DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCE
APPENDIX A
FAMILY HEALTH PROFILE
Purok and Barangay: Poblacion Juan Carino Street
Household No.: 0051
PERSONAL DATA
Name of Interviewee: Mrs. Christine Joy Reyes
Educational Attainment: High School Graduate
Status: Single
I. General Household Data
A. Family Number: 13
B. List of the Members of the Family:
Family Family S Age Birthday Religion Marital Disability Highest Immunization
Member Position e Status Blood Educational Status
(SN, FN, x Type Attainment
MN)
Delfin T. Father M 50 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Marrie ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None Elementary ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Reyes Catholic d ̶ ̶ ̶
Crisanta B. Mother F 49 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Marrie ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None Second Year ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Reyes Catholic d ̶ ̶ ̶ High School
Christine Daughte F 26 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None High School ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Joy Reyes r Catholic ̶ ̶ ̶ Graduate
Jumel Husban M 30 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None High School ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Tebia d Catholic ̶ ̶ ̶ Graduate
Jandel Son M4 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None Day Care ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Tebia Catholic ̶ ̶ ̶
John Son M1 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Jhezreil Catholic ̶ ̶ ̶
Tebia
Jhannaiah Daughte F 1 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Tebia r mont catholic ̶ ̶ ̶
h
Chrisdel B. Brother M 23 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None 2nd year ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
Reyes Catholic ̶ ̶ ̶ College
Christian Brother M 19 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None 2nd year ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
B. Reyes Catholic ̶ ̶ ̶ College
Angel Mae Sister- F 18 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None 2nd year ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCE
T. in-Law Catholic ̶ ̶ ̶ College
Casquejo
Christopher Brother M 16 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None Grade 11 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
B. Reyes Catholic ̶ ̶ ̶
Chrisjhon Brother M 13 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ None Grade 8 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
B. Reyes Catholic ̶ ̶ ̶
Crisanto Brother M 11 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ Roman Single None Grade 5 ̶̶ ̶̶̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶ ̶
B. Reyes Catholic
Type of Family Characteristics
(/) Extended ( ) Patriarchal
( ) Nuclear ( ) Dominant Family Member
( ) Matriarchal
II. Economic Data
A. Source of Income
Occupations: House Wife
Estimated Monthly Income: 6,800
B. Land:
Owned ( ), Rented ( ), or Tenanted ( /)
Type: Plain (/), Rolling ( )
C. Products, if land is farmed:
D. Type of Housing:
Concrete ( ), Ordinary ( ), or Scrap ( ), Mixed ( ̷̷̷̷)
E. Household Appliances:
Washing Machine, TV, Electric fan
F. Animal Raising Pet Dogs:
Dogs, Cat, Chicken Dove, Goat, Cow
G. Transportation Facilities
Owned ( ̷ ), Rented ( ), or others Jeepney ( ), Tricycles ( ),
H. Water
Bought (/), Free ( )
III. Environmental Data
DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCE
A. Toilet Facilities:
Owned (/), Shared ( ), or None ( )
B. Source of Drinking Water Supply: Water Refilling Station
C. Type of Drainage System:
(/) Open ( ) Close
D. Type of Garbage Disposal:
(/) Collected ( ) Burning
( ) Waste segregation ( )Burying
( ) Feeding to animals ( )Open Dumping
IV. Health Data
A. Common Diseases and Common Treatments:
Cough, Pneumonia
B. Immediate Sources of Medical Care:
RHU 5-10 minutes walks
C. Family Planning: None
D. Pregnancy: None
E. Lactating: 1 Lactating mother
F. Death in the Family: None
G. Other pertinent observations/ informations like presence of Personality Disturbances:
None
H. Disable Member of the Family: None
DIVINE WORD COLLEGE OF BANGUED
Rizal St., Zone 6, Bangued, Abra
SCHOOL HEALTH SCIENCE