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PROVINCIA CHIMBORAZO

MSP-SCI-SISVAN-FORM 568-2015

DATOS DE LA UNIDAD OPERATIVA NOMBRE DE RESPONSABLE

UNIDAD OPERATIVA PROVINCIA CANTON PARRO!UIA APELLIDOS NOMBRES CAR

1GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO2GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO3GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO!GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO5GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO6GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICOGUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO8GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO%GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO

10GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO11GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO12GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO13GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO1!GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO15GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO16GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO1GUANO CHIMBORAZO GUANO GUANO ASTUDILLO URQUIZO GUILLERMO EDUARDO MEDICO181%202122232!2526

2282%303132333!35363383%!0

!1!2!3!!!5!6!!8!%50

DEIE

ES

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%%8%%000102030!

05060080%101112131!15161181%202122232!25262282%30313233

3!35363383%!0!1!2!3!!!5!6!!8

!%505152535!55565585%606162

636!65666686%0123

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15161181%202122

232!25262282%303132333!35363383%!0!1!2!3!!!5!6!!8!%5051

52535!55565585%606162636!6566

6686%0123!568%80

8182838!85868888%%0%1

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333!35363383%!0

!1!2!3!!!5!6!!8!%505152535!55565585%606162636!65666686%

0123!568%808182838!

85868888%%0%1%2%3%!%5%6%%8

%%000102030!05060080%

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5152535!5556558

5%606162636!65666686%0123!568%808182838!85868

888%%0%1%2%3%!%5%6%%8%%000102

030!05060080%101112131!1516

1181%202122232!25262

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6%0123!56

8%808182838!85868888%%0%1%2%3%!%5%6%%8%%000102030!05

060080%101112131!15161181%20

2122232!25262282%303132333!

35363383%!0!1!2!3!!!5

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8888%%0%1%2%3%!

%5%6%%8%%000102030!05060080%101112131!15161181%20212223

2!25262282%303132333!3536338

3%!0!1!2!3!!!5!6!!8!%505152

535!55565585%60616263

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05060080%101112

131!15161181%202122232!25262282%303132333!35363383%!0!1

!2!3!!!5!6!!8!%505152535!5556

5585%606162636!65666686%0

123!568%8081

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232!25262282%30

3132333!35363383%!0!1!2!3!!!5!6!!8!%505152535!55565585%

606162636!65666686%0123!

568%808182838!8586888

8%%0%1%2%3%!%5%6%%8%%

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!1!2!3!!!5!6!!8

!%505152535!55565585%606162636!65666686%0123!56

8%808182838!85868888%%0%1%2

%3%!%5%6%%8%%000102030!0506

0080%101112131!15161

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  D  I  A  D  E  L  M  E  S

   N   8   P   E   R   S   O   N   A   S   A   T   E   N   D   I   D

   A   S

NIÑOS MENORES DE 5 AÑOS

SE*O

NIÑOS MENORES DE AÑO N

   P   R   I   M   E   R   A   S

   S   U   B   S   E   C   U   E   N   T   E   S

EVALUACION ESTADO NUTRICIONAL NIÑOS AÑO

   P   R   I   M   E   R   A   S

   S   U   B   S   E   C   U   E   N   T   E   S

EVA

   "   O   M   B   R   E

   M   U   J   E   R

TALLA/EDAD PESO EDAD IMC/EDAD TALL

   S   I

   N   O

   B  %     %   T  %   7   7  %

   N  +  4  $  %   7

   B  %     +   P  5  .  +

   N  +  4  $  %   7

   E  $  %     ,  %   #  +

   N  +  4  $  %   7

   S  +   :  4  5  6  5  .  +

   O   :  5  .   ,   #  %   #

   S   I

   N   O

   B  %     %   T  %   7   7  %

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 >H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

KH+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

?H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

>H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

KH+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PRESENTA

ANEMIA

PRESENTA

ANEMIA

   B  %     %   T  %   7   7  %

   S  5    5  4  %

   A   7     %   T  %   7   7  %

  6  %  4  %   E   #  %   #

   B  %     +   P  5  .  +

   S  5    5  4  +

   P  5  .  +

   E   7  5    %   #  +

   E   #  %   #

   S  5    5  4  %  $  5  1

     5   E  $  %     ,  %   #  +

   B  %     %   T  %   7   7  %

   S  5    5  4  %

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H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

?H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

>H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

KH+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

?H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0H+   0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

OTAL ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?

