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  • Vision Form 1 2019-2020

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    Zaldy Tomas
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    This document is a school vision screening form for Calangitan Elementary School in Capas, Philippines for the 2019-2020 school year. It lists 20 male students screened for vision acuity in their right and left eyes, with all found to have 20/20 vision. No female students are listed as being screened. A summary at the bottom indicates the total screened and breakdown of vision acuity findings.

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    Vision screening form

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    This document is a school vision screening form for Calangitan Elementary School in Capas, Philippines for the 2019-2020 school year. It lists 20 male students screened for vision acuity in their right and left eyes, with all found to have 20/20 vision. No female students are listed as being screened. A summary at the bottom indicates the total screened and breakdown of vision acuity findings.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Vision Form 1 2019-2020

    Uploaded by

    Zaldy Tomas
    This document is a school vision screening form for Calangitan Elementary School in Capas, Philippines for the 2019-2020 school year. It lists 20 male students screened for vision acuity in their right and left eyes, with all found to have 20/20 vision. No female students are listed as being screened. A summary at the bottom indicates the total screened and breakdown of vision acuity findings.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SCHOOL VISION SCREENING FORM

    GRADE: ________
    School Year: 2019-2020
    School: Calangitan Elementary School Municipality: Capas
    District: Capas East District Section: _______

    Student identified with visual impairment or other findings:


    VA 
    No. Surname First Name MI Age Sex RE LE (Abnormal) Other Findings
    Light Reflex
    BOYS
    1 BANAG ANGEL R 8,5 M 20/20 20/20
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20
    GIRLS
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
    11
    12
    13
    14
    15
    16
    17
    18
    19
    20

    SUMMARY OF TOTAL SCREENED


    MALE FEMALE
    VA RE LE RE LE

    20/20
    20/32
    20/40
    20/63
    20/100
    0 (Worse than 20/100)

    Prepared by: ______________________


    Teacher I

    Noted: LORETA C. RAZON


    Head Teacher III

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