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Target Client List For Family Planning

This document appears to be a template for tracking family planning clients. It includes columns for registration date, family serial number, name, address, age/birthdate, type of client, previous method, and follow up visit dates. The bottom section provides codes for reasons a client may drop out of the program such as becoming pregnant, wanting to become pregnant, medical complications, fear of side effects, or no longer being eligible for a particular method.

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Gwendareign Elizan
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807 views3 pages

Target Client List For Family Planning

This document appears to be a template for tracking family planning clients. It includes columns for registration date, family serial number, name, address, age/birthdate, type of client, previous method, and follow up visit dates. The bottom section provides codes for reasons a client may drop out of the program such as becoming pregnant, wanting to become pregnant, medical complications, fear of side effects, or no longer being eligible for a particular method.

Uploaded by

Gwendareign Elizan
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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TARGET CLIENT LIST FOR FAMILY PLANNING

DMPA (INJECTIBLES)
PUT A NAME OF FP
METHOD
DATE OF FAMILY SERIAL NAME ADDRESS AGE/ BIRTHDATE TYPE OF CLIENT PREVIOUS METHOD
REGISTRATION NUMBER 3 4 5 6 7
MM/DD/YY 2
1

*TYPE OF CLIENT: CU= current users *PREVIOUS METHOD:


NA= new acceptors CON= condom NFP-BBT= basal body
temperature SDM= standard days method
Other acceptors: INJ= DMPAN or CIC NFP-CM= cervical
mucus method MSTR/VASECTOMY= male ster./vasectomy
*CU-CM= changing method IUD= Intrauterine device (PP-IUD and I-IUD) NFP-STM= Sympothermal
method FSTR/BTL= female ster./bilateral tubal ligation
*CU-CC= changing clinic PILLS= pills NFP-LAM= lactation
amenorrhea method
*CU-RS= restarter IMP= single rod sub-thermal implant
TARGET CLIENT LIST FOR FAMILY PLANNING
None or NEW ACCEPTORS

FOLLOW-UP VISITS DROP-OUT Remark


(Upper Space: Next Service Date/ Lower Space: Date Accomplished) s or
8 9 Action
Taken
10
1ST 2ND 3RD 4TH 5TH 6TH 7TH 8TH 9TH 10TH 11TH 12TH DATE REASO
N

REASONS:
A= Pregnant G= Menopause M= Underwent Bilateral Salpingo-oophorectomy For
LAM:
B= Desire to become Pregnant H= Lost or Moved out of the Area/Residence N= No FP Commodity A= Mother
has a Menstruation or not ammenorhei
C= medical complications I= Failed to get supply O= Unknown
within 6 months or
TARGET CLIENT LIST FOR FAMILY PLANNING
D= fear of side Effects J= IUD expelled P= Age Out for BTL B= No longer
practicing fully/ exclusively breastfeeding
E= Change clinic K= Change Method or
F= Husband Disapproves L= Underwent Hysterectomy C= Baby is more than 6
months

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