIA PEREZ 84 F

BAJETA, TIMOTEO PEREZ 59 M

BAJETA, MERLITA BAJETA 53 F

DELOS REYES, RONIE CRISTOBAL 46 M

CATOY, LUZVIMINDA ILAO 49 F

BAJETA, JEFFERSON IAN BATAYOLA 7 MOS. M

VALDEZ, GUILLERMO SORIZO 61 M

CAGUIMBAL, BENIGNO ROSA 64 M

ENRIQUEZ, NENITA PAGCALIWAGAN 73 F

CORPIN, AILEEN ENRIQUEZ 40 F


CORPIN, MYLENE ENRIQUEZ 18 F

DE VILLA, MARINA PEREZ 71 F

SICO, TEODORA MAGBUHOS 55 F

ENRIQUEZ, LUDILINA SANTOC 65 F

ENRIQUEZ, SILVESTRE DE TORRES 72 M

ILAO, ESTELITA BAJETA 70 F

BAJETA. ERNESTO BAJETA 34 M

CUSTUDIO, JULIA MAIZY RUBIA 5F


CUSTUDIO, EDUVEJES BAJETA 64 F

BAJETA, LILIBETH CUSTODIO 43 F

CUSTODIO, SALOME PEREZ 75 F

EMRIQUEZ, ALICIA ILAO 50 F

BAJETA, JHUN MARK ENRIQUEZ 19 M

ENRIQUEZ, ALDEN BAILES 2M

CUSTODIO, KHENDZTER MIEL MARASIGAN 10 M


**Do not limit interventions/assistances based on the current health condition/problem, but also from other o
***Indicate the name of health facility, intervention needed and actions taken.
Address Barangay
(House No., Street, Purok)

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0


SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0


SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0


SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0

SITIO PUTING UWAY CALUBCUB 2.0


ealth condition/problem, but also from other observations that may be noted during profiling. Interventions/assistances
actions taken.
Republic of the Phil
Department of He
CENTER FOR HEALTH DE
CaLaBaRZon
QMMC Compound, Project 4,
Trunkline: (02)990.4032/Direct Line: (0
Email Add: chd4a_doh_calabarz

HEALTH CONDITION/PROBLEM

Date Profiled Health Condition/Problem*


(mm/dd/yyyy)

10/7/2019 HPN

10/7/2019 HPN

10/7/2019 HEART DISEASE


ANEMIA

10/7/2019 FEVER AND COUGH

10/7/2019 HEART DISEASE


DM

10/7/2019 HPN
DM

10/7/2019 ANEMIA
10/7/2019 HPN
UTI

10/7/2019 COUGH

10/7/2019 GOITER

10/7/2019 HPN

10/7/2019 HPN

10/7/2019 COUGH

10/7/2019 MILD STROKE

10/7/2019 HPN

10/7/2019 BACK PAIN

10/7/2019 ASTHMA
10/7/2019 FEVER AND COUGH

10/7/2019 HPN
BP: 130/80

10/7/2019 HPN

10/7/2019 KIDNEY DISEASE

10/7/2019 HPN
HEART DISEASE

10/7/2019 ASTHMA

10/7/2019 KIDNEY DISEASE

10/7/2019 COUGH
10/7/2019 HPN

10/7/2019 HEART DISEASE

10/7/2019 HEART DISEASE

10/7/2019 ASTHMA

10/7/2019 EPILEPTIC

10/7/2019 FEVER AND COUGH

10/7/2019 MALNOURISHED
WITH 1ST DEGREE BURN AT CHEST
COUGH
ventions/assistances may be health education/advocacies, referrals, VS takings, commodities, among .others
Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032/Direct Line: (02) 440.3551/440.3372
Email Add: chd4a_doh_calabarzon@yahoo.com

HEALTH CONDITION/PROBLEM AND INTERVENTIONS

Interventions/Assistances Neede
from RHU/CHO from Other HF-Name***
MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC
LOSARTAN; AMLODIPINE
ATORVASTATIN; ASPIRIN

