Good day!

Please faithfully follow the following guidelines in filling-out the CBDRP Reporting Form 1

A. LGU
1. In Column C, kindly indicate your City/Municipality as the first entry, followed by your respective barangays.
2. Kindly indicate in Column D "1" if there is existing DOH-certified CBDRP and "0" if there is none.
3. If there are no surrenderers or if the LGU is drug-free or drug-cleared, please indicate "1" if there is a CBDRP Plan ready should the need arise, and "0" if there is non

Note: Please know that there is a separate CBDRP for City/Municipal and for Barangays. As per the JMC, all cities/municipalities should have
CBDRPs, while for barangays, it is optional, considering the need thereof and the capacity of the barangay. All CBDRPs should be certified by the
DOH as per DDB BR 4 2020 before implementation.

B. Participants
1. In Column F, kindly indicate the total no. of surrenderers for the quarter being covered
2. In Column G, kindly indicate the total no. of CBDRP participants that are new to the program
3. In Column H, kindly indicate the total no. of CBDRP participants that were once admitted to the program but stopped, then presented themselves again to continue
4. In Column I, kindly indicate the total no. of CBDRP participants who completed the program during the quarter being covered

C. Referral
1. In Column K, kindly indicate the total no. of clients with Low Risk and were referred to General Intervention
2. In Column L, kindly indicate the total no. of clients with Moderate Risk/MILD SUD and were referred to CBDRP
3. In Column M, kindly indicate the total no. of clients with Moderate SUD and were referred to out-patient facility/program
4. In Column N, kindly indicate the total no. of clients with Severe SUD and were referred to in-patient facility/program
4. In Column O, kindly indicate the total no. of clients with risk and co-occuring psychiatric/medical comorbidity and were referred to mental health facilty/medical pro

Note: The total number in column L should be the same with the sum of the total number in column G and H.

Column L = Column G + Column H

(Total no. of CBDRP Participants) (New CBDRP Participants) (Readmitted/Old CBDRP Participants)

Note: The total number in column F should be the same with the sum of the total number in column K, L, M, N, and O.

Column F = Column K + Column L + Column M

Total no. of Surrenderees (GI Participants) (CBDRP Participants) (Out-patient clients)

D. CBDRP Interventions
1. In Columns Q-AA, kindly indicate "1" if the intervention is being implemented and "0" if there is no available intervention in the LGU

Note: Please do not encode the total no. of participants in each intervention, just kindly encode "1" if the intervention is available and "0" if not.
eed arise, and "0" if there is none.

d themselves again to continue the program

ental health facilty/medical professionals

Column M + Column N + Column O

(Out-patient clients) (In-patient clients) (Clients referred to Mental Health Facilities)
CBDRP REPORTING FORM 1
COMMUNITY-BASED DRUG REHABILITATION PROGRAM QUARTERLY REPORT
City/Municipality of Lupao
Province of Nueva Ecija
Region 3
1st Quarter of 2023

Community-based Drug Rehabilitation Program Interventions

Participants Referral
Community-based Treatment
Community-based Support Services Aftercare Interventions Reintegration Services
Services

Life Skills Training,

With DOH Community
Total no. of Total no. of Total no. of Vocational Skills Family
LGU certified Total no. of Total no. of Total no. of Medication- Health Services Spirituality Individual, Psychoeduca Literacy and Relapse service, Civic
Total no. of clients clients clients training, Livelihood, relationship
CBDRP? Total no. of readmitted Total no. of clients clients assisted and Wellness and moral Group and tion/ Educational management and and
new CBDRP referred to referred to referred to Micro_Credit, restoration
surrenderer CBDRP graduates referred to referred to In- Treatment, Promotion recovery Family psychosocial Programs or early recovery Environment
participants General Out-patient mental health Employment and sessions and
participants CBDRP patient facility Detoxification Programs programs Counselling support support skills Awareness
Interventions facility facility Other Support for counselling
programs
Income Generation

Lupao no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Agupalo Este no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Agupalo Weste no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Alalay Chica no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Alalay Grande no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bagong Flores no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Balbalungao no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Burgos no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Cordero no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mapangpang no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Namulandayan no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parista no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion East no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion North no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion South no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion West no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salvacion 1 no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salvacion 2 no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Antonio Este no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Antonio Weste no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Isidro no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Pedro no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Roque no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sto Domingo no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tienzo no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total
tion Services

Preventive Drug
Education,
community-
reconciliation
sessions or
community
information
sessions

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Good day! Please faithfully follow the following guidelines in filling-out the CBDRP Reporting Form 2

A. LGU
1. In Column C, kindly indicate your Province as the first entry, followed by your respective C/Ms.
2. Kindly indicate in Column D the total no. of brgy in each C/M
3. Kindly indicate in Column E the total no. of brgy in each C/M which have DOH Certified CBDRP
4. Kindly indicate in Column F "1" if there is existing DOH-certified CBDRP in the province/city/municipality and "0" if there is none.
5. If there are no surrenderers or if the LGU is drug-free or drug-cleared, please indicate "1" if there is a CBDRP Plan ready should the need arise, and "0" if there is non

Note: Please know that there is a separate CBDRP for City/Municipal and for Provinces. As per the JMC, all cities/municipalities should have
CBDRPs, while for provinces, it is optional, considering the need thereof and the capacity of the barangay. All CBDRPs should be certified by the
DOH as per DDB BR 4 2020 before implementation.