OMBRE RESPONSABLE CARGO

DULA DEL PRESTADOR DEL SERVICIO

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O MENSUAL DE ATENCIONES EN NUTRICION

EMBARA&ADAS Y MADRES EN PERIODO DE LACTANCIASES MENONAL NIÑOS DE A 5 MESES

AD IMC/EDAD

   P   R   I   M   E   R   A   S

   S   U   B   S   E   C   U   E   N   T   E   S

   E  $  %     ,  %   #  +

   N  +  4  $  %   7

   S  +   :  4  5  6  5  .  +

   O   :  5  .   ,   #  %   #

   S   I

   N   O

   B  %     +   P  5  .  +

   N  +  4  $  %   7

   S  +   :  4  5  6  5  .  +

   O   :  5  .   ,   #  %   #

   S   I

   N   O

   N   O   A   P   L   I   C   A

   P   R   I   M   E   R   A   S

   P   R   I   M   E   R   A   S

   S   I

   N   O

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

   P   R   O   M   E   D   I   O

    D   E   P   E   S   O

    A   L

   N   A   C   E   R

   :   2  ;

   <PINZAMIENTO

OPORTUNODEL CORDON

UMBILICAL

PRESENTAANEMIA

EVALUACIONPRECONCEPCIONAL

GANANCIADE PESO

   P   R   E   S   C   R   I   P   C   I   O   N   D   E

   "   I   E   R   R   O   Y   A   C   I   D   O

   F   O   L   I   C   O

ENTREGA DE"IERRO MÁS

ACIDO FÓLICO

MADRES ENPERIODO DELACTANCIA

   P  5  .  +

   E   7  5    %   #  +

   E   #  %   #

   S  5    5  4  %  $  5  1

     5   E  $  %     ,  %   #  +

   S   U   B   S   E   C   U   E   N

   T   E   S

   S   U   B   S   E   C   U   E   N

   T   E   S

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O MENSUAL DE ATENCIONES EN NUTRICION

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?? ? ? ? ? ?

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  RES DE 3 A9OS DE EDAD

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   P   R   E   S   C   R   I   P   C   I   =   N

   V   I   T   A   M   I   N   A

   G   O   T   E   R   O

   #   A   R   A   B   E

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   S   U   B   S   E   C   U   E   N   T   E

0 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 0

0 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 0

0 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 0

ES DE A OS(P4+$)

   A   Q   U   E   E   D   A   D

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    A   D   A   R   L   E   A   L

   N   I   9   O   S   A   L   I   M   E   N   T   O   S   D   I   S   T   I   N   T   O   S   A   L   A

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0 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 00 0 0 0 0 0 0 0   0 0 0

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   N  +    P  %     ,

  5  1     5

DATOS DE LA UNIDAD OPERATIVA

   C   Ó   D   I   G   O

   P   R   O   V   I   N   C   I   A

   C   A   N   T   Ó   N

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1 000!62 CHIMBORAZO GUANO GUANO 06D052 000!62 CHIMBORAZO GUANO GUANO 06D05

3 000!62 CHIMBORAZO GUANO GUANO 06D05! 000!62 CHIMBORAZO GUANO GUANO 06D055 000!62 CHIMBORAZO GUANO GUANO 06D056 000!62 CHIMBORAZO GUANO GUANO 06D05 000!62 CHIMBORAZO GUANO GUANO 06D058 000!62 CHIMBORAZO GUANO GUANO 06D05% 000!62 CHIMBORAZO GUANO GUANO 06D05

10 000!62 CHIMBORAZO GUANO GUANO 06D0511 000!62 CHIMBORAZO GUANO GUANO 06D0512 000!62 CHIMBORAZO GUANO GUANO 06D05

13 000!62 CHIMBORAZO GUANO GUANO 06D051! 000!62 CHIMBORAZO GUANO GUANO 06D0515 000!62 CHIMBORAZO GUANO GUANO 06D0516 000!62 CHIMBORAZO GUANO GUANO 06D051 000!62 CHIMBORAZO GUANO GUANO 06D0518 @N/A @N/A1% @N/A @N/A20 @N/A @N/A21 @N/A @N/A22 @N/A @N/A

23 @N/A @N/A2! @N/A @N/A25 @N/A @N/A26 @N/A @N/A2 @N/A @N/A28 @N/A @N/A2% @N/A @N/A30 @N/A @N/A31 @N/A @N/A32 @N/A @N/A

33 @N/A @N/A3! @N/A @N/A35 @N/A @N/A

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36 @N/A @N/A3 @N/A @N/A38 @N/A @N/A3% @N/A @N/A!0 @N/A @N/A!1 @N/A @N/A

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GUANO 1 11 2015 2158 60!853556 BA"RON #AMGUANO 1 11 2015 22!03 606!3236 MA"OL #HO

GUANO 1 11 2015 23563 650562036 SEBASTIANGUANO 1 11 2015 2316 6505602% TATIANA LISBGUANO 1 11 2015 23!%5 65056212 ELLER" GEOGUANO 1 11 2015 16%1% 650066251 BIANA SALOGUANO 1 11 2015 22!%8 650!811%5 ARIANA SARGUANO ! 11 2015 2!3%3 65060%!80 MAITE ALE#AGUANO ! 11 2015 2!321 06505%!!01 ATHIA VALEGUANO 11 2015 2358% 60!60835 ()') &*)GUANO 11 2015 25!11 650!82128 TATIANA "A#AGUANO 11 2015 25!15 606362150 GUIDO MARC

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