MAINTENANCE FOR HPN


LOSARTAN

FERROUS SULFATE
MEDICATIONS FOR HEART DISEASE

CONSULTATIUO DUE TO FEVER AND COUGH


TSB INSTRUCTED
AUSCULTATION DONE (-_ CRACKLES

PARACETAMOL SYRUP 5ML GIVEN


LAGUNDI SYRUP

MAINTENANCE FOR HEART DISEASE


MAINTENANCE FOR DM
BISOPROLOL; TWYNSTA

MAINTENANCE FOR HPN


LOSARTAN
MAINTENANCE FOR DM
GLICLAZIDE; METFORMIN
FEBUXOSTAT

IBERET; MEDIFAORTAN
MVM +IRON
MAINTENANCE FOR HPN ST. VINCENT DE PAUL HOSPITAL
LOSARTAN
OMEPRAZOLE; CEFIXIME;

AUSCULTATION DONE (-) CRACKLES


LAGUNDI TAB

(+) PALPITATION
(+) DOB

MAINTENANCE FOR HPN


KENZAR

MAINTENANCE FOR HPN

CONSULTATION DUE TO COUGH


AUSCULTATION DONE (+) CRACKLES
REFER TO RHU 2

REFER AT TERTIARY HOSPITAL VILLA HOSPITAL

MAINTENANCE FOR HPN


LOSARTAN

CONSULTATION DUE TO BACK PAIN DIVINE CARE HOSPITAL


TRAMADOL PRN

MAINTENANCE FOR ASTHMA


PREDNISONE; SALBUTAMOL TAB

CONSULTATION DUE TO FEVER AND COUGH


TSB INSTRUCTED
AUSCULTATION DONE

TORNIQUET TEST DONE (+)


(-) CRACKLES
REFER TO RHU 1 FOR FURTHER MANAGEMENT
PAARACETAMOL TAB
ORS

MAINTENANCE FOR HPN DIVINE CARE HOSPITAL


LOSARTAN

MAINTENANCE FOR HPN


AMLODIPINE

MAINTENANCE FOR THE KIDNEY DISEAARANAS MEDICAL CLINIC


INTRA AND KIDNEY CARE

MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC


LANOXIN; METOPROLOL

MAINTENANCE FOR ASTHMA


PREDNISONE

ADVISED FOLLOWUP CHECKUP


REFER TO RHU 2

AUSCULTATION DONE
CLEAR BREATH SOUNDS
MAINTENANCE FOR HPN
AMLODIPINE

MAINTENANCE FOR HEART DISEASE


ANGIREL;CLOPIDOGREL

MAINTENANCE FOR HEART DISEASE


TMZ-MR; CLOPIDOGREL;ISORDIL

MAINTENANCE FOR ASTHMA MERCADO GENERAL HOSPITAL


SALBUTAMOL; CETIRIZINE

MAINTENANCE FOR EPILEPTIC

CONSULTATION DUE TO FEVER AND COUGH


TSB INSTRUCTED
PARACETAMOL SYRUP

AUSCULTATION DONE (+) CRACKLES


ORS GIVEN
REFER TO RHU 2

REFER TO RHU 2
PALE; WEAK
AUSCULTATION DONE (+) CRACKLES
WOUND DRESSING DONE
akings, commodities, among .others
/Assistances Needed**
from Other HF-Intervention from CHD
CONSULTATION WITH IM MAINTENANCE FOR HPN
LOSARTAN; AMLODIPINE
ATORVASTATIN; ASPIRIN

MAINTENANCE FOR HPN


LOSARTAN

CONSULTATION WITH IM FERROUS SULFATE


MEDICATIONS FOR HEART DISEAS

PARACETAMOL SYRUP 5ML GIVEN


LAGUNDI SYRUP

CONSULTATION WITH IM MAINTENANCE FOR HEART DISEA


MAINTENANCE FOR DM
BISOPROLOL; TWYNSTA

MAINTENANCE FOR HPN


LOSARTAN
MAINTENANCE FOR DM
GLICLAZIDE; METFORMIN
FEBUXOSTAT

IBERET; MEDIFAORTAN
MVM +IRON
CONSULTATION WITH IM MAINTENANCE FOR HPN
LOSARTAN
OMEPRAZOLE; CEFIXIME;

