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BADAC DATA CAPTURE FORM 4
UNIFIED BARANGAY REPORT ON REFERRAL ACTION (UBRRA)
Data provided herein are those recorded within the months of: January to June ( ) July to December ( ) Year (YYYY):
NO. OF SURRENDERERS NO. OF REFERRED SURRENDERERS
INDICATOR INDICATOR MALE FEMALE MALE FEMALE BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 TOTAL BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 TOTAL
Submission of Updated Submission of Updated Number Number of Residents who of Referred Surrenderers Surrenderred
WELLNESS & NO. OF SURRENDERERS ENROLLED IN WELLNESS &
STATUS / STATUS AND NO. OF ASSESSED SURRENDERERS RECOVERY RECOVERY INTERVENTIONS INDICATOR LEVEL OF INDICATOR INTERVENTION RISK MALE FEMALE MALE FEMALE TOTAL S TOTAL BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18
General Low Interventions
Community- Submission of Mild Submission of based Treatment Updated Number Updated & Rehab of Assessed Number of Health Facility- Surrenderers Enrolled based Outpatient Moderate Surrenderers Treatment & Rehab Inpatient Severe Treatment & Rehab
NO. OF SURRENDERERS WHO COMPLETED WELLNESS
The purpose of this form is to determine the number of surrenderers per semester (January- June, July-December), and monitor the number of who, among those surrenderers, have been referred, & RECOVERY INTERVENTIONS assessed, and who have completed any Wellness and Recovery Program interventions within the 6-month time frame. Counting shall restart at the onset of the new semester; meaning, the data on INDICATOR MALE FEMALE those who surrendered in the previous semester shall no longer be accounted in the next, regardless BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 TOTAL of whether they have been referred or assessed in the following semester. Submission of Updated Number of Surrenderers Who Completed Wellness & Recovery Interventions
Psychiatry Black Art and Confidence Trick A Short Monograph Explaining The Enduring and Expanding Myth of Mental Illness and Why You Should Never Trust A Psychiatrist. by DR Vernon Coleman (Coleman, D
