Republic of the Philippines

Province of Southern Leyte

Bontoc,Southern Leyte
Office of the Rural Health Services
Rural Health Unit – Bontoc
Poblacion, Bontoc, Southern Leyte
Email Address: bontocrhu@gmail.com
ITINERARY AND MONTHLY ACCOMPLISHMENT REPORT
FOR THE MONTH OF _________________

Name: ______________________________________
Area of Assignment: ___________________________
Catchment: __________________________________
D MORNING AFTERNOON PLACE
A OF PURPOSE SIGNATURE
Y ARRIVAL DEPARTURE ARRIVAL DEPARTURE VISIT
1
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I HEREBY CERTIFY that the above is true and correct report of hours of work performed with each
accomplishment records of what was made daily.

Prepared by: Attested by:

________________________ _________________________
Name / Signature Rural Health Midwife

Approved by:
DR. EVA C. PADALAPAT ENGR. JOYCE D. BANZON
Municipal Health Officer DMO IV