LAGUNDI TAB

REFER TO RHU 2 FOR FURTHER

MAINTENANCE FOR HPN


KENZAR

MAINTENANCE FOR HPN

REFER TO RHU 2

CONSULTATION WITH CARDIOLOGIST REFER AT TERTIARY HOSPITAL

MAINTENANCE FOR HPN


LOSARTAN

CONSULTATION WITH IM TRAMADOL PRN

MAINTENANCE FOR ASTHMA


PREDNISONE; SALBUTAMOL TAB

REFER TO RHU 1 FOR FURTHER


PAARACETAMOL TAB; ORS

CONSULTATION WITH IM MAINTENANCE FOR HPN


LOSARTAN

MAINTENANCE FOR HPN


AMLODIPINE

CONSULTATION WITH IM MAINTENANCE FOR THE KIDNEY D


INTRA AND KIDNEY CARE

CONSULTATION WITH IM MAINTENANCE FOR HPN


LANOXIN; METOPROLOL

MAINTENANCE FOR ASTHMA


PREDNISONE
MAINTENANCE FOR HPN
AMLODIPINE

MAINTENANCE FOR HEART DISEA


ANGIREL;CLOPIDOGREL

MAINTENANCE FOR HEART DISEA


TMZ-MR; CLOPIDOGREL;ISORDIL

CONSULTATION WITH PULMONOLOGISTMAINTENANCE FOR ASTHMA


SALBUTAMOL; CETIRIZINE

MAINTENANCE FOR EPILEPTIC

PARACETAMOL SYRUP
ORS GIVEN
REFER TO RHU 2

CONSULTATION WITH PEDIA REFER TO RHU 2


Actions Taken
c/o RHU/CHO/NDP c/o Other HF-Name***
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
BP MONITORING C/O BHW

MAINTENANCE FOR HEART DISEASE


MAINTENANCE FOR DM
BISOPROLOL; TWYNSTA
BP MONITORING C/O BHW

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
WOF DOB, FEVER AND
DECREASE APPETITE

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
BP MONITORING C/O BHW
INCREASE OFI

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
INCREASE OFI
WOF DOB, DECREASE APPETITE
AND FEVER

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

INCREASE OFI
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
SAFETY PRECAUTIONS

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB AND WHEEZES

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
WOF DOB AND WHEEZES

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
WOF DOB AND WHEEZES

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
SAFETY PRECAUTIONS

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI
CHD4A-FamilyProfile-Form2.Rev0

n
c/o Other HF-Action Taken
Municipality/City:
Family Name Age Sex
(Surname, First Name, Middle Name) (M,F)

