Health Nursing

Community- Based Monitoring System

Interviewee Elena Macuha Barangay

Wakas, Tayabas Quezon

Address

No. of household Members A. Family Member’s Data Family Members

Positio n in the family

Relation Se ship x to the family head

Cs

Birth day

Ag e

Religi on

Occupat ion

Elena Macuha

Mothe r

Wife

Marri ed

Marc 31 h 18, 1978

Catho lic

Farmer

31

N

Andres Macuha

Father

Head

Marri ed

Feb. 15, 1973

36

Catho lic

Farmer

18

N

F

M

Length of Residenc y in the barangay

Phil healt h mem ber

Angelica Macuha

Daughte r

F

May 11, 1994

15

Catho lic

Student

15

N

Allan Macuha

Son

M

Oct. 20, 1995

14

Catho lic

Student

14

N

Aira Macuha

Daughte r

F

Sept. 26, 1997

12

Catho lic

Student

12

N

Aries Macuha

Son

M

Dec. 4, 2004

5

Catho lic

Student

5

N

B.

Educational Attainment

Family Studying/no Members t studying (Y/N)

Elena Macuha

Grade/le Highest vel educational Attainment

Literac y (can read & write? Y/N)

Langu age spoke n

N

Elementary graduate

Y

tagalo g

N

Grade 4

Y

tagalo g

Andres Macuha Y

3rdyr. high school

Y

tagalo g

Y

Grade 6

Y

tagalo g

Y

Grade 6

Y

tagalo g

N

tagalo g

Angelica Macuha Allan Macuha Aira Macuha N Aries Macuha

C. Combined family income per month