Beruflich Dokumente
Kultur Dokumente
Department of Education
Region IV - A CALABARZON
District: _____________________________
Name of School:_________________________________ School ID: _____________________
Enrolment: _______________________________ Grade /Section: _________________
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
TOTAL
Accomplished by: N O T E D:
___________________________ ______________________________
Class Adviser School Deworming Coordinator
Date Accomplished: ___________
epublic of the Philippines
epartment of Education
gion IV - A CALABARZON
Adverse Event
________________________________
School Deworming Coordinator
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
DIVISION OF RIZAL
Form 2 - School Level (Elementary)
National School Deworming Month (NSDM) Round __
_____________ _______
Month Year
District / Name of School:_____________________________________________________________
No. of Children Dewormed No. of Children NOT Dewormed
Consented to Precautionary measure
Refused Adverse event % Dewormed
Deworming (as No consent (Seriously ill, with abdominal pain,
Grade Enrolment indicated in
Deworming (as reported (yes (total dewormed /
TOTAL 4Ps indicated in form diarrhea, has previous sensitivity with or no) enrollment)
4Ps Non-4Ps consent form) returned deworming drug
& Non-4Ps consent form)
"Annex B" MDAP Guide #1 page 14
Kindergarten 0 0 0 #DIV/0!
Grade 1 0 0 0 #DIV/0!
Grade 2 0 0 0 #DIV/0!
Grade 3 0 0 0 #DIV/0!
Grade 4 0 0 0 #DIV/0!
Grade 5 0 0 0 #DIV/0!
Grade 6 0 0 0 #DIV/0!
TOTAL
(1-6) 0 0 0 0 0 0 #DIV/0!
SPED 0 0 0 #DIV/0!
Grand
0 0 0 0 0 0 #DIV/0!
Total
Accomplished by: N O T E D:
____________________________ _________________________________________
Deworming Coordinator School Nurse School Head
Date Accomplished: __________________
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
DIVISION OF RIZAL
Form 2 - School Level (Secondary)
National School Deworming Month (NSDM) Round 1
JULY 2017
Month Year
District / Name of School: RODRIGUEZ IA - MANGGAHAN NATIONAL HIGH SCHOOL
SPED
ALS
Grand
814 47 476 523 523 291 64.2506142506
Total
Accomplished by: N O T E D:
Grade 11 0 0 0
Grade 12 0 0 0
TOTAL
(11-12) 0 0 #REF! #REF! #REF! #REF!
SPED 0 0 0
ALS 0 0 0
Grand
0 0 #REF! #REF! #REF! #REF!
Total
Accomplished by:
_____________________
Deworming Coordinator School Nurse
Date Accomplished: __________________
blic of the Philippines
MENT OF EDUCATION
n IV-A CALABARZON
ISION OF RIZAL
#DIV/0!
#DIV/0!
#DIV/0!
#REF!
#DIV/0!
#DIV/0!
#REF!
N O T E D:
______________________________
School Head
Republic of the Philippines
DEPARTMENT OF EDUCATION
Region IV-A CALABARZON
DIVISION OF RIZAL
Form 2 - School Level (Secondary)
National School Deworming Month (NSDM) Round __
_____________ _______
Month Year
District / Name of School:_____________________________________________________________
Consented
No. of Children Dewormed to No. of Children NOT Dewormed Adverse
Deworming
Refused abdominal event
Grade 7 Enrolment TOTAL 4Ps (as No consent
pain, reported
4Ps Non-4Ps indicated in deworming form
& Non-4Ps consent (as indicated returned
diarrhea, has (yes or no)
in the previous
form)
7-Sampaguita
7-Camia
7-Sunflower
7-Gumamela
TOTAL
GRADE 7
Consented
No. of Children Dewormed to No. of Children NOT Dewormed Adverse
Deworming
Refused abdominal event
Grade 8 Enrolment TOTAL 4Ps (as No consent
pain, reported
4Ps Non-4Ps indicated in deworming form
& Non-4Ps consent (as indicated returned
diarrhea, has (yes or no)
in the previous
form)
8-Diamond
8-Amethyst
8-Emerald
8-Sapphire
TOTAL
GRADE 8
Consented
No. of Children Dewormed to No. of Children NOT Dewormed Adverse
Deworming
Refused abdominal event
Grade 9 Enrolment TOTAL 4Ps (as No consent
pain, reported
4Ps Non-4Ps indicated in deworming form
& Non-4Ps consent (as indicated returned
diarrhea, has (yes or no)
in the previous
form)
9-Love
9-Hope
9-Joy
9-Faith
TOTAL
GRADE 9
Consented
No. of Children Dewormed to No. of Children NOT Dewormed Adverse
Deworming abdominal
Refused event
Grade 10 Enrolment TOTAL 4Ps (as No consent
pain, reported (yes
4Ps Non-4Ps indicated in deworming form
& Non-4Ps consent (as indicated returned
diarrhea, has or no)
in the previous
form)
10-Rizal
10-Aguinaldo
10-Bonifacio
10-Del Pilar
TOTAL
GRADE 10
worming Month (NSDM) Round __
_______ _______
Month Year
%
Dewormed
(total
dewormed /
enrollment)
%
Dewormed
(total
dewormed /
enrollment)
%
Dewormed
(total
dewormed /
enrollment)
% Dewormed
(total
dewormed /
enrollment)