B. Participants
1. In Column H, kindly indicate the total no. of surrenderers for the quarter being covered
2. In Column I, kindly indicate the total no. of CBDRP participants that are new to the program
3. In Column J, kindly indicate the total no. of CBDRP participants that were once admitted to the program but stopped, then presented themselves again to continue
4. In Column K, kindly indicate the total no. of CBDRP participants who completed the program during the quarter being covered

Note: The total number in Columns H-K should reflect the total no. of surrenderers/participants from the City/Municipal and its Barangays from
CBDRP RF 1. For example, if there are 3 surrenderers from City 1, and 15 surrenderers from City 1's barangays, then the total no. of surrenderers
is 18 for City 1.

C. Referral
1. In Column M, kindly indicate the total no. of clients with Low Risk and were referred to General Intervention
2. In Column N, kindly indicate the total no. of clients with Moderate Risk/MILD SUD and were referred to CBDRP
3. In Column O, kindly indicate the total no. of clients with Moderate SUD and were referred to out-patient facility/program
4. In Column P, kindly indicate the total no. of clients with Severe SUD and were referred to in-patient facility/program
5. In Column Q, kindly indicate the total no. of clients with risk and co-occuring psychiatric/medical comorbidity and were referred to mental health facilty/medical pro

Note: The total number in column N should be the same with the sum of the total number in column I and J.

Column N = Column I + Column J

(Total no. of CBDRP Participants) (New CBDRP Participants) (Readmitted/Old CBDRP Participants)

Note: The total number in column H should be the same with the sum of the total number in column M, N, O, P, and Q.
 Column F = Column M + Column N + Column O
Total no. of Surrenderees (GI Participants) (CBDRP Participants) (Out-patient clients)

Note: The total number in Columns M-Q should reflect the total no. of clients from the City/Municipal and its Barangays from CBDRP RF 1. For
example, if there are 3 CBDRP clients in City 1, and 12 CBDRP clients from City 1's barangays, then the total no. of CBDRP clients is 15 for City 1.

D. CBDRP Interventions
1. In Columns S-AC, kindly indicate "1" if the intervention is being implemented and "0" if there is no available intervention in the LGU

Note: Please do not encode the total no. of participants in each intervention, just kindly encode "1" if the intervention is available and "0" if not.

Legend
= do not fill-out
ed arise, and "0" if there is none.

themselves again to continue the program

ental health facilty/medical professionals

 Column O + Column P + Column Q
Out-patient clients) (In-patient clients) (Clients referred to Mental Health Facilities)
CBDRP REPORTING FORM 2
COMMUNITY-BASED DRUG REHABILITATION PROGRAM QUARTERLY REPORT
Province of Nueva Ecija
Region 3
2nd Quarter of 2023

Community-based Drug Rehabilitation Program Interventions

Participants Referral
Community-based Treatment
Community-based Support Services Aftercare Interventions Reintegration Services
Services

Life Skills Training,

Total no. of Brgy With DOH Community
Total no. of Total no. of Total no. of Vocational Skills Family
LGU Total no. of Brgy w/ DOH Certified certified Total no. of Total no. of Total no. of Medication- Health Services Spirituality Individual, Psychoeduca Literacy and Relapse service, Civic
Total no. of clients clients clients training, Livelihood, relationship
CBDRP CBDRP? Total no. of readmitted Total no. of clients clients assisted and Wellness and moral Group and tion/ Educational management and and
new CBDRP referred to referred to referred to Micro_Credit, restoration
surrenderer CBDRP graduates referred to referred to in- Treatment, Promotion recovery Family psychosocial Programs or early recovery Environment
participants General out-patient mental health Employment and sessions and
participants CBDRP patient facility Detoxification Programs programs Counselling support support skills Awareness
Interventions facility facility Other Support for counselling
programs
Income Generation

Lupao 24 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Agupalo Este no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Agupalo Weste no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Alalay Chica no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Alalay Grande no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bagong Flores no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Balbalungao no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Burgos no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Cordero no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Mapangpang no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Namulandayan no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Parista no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion East no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion North no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion South no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Poblacion West no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salvacion 1 no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salvacion 2 no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Antonio Este no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Antonio Weste no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Isidro no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Pedro no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
San Roque no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sto Domingo no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Tienzo no 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Total
ation Services

Preventive Drug
Education,
community-
reconciliation
sessions or
community
information
sessions

