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3.1.9. BADAC Form 4 (UBRA)

The document provides data on the number of surrenderers and those referred for wellness/recovery interventions from January to June and July to December of 2023. It includes tables tracking indicators by gender and age for surrenderers, referred surrenderers, those assessed, and those completing interventions.

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Ronnie Manao
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5K views1 page

3.1.9. BADAC Form 4 (UBRA)

The document provides data on the number of surrenderers and those referred for wellness/recovery interventions from January to June and July to December of 2023. It includes tables tracking indicators by gender and age for surrenderers, referred surrenderers, those assessed, and those completing interventions.

Uploaded by

Ronnie Manao
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
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Page 6

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 ( x) July to December ( x) 2023
Year (YYYY): __________________________

NO. OF SURRENDERERS NO. OF REFERRED SURRENDERERS


INDICATOR INDICATOR
MALE FEMALE MALE FEMALE
TOTAL TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 BELOW 18 ABOVE 18

Submission of Updated
0 0 Submission of Updated Number 0
Number of Residents who 0 0 0 0 0 0 0
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 0 0 0
Low 0 0 0 0 0 0 0
Interventions

Community- 0
0 0 Submission of based Treatment
0 0 0 0
Submission of
Mild 0 0 0
Updated & Rehab
Updated Number
Number of Health Facility-
of Assessed
Enrolled based Outpatient 0
Surrenderers Moderate 0 0 0 0 0 0 0
0 0 Surrenderers Treatment &
Rehab
Inpatient
0 0 0 0 0 0 0 0 0 0
Severe Treatment &
Rehab

NO. OF SURRENDERERS WHO COMPLETED WELLNESS The purpose of this form is to determine the number of surrenderers per semester (January-
& RECOVERY INTERVENTIONS
INDICATOR June, July-December), and monitor the number of who, among those surrenderers, have
MALE FEMALE been referred, assessed, and who have completed any Wellness and Recovery Program
TOTAL
BELOW 18 ABOVE 18 BELOW 18 ABOVE 18 interventions within the 6-month time frame. Counting shall restart at the onset of the new
Submission of Updated semester; meaning, the data on those who surrendered in the previous semester shall no
Number of Surrenderers Who 0 0 0 0 0 longer be accounted in the next, regardless of whether they have been referred or assessed
Completed Wellness & in the following semester.
Recovery Interventions

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