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    Republic of The Philippines

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    barangay kuya
    This document provides information about a community-based drug rehabilitation program (CBDRP) in Barangay Kuya, Maramag, Bukidnon. It includes an intake report form that collects identifying information about program participants such as name, age, address, family, education level, and income. It also documents their civil and legal status regarding substance abuse and previous rehabilitation attempts. The form is used by the Barangay Anti-Drug Abuse Council of Kuya and their SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT crisis center to enroll and assess individuals in their aftercare and medical social services programs.

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    Republic of The Philippines

    Uploaded by

    barangay kuya
    27 views2 pages
    This document provides information about a community-based drug rehabilitation program (CBDRP) in Barangay Kuya, Maramag, Bukidnon. It includes an intake report form that collects identifying information about program participants such as name, age, address, family, education level, and income. It also documents their civil and legal status regarding substance abuse and previous rehabilitation attempts. The form is used by the Barangay Anti-Drug Abuse Council of Kuya and their SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT crisis center to enroll and assess individuals in their aftercare and medical social services programs.

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    This document provides information about a community-based drug rehabilitation program (CBDRP) in Barangay Kuya, Maramag, Bukidnon. It includes an intake report form that collects identifying information about program participants such as name, age, address, family, education level, and income. It also documents their civil and legal status regarding substance abuse and previous rehabilitation attempts. The form is used by the Barangay Anti-Drug Abuse Council of Kuya and their SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT crisis center to enroll and assess individuals in their aftercare and medical social services programs.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    27 views2 pages

    Republic of The Philippines

    Uploaded by

    barangay kuya
    This document provides information about a community-based drug rehabilitation program (CBDRP) in Barangay Kuya, Maramag, Bukidnon. It includes an intake report form that collects identifying information about program participants such as name, age, address, family, education level, and income. It also documents their civil and legal status regarding substance abuse and previous rehabilitation attempts. The form is used by the Barangay Anti-Drug Abuse Council of Kuya and their SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT crisis center to enroll and assess individuals in their aftercare and medical social services programs.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Republic of the Philippines

    Province of Bukidnon
    BADAC
    BARANGAY ANTI- DRUG
    Municipality of Maramag ABUSE COUNCIL
    BARANGAY KUYA

    Aftercare Program Contact No.


    0915321081/09977301464/09555032108

    SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT (SAFE) CRISIS CENTER


    Barangay Kuya, Maramag, Bukidnon
    BARANGAY ANTI-DRUG ABUSE COUNCIL OF KUYA
    COMMUNITY-BASED DRUG REHAB PROGRAM (CBDRP)
    PROGRESS NOTES

    NAME: ______________________________ AGE: _____ CIVIL STATUS: ____________


    ADDRESS: _________________________________________________________________

    Republic of the Philippines


    BADAC
    BARANGAY ANTI- DRUG
    ABUSE COUNCIL
    Province of Bukidnon
    Municipality of Maramag
    BARANGAY KUYA

    Aftercare Program Contact No.


    0915321081/09977301464/09555032108

    SUBSTANCE ABUSE AND FAMILY ENLIGHTENMENT (SAFE) CRISIS CENTER


    Barangay Kuya, Maramag, Bukidnon
    BARANGAY ANTI-DRUG ABUSE COUNCIL OF KUYA
    MEDICAL SOCIAL SERVICE
    COMMUNITY-BASED DRUG REHAB PROGRAM

    INTAKE REPORT

    I. INDENTIFYING DATA
    NAME: NICKNAME:
    CIVIL STATUS: RELIGION:
    BIRTHPLACE: BIRTHDATE: AGE:
    EDUCATIONAL ATTAINMENT:
    MONTHLY INCOME:
    ADDRESS:
    CONTACT NO.
    CONTACT PERSON: CONTACT NO.
    STATUS OF CONFINEMENT/ DISCHARGE VTP( ) VTC ( ) ST ( )

    COURT ADDRESS:
    CASE NO. NAME OF JUDGE:
    PREVIOUS REHABILITATION CONFINEMENT:
    DATE DISCHARGE: DATE OF INTERVIEW:

    II. FAMILY COMPOSITION

    Name Age Civil Relationship Educational Occupation Income


    Status to Patient attainment

    Prepared by:

    SHEILA AMOR V. PALAMINE


    BADAC Coordinator

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