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Itr (A4 Band)

This document is an individual treatment record from the Office of the Municipal Health Office in La Castellana, Negros Occidental, Philippines. It contains fields to record personal information like name, family number, barangay, and medical history including date of birth, weight, complaints, diagnosis, and treatments. The record leaves space to document multiple medical visits over time.

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Paulo Justin Tabangcora Oropilla
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39 views1 page

Itr (A4 Band)

This document is an individual treatment record from the Office of the Municipal Health Office in La Castellana, Negros Occidental, Philippines. It contains fields to record personal information like name, family number, barangay, and medical history including date of birth, weight, complaints, diagnosis, and treatments. The record leaves space to document multiple medical visits over time.

Uploaded by

Paulo Justin Tabangcora Oropilla
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Family Serial No.

_____________ Republic of the Philippines ( ) Pantawid Pamilya


Philheatlh No._______________ Province of Negros Occidental ( ) NHTS
Municipality of La Castellana ( ) Non PHIC
OFFICE OF THE MUNICIPAL HEALTH OFFICE ( ) With PHIC
INDIVIDUAL TREATMENT RECORD

H.H.:____________________________ DATE OF BIRTH:__________________________


NAME:__________________________ FAMILY #:___________ ZONE:______________
BARANGAY:______________________ SEX:____________ STATUS:________________
OCCUPATION:____________________ EDUCATIONAL ATTAINMENT:_______________
MOTHER'S NAME:_________________ DOB:__________________________________
RELIGION:_______________________
DATE BIRTH WT. COMPLAINTS DIAGNOSIS TREATMENTS
Time In: WT:
Time Out: H:
AGE: WC:
B/P: HR:
TEMP: RR:

Time In: WT:


Time Out: H:
AGE: WC:
B/P: HR:
TEMP: RR:

Time In: WT:


Time Out: H:
AGE: WC:
B/P: HR:
TEMP: RR:

Time In: WT:


Time Out: H:
AGE: WC:
B/P: HR:
TEMP: RR:

Time In: WT:


Time Out: H:
AGE: WC:
B/P: HR:
TEMP: RR:

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