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Good day! Please faithfully follow the following guidelines in filling-out the CBDRP Reporting Form 3

A. LGU
1. In Column C, kindly indicate the Provinces, HUCs and ICCs under your region
2. Kindly indicate in Column D the total no. of brgy
2. Kindly indicate in Column E the total no. of brgy which have DOH Certified CBDRP
2. Kindly indicate in Column F the total no. of city/municipality
2. Kindly indicate in Column G the total no. of C/M which have DOH Certified CBDRP
2. Kindly indicate in Column H "1" if there is existing DOH-certified CBDRP in the province and "0" if there is none.
3. If there are no surrenderers or if the LGU is drug-free or drug-cleared, please indicate "1" if there is a CBDRP Plan ready should the need arise, and "0" if there is non

Note: Please know that there is a separate CBDRP for City/Municipal and for Provinces. As per the JMC, all cities/municipalities should have
CBDRPs, while for provinces, it is optional, considering the need thereof and the capacity of the barangay. All CBDRPs should be certified by the
DOH as per DDB BR 4 2020 before implementation.

B. Participants
1. In Column J, kindly indicate the total no. of surrenderers for the quarter being covered
2. In Column K, kindly indicate the total no. of CBDRP participants that are new to the program
3. In Column L, kindly indicate the total no. of CBDRP participants that were once admitted to the program but stopped, then presented themselves again to continue
4. In Column M, kindly indicate the total no. of CBDRP participants who completed the program during the quarter being covered
te: The total number in Columns J-M should reflect the total no. of surrenderers/participants from the Barangay up to the Provincial level.

C. Referral
1. In Column O, kindly indicate the total no. of clients with Low Risk and were referred to General Intervention
2. In Column P, kindly indicate the total no. of clients with Moderate Risk/MILD SUD and were referred to CBDRP
3. In Column Q, kindly indicate the total no. of clients with Moderate SUD and were referred to out-patient facility/program
4. In Column R, kindly indicate the total no. of clients with Severe SUD and were referred to in-patient facility/program
4. In Column S, kindly indicate the total no. of clients with risk and co-occuring psychiatric/medical comorbidity and were referred to mental health facilty/medical pro

Note: The total number in column N should be the same with the sum of the total number in column I and J.

Column P = Column K + Column L

(Total no. of CBDRP Participants) (New CBDRP Participants) (Readmitted/Old CBDRP Participants)

Note: The total number in column H should be the same with the sum of the total number in column O, P, Q, R and S.
 Column J = Column O + Column P + Column Q
Total no. of Surrenderees (GI Participants) (CBDRP Participants) (Out-patient clients)
Note: The total number in Columns J-M should reflect the total no. of clients from the Barangay up to the Provincial level.

D. CBDRP Interventions
1. In Columns U-AE, kindly indicate "1" if the intervention is being implemented and "0" if there is no available intervention in the LGU

Note: Please do not encode the total no. of participants in each intervention, just kindly encode "1" if the intervention is available and "0" if not.
ed arise, and "0" if there is none.

themselves again to continue the program

ental health facilty/medical professionals

 Column Q + Column R + Column S
Out-patient clients) (In-patient clients) (Clients referred to Mental Health Facilities)
CBDRP REPORTING FORM 3

Total no. of Brgy

LGU Total no. of Brgy w/ DOH Certified
CBDRP

Province 1
Province 2
Province 3
HUC/ICC 1
HUC/ICC 2

Total
 C

Participants

Total no. of C/M w/ With DOH

Total no. of C/Ms DOH Certified certified
Total no. of
CBDRP CBDRP? Total no. of
new CBDRP
surrenderer
participants
 COMMUNITY-BASED DRUG REHABILITATION PROGRAM QUAR
Region ___
___ Quarter of ___(year)___

Participants Referral

Total no. of Total no. of

Total no. of Total no. of Total no. of
clients clients
readmitted Total no. of clients clients
referred to referred to
CBDRP graduates referred to referred to in-
General out-patient
participants CBDRP patient facility
Interventions facility
N PROGRAM QUARTERLY REPORT
year)___

Community-based Drug Re
Community-based Treatment
Community-based Support Services
Services

Total no. of
Medication- Health Services Spirituality Individual, Psychoeduca
clients
assisted and Wellness and moral Group and tion/
referred to
Treatment, Promotion recovery Family psychosocial
mental health
Detoxification Programs programs Counselling support
facility
ty-based Drug Rehabilitation Program Interventions
Aftercare Interventions Reintegration Services

Life Skills Training,

Community
Vocational Skills Family
Literacy and Relapse service, Civic
training, Livelihood, relationship
Educational management and and
Micro_Credit, restoration
Programs or early recovery Environment
Employment and sessions and
support skills Awareness
Other Support for counselling
programs
Income Generation
gration Services

Preventive Drug
Education,
community-
reconciliation
sessions or
community
information
sessions