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Family Planning Client Records

This document appears to be a template for tracking client information for family planning services. It includes fields for client details, current and previous contraceptive methods used, follow up visit dates, and reasons for dropping out of services.

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Barangay Salong
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412 views2 pages

Family Planning Client Records

This document appears to be a template for tracking client information for family planning services. It includes fields for client details, current and previous contraceptive methods used, follow up visit dates, and reasons for dropping out of services.

Uploaded by

Barangay Salong
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

FHSIS v.

2012

TCL-FP

TARGET CLIENT LIST FOR FAMILY PLANNING


DATE OF REGISTRATION FAMILY SERIAL NAME ADDRESS AGE Birthdate TYPE OF PRESENT/
NO. CLIENT* PREVIOUS
METHOD**
(use codes)
mm/dd/yy (use codes)
(1) (2) (3) (4) (5) (6) (7)

*Type of Client: CU = Current Users **Previous Method: CON = Condom


NA = New Acceptors INJ = DMPA or CIC NFP-BBT = Basal Body Temperature SDM = Standard Days Method
Other Acceptors: IUD = Intra-Uterine Device (PP-IUD and I-IUD) NFP-CM = Cervical Mucus Method MSTR/Vasec = Male Ster./Vasectomy
! CU-CM = Changing Method PILLS = Pills NFP-STM = Sympothermal Method FSTR/BTL = Female Ster./Bilateral Tubal Ligation
* CU-CC = Changing Clinic IMP = Single rod sub-thermal Implant NFP-LAM = Lactational Amenorrhea Method
* CU-RS = Restarter NONE or New Acceptor
FHSIS v. 2012

TCL-FP

TARGET CLIENT LIST FOR FAMILY PLANNING


FOLLOW-UP VISITS DROP-OUT REMARKS/
(Upper Space: Next Service Date / Lower Space: Date Accomplished) ACTION
TAKEN
(8) (9) (10)
1ST 2ND 3RD 4TH 5TH 6TH 7TH 8TH 9TH 10TH 11TH 12TH DATE Reason***

*** Reasons: A = Pregnant G = Menopause L = Underwent Hysterectomy For LAM:


B = Desire to become pregnant H = Lost or moved out of the M = Underwent Bilateral A – Mother has a menstruation or not amenorrheic within 6 mos. Or
C = Medical complications area or residence Salpingo-oophorectomy B – No longer practicing fully/exclusively breastfeeding or
D = Fear of side effects I = Failed to get supply N = No FP commodity C – Baby is more than six (6) months old
E = Changed Clinic J = IUD expelled O = Unknown
F = Husband disapproves K = Change method P = Age out for BTL

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