CABATIC, ROGELIO ALIM 50 M

MANALO, ALFREDO GOC 46 M

MILAN, DIOSDADO GOC 54 M

DELOS REYES, VICTORINO ARELLANO 62 M

ERNA, ANGELITO BUENDIA 52 M

CALINGAY, ANASTACIA ATIENZA 69 F

CALINGAY, ROMEO DELOS REYES 66 M


CALINGAY, CRISTETA MERCADO 64 F

ELNAS, ALLAN ATIENZA 52 M

PENDAEL, YOLANDA ATIENZA 72 F

CADEVIDA, DARWIN ARELLANO 45 M

ARELLANO, ROLANDO SAYAT 41 M

CADEVIDA, CEEJAY TRIVIŇO 16 M

CADEVIDA, MARILOU SALAPARE 50 F

RAMIREZ, EDWIN HAWAK 59 M

CADEVIDA, ISIDORO PERODILLA 75 M

DELOS REYES, TERESITA TAŇA 77 F


LANDICHO, JAKE PEŇARANDA 2M

DOLOR, ISIDRO DAPULA 79 M

MURILLO, MERLYN SOGUILON 29 F

ABELLA, NENITA SOGUILON 79 F

SEBUC, RUEL PERADILLA 46 M

GRAGAS, KRIS TENORIO 28 F

PEREZ, DIONISIO COMIA 56 M

GALLEROS, MYLA CAPONPON 43 F

ALVAREZ, LORNA RAZON 52 M

EROLES, REYNALDO LUZ 39 M


EROLES, SHIENA DE VILLA 32 F

GOC, CHRISTOPHER CAMPANG 40 M

MURILLO, SIMEON TATLONGHARI 70 M

MURILLO, ELIZABETH MAŇOSO 3F

MURILLO, DELSA SAQUILLON 55 F

ROQUEZA, JUSTINE MURILLO 3M

PERDIGUERRA, GUILLERMO MACARAIG 81 M

ILAO, WILMA RAMIREZ 58 F

ALDOVINO, MARIE JOY DELOS REYES 38 F

VILLANUEVA, SHERLY DELOS REYES 56 F


*Health condition/problem is not always a disease/diagnosis, but also consider what the client has been com
**Do not limit interventions/assistances based on the current health condition/problem, but also from other o
***Indicate the name of health facility, intervention needed and actions taken.
Address Barangay
(House No., Street, Purok)

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0


SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0


SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0


SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0

SITIO APLAYA TAPAT CALUBCUB 2.0


t also consider what the client has been complaining for a time period.
ealth condition/problem, but also from other observations that may be noted during profiling. Interventions/assistances
actions taken.
Republic of the Phil
Department of He
CENTER FOR HEALTH DE
CaLaBaRZon
QMMC Compound, Project 4,
Trunkline: (02)990.4032/Direct Line: (0
Email Add: chd4a_doh_calabarz

HEALTH CONDITION/PROBLEM

Date Profiled Health Condition/Problem*


(mm/dd/yyyy)

10/9/2019 HPN

10/9/2019 HPN

10/9/2019 HPN
DM
HEART PROBLEM

10/9/2019 HPN

10/9/2019 COUGH FOR 1 WEEK

10/9/2019 HPN
ASTHMA
HEART PROBLEM

10/9/2019 LEFT SIDED BODY WEAKNESS


HPN
10/9/2019 HPN

10/9/2019 MASS ON HEAD

10/9/2019 HPN

10/9/2019 PTB

10/9/2019 GOITER

10/9/2019 CONGENITAL HEART DISEASE

10/9/2019 DM

10/9/2019 HPN

10/9/2019 HPN
DM

10/9/2019 HPN
10/9/2019 FEVER

10/9/2019 HPN

10/9/2019 HEART PROBLEM

10/9/2019 INCREASE BP
ASTHMA

10/9/2019 AMPUTATED ARMS

10/9/2019 COUGH

10/9/2019 HYPERACIDITY
ENLARGED PROSTATE

10/9/2019 DM

10/9/2019 INCREASE BP
BP; 140/80

10/9/2019 DM
10/9/2019 CONGENITAL KIDNEY FAILURE

10/9/2019 SORETHROAT

10/9/2019 ENLARGED PROSTATE

10/9/2019 EPILEPSY

10/9/2019 ASTHMA
MASS ON NECK

10/9/2019 PAIN ON URINATION

10/9/2019 ARTHRITIS

10/9/2019 HPN
DM

10/9/2019 GOITER

10/9/2019 GOITER
DM
ventions/assistances may be health education/advocacies, referrals, VS takings, commodities, among .others
Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032/Direct Line: (02) 440.3551/440.3372
Email Add: chd4a_doh_calabarzon@yahoo.com

HEALTH CONDITION/PROBLEM AND INTERVENTIONS

Interventions/Assistances Neede
from RHU/CHO from Other HF-Name***
MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC

MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC


LOSARTAN; AMLODIPINE

MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC


LOSARTAN; ATORVASTATIN;
CLOPIDOGREL
MAINTENANCE FOR DM
DIAMICRON

MAINTENANCE FOR HPN


LOSARTAN

AUSCULTATION DONE
LAGUNDI TAB; MVT

MAINTENANCE FOR HPN; ASTHMA; HEART PROBLEM


ADEFLO

MAINTENANCE FOR HPN PALMA-MALALUAN HOSPITAL


ATORVASTATIN; CELCOXIB,
PREGMAX M-75
MAINTENANCE FOR HPN
LOSARTAN

REFER TO RHU 1 FOR FURTHER CHECKUP

MAINTENANCE FOR HPN


LOSARTAN

TB-DOTS MEDICATIONS

UTZ; T3T4 TSH


PROPANOLOL; INDERAL

LANOXIN; FUROSEMIDE
FOLLOWUP AT HEART CENTER ON 11-29-19

MAINTENANCE FOR DM ARANAS MEDICAL CLINIC


AZOKON 30MG

MAINTENANCE FOR HPN


REFER TO RHU 2 FOR FURTHER MANAGEMENT

MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC


MAINTENANCE FOR DM
VICLAGLIPTIN; CANDESARTAN

MAINTENANCE FOR HPN MARY MEDIATRIX MEDICAL CENTER


PRYANOL; CLOPIDOGREL;
AMLODIPINE
CONSULTATION DUE TO FEVER
TSB INSTRUCTED
PARACETAMOL SYRUP; ORS

FOLLOW-UP IF FEVER PERSIST

MAINTENANCE FOR HPN MARY MEDIATRIX MEDICAL CENTER


AMLODIPINE

DIGOXIN TAB BATMC

VENTOLIN INHALER

NEEDS FOR ASSISTANCE

AUSCULTATION DONE
LAGUNDI TAB

ADVISED FOLLOW UP TO AP

MAINTENANCE FOR DM MARY MEDIATRIX MEDICAL CENTER


DIAMICRON

MAINTENANCE FOR HPN ARANAS MEDICAL CLINIC

MAINTENANCE FOR DM
METFORMIN

DIALYSIS 2X A WEEK
FESO4; BONCARE D BCOMPLEX

ADVISED GARGLE WARM SALINE

TAMSULOSIN

ADVISED FOLLOWUP CHECKUP


PHENOBARBITAL

REFER TO SAN JUAN DISTRICT HOSP.


MAINTENANCE FOR ASTHMA

CEFIXIME SYRUP
ERCEFLORA

COLCHICINE ARANAS MEDICAL CLINIC

MAINTENANCE FOR HPN


LOSARTAN
MAINTENANCE FOR DM
METFORMIN

K-LYTE TAB; TAPDIN TAB;


ADVISED FOLLOW UP TO AP

MAINTENANCE FOR DM
METFORMIN
LEVOTHYROXINE; XELEVIA
akings, commodities, among .others
/Assistances Needed**
from Other HF-Intervention from CHD
CONSULTATION WITH IM MAINTENANCE FOR HPN

