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DOH report to ICAD

(Report per barangay)

I. Advocacy Cluster:
II. Rehabilitation and Re-integration Cluster

ADVOCACY
Barangay:

IA. Information Education Campaigns

1. Barangay:
2. What advocacy activity: _________________________
3. Where:
4. When:
5. No. of participants/ audience/attendees:
6. Proponents:
7. Remarks:
IB. Drug Testing
1. Date Conducted:
2. Workplace/school/place tested:
3. Random or Mandatory?
4. No. of employees or students or participants tested:
5. No. Screened(+ ) for: Meth (shabu) THC(marijuana)
6. No. confirmed (+) for: Meth (shabu) THC(marijuana)
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IC. Implementation of Drug-free workplace program

1. Activity:
2. Venue of Activity:
3. Date of activity:
4. No. of participants:
5. Objective of Activity:
6. Proponents:
7. Remarks:

Rehabilitation Cluster

2A. Establishment 0f Rehabilitation program

2A1. Community-based program
1. Where:
2. Number of patients enrolled:
3. Number of active patients:
4. Number of patients who discontinued/terminated:
5. Number of patients graduated:
6. Inclusive dates of this report:
7. Program/services included in this program:
8. Was the program approved by Regional DOH office?
9. Remarks
2A2. Outpatient rehab program
1. Where:
2. DOH-accredited rehab?
3. Patients referred by/from?
4. Number of patients enrolled:
5. Number of active patients:
6. Number of patients who discontinued/terminated:
7. Number of patients graduated:
8. Inclusive dates of this report:
9. Program/services included in this program:
10.Remarks
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2A3. Residential Drug Rehab Program:

1. Where:
2. DOH-accredited rehab?
3. Patients referred by/from?
4. Number of patients enrolled:
5. Number of active patients:
6. Number of patients who discontinued/terminated:
7. Number of patients graduated:
8. Inclusive dates of this report:
9. Program/services included in this program:
10.Remarks:
2B1.Drug Dependency Evaluation services
1. Where:
2. When:
3. How many participated? How many are surrenderers?
3. How many were assessed as mild? Where did you refer?
4. How many were assessed moderate?? Where did you refer?
5. How many were assessed as severe? Where did you refer?
6. Remarks
2B2.Successfully graduated from rehab program
1. How many surrenderers graduated from Community-based program?
2. When?
3. Where?
4. How many graduated from outpatient rehab program?
5. When?
6. Where?
7. How many graduated from residential rehab program?
8. When?
9. Where?
10.Who conducted the screening?
11.11. Who conducted the assessment?