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Republic of the Philippines

Department of Education
Region IV-A CALABARZON
City Schools Division of Antipolo
District I-C

MUNTINDILAW NATIONAL HIGH SCHOOL

VISION AND HEARING SCREENING

Grade and Section: ___________________________________________________


Date and Time Conducted: _____________________________________________
Instructions: F-Failed, P-Passed (Remarks)
Hearing
Vision Screening
Se Screening
NO. Name Age Remarks Remarks
x Right Left Right Left
Eye Eye Ear Ear

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