Department of Education

Division of City Schools Caloocan

Caloocan City

Vision and Hearing Screening Report

School Year 2018 - 2019

District: NORTH IV Date / Time Conducted: August 3, 2018

School: BAGUMBONG ELEMENTARY SCHOOL Grade and Section: IV- Mars

No. Name Age Sex Vision Screening Remarks Hearing Screening Remarks
Right Eye Left Eye Right Ear Left Ear
1 ANGELES, JOHN CLEAVON M Passed Passed Passed Passed
2 CABASING, ADRIEL JAYCE R. M Passed Passed Passed Passed
3 CANIZARES, DEX ANDREI M Passed Passed Passed Passed
4 CHAVEZ, JOHN VINCENT I. M Passed Passed Passed Passed
5 DATING, NICOLAI ANDREI M Passed Passed Passed Passed
6 EMADEN, CEASAR B. M Passed Passed Passed Passed
7 EPIL, JACE JERROL M Passed Passed Passed Passed
8 ESTROPIA, JOHN WAYNE M Passed Passed Passed Passed
9 GOMEZ, JEMAR M Passed Passed Passed Passed
10 MACANDOG, GWAINE LESTER C. M Passed Passed Passed Passed
11 MERCADO, RONAN ALVIN M Passed Passed Passed Passed
12 MOLANO, ANGELO M M Passed Passed Passed Passed
13 MURILLO, KYLE ANDREW P. M Passed Passed Passed Passed
14 NAVARRO, MARK NATHANIEL M Passed Passed Passed Passed
15 NIPAY, CHRIZ ACCEL B. M Passed Passed Passed Passed
16 OYZON, JOHN LOWELL B. M Passed Passed Passed Passed
17 PACTOL, JOHN MARK H. M Passed Passed Passed Passed
18 REVILLOSA, KIM JERIMI L. M Passed Passed Passed Passed

Vision and Hearing Screening Report Form

 19 RICOHERMOSA, KIRBY M Passed Passed Passed Passed
20 SANORJO, CHRISJHOSIAH EFRAIN R. M Passed Passed Passed Passed
21 ZACARIAS, TIMOTHY R. M Passed Passed Passed Passed
22 ALVAREZ, AZMINA MARIE F Passed Passed Passed Passed
23 ASUNCION, PRINCESS ANGEL R. F Passed Passed Passed Passed
24 BALOD, SHYLLEYREIGHNE F Passed Passed Passed Passed
25 COCHING, PRINCESS F Passed Passed Passed Passed
26 DELA CRUZ, ALLIAH NICOLE F Passed Passed Passed Passed
27 DELA CRUZ, PHENNYLYN F Passed Passed Passed Passed
28 DESAGUN, HANNA JANE M. F Passed Passed Passed Passed
29 DIZON, MIKHAELLA B. F Passed Passed Passed Passed
30 DUKA, QUEEN NHALLIA F Passed Passed Passed Passed
31 ESTONILO, GIANA OLIE T. F Passed Passed Passed Passed
32 GUMAWID, ERICA MAE G. F Passed Passed Passed Passed
33 GUTIEREZ, NICOLE JONE B. F Passed Passed Passed Passed
34 INOSANTO, ANDREA DIORESSA L F Passed Passed Passed Passed
35 LAYA, JAYCHELLE CONNIE F Passed Passed Passed Passed
36 LOCHING, RACELYN T F Passed Passed Passed Passed
37 MONTIBON, JOSA MARI F Passed Passed Passed Passed
38 ORAA, CY G. F Passed Passed Passed Passed
39 PACHECO, SHIELA MAE F Passed Passed Passed Passed
40 PARIS, ZCARHYN MARGARYTH F Passed Passed Passed Passed
41 RAMOS, JADA AYEZAH P. F Passed Passed Passed Passed
42 ROMERO, ANDHRIA DANAYA F Passed Passed Passed Passed
43 VILLAREAL, AHIAH REIN D. F Passed Passed Passed Passed
44 ZONIO, ANGELYN M. F Passed Passed Passed Passed

Vision and Hearing Screening Report Form

 Summary Report for Vision and Hearing Screening

Vision Screening

Vision Screening Male Female Total Remarks /

Recommendation
Passed 21 23 44
Failed 0 0 0
Total 21 23 44

Hearing Screening

Hearing Screening Male Female Total Remarks /

Recommendation
Passed 21 23 44
Failed 0 0 0
Total 21 23 44

Prepared By: Noted By:

MARIA ELENA RONQUILLO GINA J. TOLLEDO,Ph.D.

Name and Signature of Clinic Teacher Name and Signature of School Principal

Vision and Hearing Screening Report Form