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  • HSCMDA ANNEX D (Deworming July 2017)

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    Arnelyn Garnace Agra
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    This document is a form for recording mass drug administration (MDA) in a barangay in Laguna province, Philippines. It includes fields to record the patient's name, sex, age, date of birth, address, drugs administered for soil-transmitted helminthiasis (albendazole), lymphatic filariasis (diethylcarbamazine citrate and albendazole), and schistosomiasis (praziquantel). The form also includes spaces for the date drugs were given, remarks, and signatures of the rural health midwife who administered the drugs and the public health nurse who verified the records.

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    This document is a form for recording mass drug administration (MDA) in a barangay in Laguna province, Philippines. It includes fields to record the patient's name, sex, age, date of birth, address, drugs administered for soil-transmitted helminthiasis (albendazole), lymphatic filariasis (diethylcarbamazine citrate and albendazole), and schistosomiasis (praziquantel). The form also includes spaces for the date drugs were given, remarks, and signatures of the rural health midwife who administered the drugs and the public health nurse who verified the records.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    52 views1 page

    HSCMDA ANNEX D (Deworming July 2017)

    Uploaded by

    Arnelyn Garnace Agra
    This document is a form for recording mass drug administration (MDA) in a barangay in Laguna province, Philippines. It includes fields to record the patient's name, sex, age, date of birth, address, drugs administered for soil-transmitted helminthiasis (albendazole), lymphatic filariasis (diethylcarbamazine citrate and albendazole), and schistosomiasis (praziquantel). The form also includes spaces for the date drugs were given, remarks, and signatures of the rural health midwife who administered the drugs and the public health nurse who verified the records.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    aHSCMDA-ANNEX D

    HSCMDA Barangay Master List and Recording Form (For STH Areas Co-endemic with LF and/or SCH)
    Community Based MDA*

    Region: IV-A Soil-Transmitted Helminthiasis: Albendazole (ALB) for 1-18 years old
    Province/City: Laguna Lymphatic Filiriasis: Diethylcarbamazine Citrate (DEC) + Albendazole (ALB) for 2 years old and above
    Municipality/District: Pila Schistosomiasis: Praziquantel (PZQ) for 5-65 years old
    Barangay: Pinagbayanan

    No. Surname Given Name Sex Age in Date of Birth House Number Number of Drugs Date Given Remarks
    Years and Street Given (dd/mm/yy)
    M F ALB DEC PZQ
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20

    Accomplished by: Verified by: Date Accomplished:


    dd/mm/yyyy

    Rural Health Midwife (RHM) Public Health Nurse (PHN)

    *To be filled up at the Main Health Center (MHC), Barangay Health Station or Center (BHS/BHC)

    *MDA of PZQ or DEC conducted in schools is still Community-Based since it is health worker provided.

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