CONSULTATION WITH IM MAINTENANCE FOR HPN


LOSARTAN; AMLODIPINE

CONSULTATION WITH IM MAINTENANCE FOR HPN


LOSARTAN; ATORVASTATIN;
CLOPIDOGREL
MAINTENANCE FOR DM
DIAMICRON

MAINTENANCE FOR HPN


LOSARTAN

LAGUNDI TAB; MVT

ADEFLO

CONSULTATION WITH IM MAINTENANCE FOR HPN


ATORVASTATIN; CELCOXIB,
PREGMAX M-75
MAINTENANCE FOR HPN
LOSARTAN

MAINTENANCE FOR HPN


LOSARTAN

TB-DOTS MEDICATIONS

UTZ; T3T4 TSH


PROPANOLOL; INDERAL

CONSULTATION WITH CARDIOLOGIST LANOXIN; FUROSEMIDE


FOLLOWUP AT HEART CENTER ON

CONSULTATION WITH IM MAINTENANCE FOR DM


AZOKON 30MG

MAINTENANCE FOR HPN


REFER TO RHU 2 FOR FURTHER

CONSULTATION WITH IM MAINTENANCE FOR HPN


MAINTENANCE FOR DM
VICLAGLIPTIN; CANDESARTAN

CONSULTATION WITH CARDIOLOGIST MAINTENANCE FOR HPN


PRYANOL; CLOPIDOGREL;
AMLODIPINE
PARACETAMOL SYRUP; ORS

CONSULTATION WITH CARDIOLOGIST MAINTENANCE FOR HPN


AMLODIPINE

DIGOXIN TAB

VENTOLIN INHALER

NEEDS FOR ASSISTANCE

LAGUNDI TAB

ADVISED FOLLOW UP TO AP

CONSULTATION WITH IM MAINTENANCE FOR DM


DIAMICRON

CONSULTATION WITH IM MAINTENANCE FOR HPN

CONSULTATION WITH IM MAINTENANCE FOR DM


METFORMIN

CONSULTATION WITH IM DIALYSIS 2X A WEEK


FESO4; BONCARE D BCOMPLEX

CONSULTATION WITH IM TAMSULOSIN

CONSULTATION WITH PEDIATRICIAN ADVISED FOLLOWUP CHECKUP


PHENOBARBITAL

CONSULTATION WITH SURGEON REFER TO SAN JUAN DISTRICT HOS


MAINTENANCE FOR ASTHMA

CEFIXIME SYRUP
ERCEFLORA

CONSULTATION WITH IM COLCHICINE

MAINTENANCE FOR HPN


LOSARTAN
MAINTENANCE FOR DM
METFORMIN

K-LYTE TAB; TAPDIN TAB;


ADVISED FOLLOW UP TO AP

MAINTENANCE FOR DM
METFORMIN
LEVOTHYROXINE; XELEVIA
Actions Taken
c/o RHU/CHO/NDP c/o Other HF-Name***
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
WOF DOB AND WHEEZES

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
SAFETY PRECAUTIONS

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
WOF DOB AND WHEEZES

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
SAFETY PRECAUTIONS

DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
WOF DOB, FEVER AND
DECREASE APPETITE
INCREASE OFI

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW

ADVISED GARGLE WARM SALINE


ADVISED FOLLOW-UP CHECKUP
HEALTH TEACHINGS
INCREASE OFI

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

HEALTH TEACHINGS
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
SAFETY PRECAUTIONS

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
WOF DOB AND WHEEZES

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
INCREASE OFI
DIET MODIFICATION

HEALTH TEACHINGS
DIET MODIFICATION
ADVISED FOLLOW-UP CHECKUP
SAFETY PRECAUTIONS

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION

ADVISED FOLLOW-UP CHECKUP


HEALTH TEACHINGS
DIET MODIFICATION
BP MONITORING C/O BHW
RBS MONITORING C/O MIDWIFE
CHD4A-FamilyProfile-Form2.Rev0

n
c/o Other HF-Action Taken
Municipality/City:
Family Name Age Sex
(Surname, First Name, Middle Name) (M,F)
*Health condition/problem is not always a disease/diagnosis, but also consider what the client has been complai
**Do not limit interventions/assistances based on the current health condition/problem, but also from other obse
***Indicate the name of health facility, intervention needed and actions taken.
Address Barangay
(House No., Street, Purok)
t also consider what the client has been complaining for a time period.
ealth condition/problem, but also from other observations that may be noted during profiling. Interventions/assistances ma
actions taken.
Republic of the Philippin
Department of Health
CENTER FOR HEALTH DEVE
CaLaBaRZon
QMMC Compound, Project 4, Que
Trunkline: (02)990.4032/Direct Line: (02) 4
Email Add: chd4a_doh_calabarzon@

HEALTH CONDITION/PROBLEM AN

Date Profiled Health Condition/Problem*


(mm/dd/yyyy)
ventions/assistances may be health education/advocacies, referrals, VS takings, commodities, among .others
Republic of the Philippines
Department of Health
CENTER FOR HEALTH DEVELOPMENT
CaLaBaRZon
QMMC Compound, Project 4, Quezon City
Trunkline: (02)990.4032/Direct Line: (02) 440.3551/440.3372
Email Add: chd4a_doh_calabarzon@yahoo.com

HEALTH CONDITION/PROBLEM AND INTERVENTIONS

Interventions/Assistances Needed*
from RHU/CHO from Other HF-Name***
akings, commodities, among .others
/Assistances Needed**
from Other HF-Intervention from CHD
Actions Taken
c/o RHU/CHO/NDP c/o Other HF-Name***
CHD4A-FamilyProfile-Form2.Rev0

n
c/o Other HF-Action Taken

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