Republic of the Philippines Document Code: SDO-WIM-QF-SGOD-SHN-011

Department of Education
Revision: 00
Region III
SCHOOLS DIVISION OF ZAMBALES Effectivity date: 06-01-2018
Zone 6, Iba, Zambales
Tel./Fax No. (047) 602 1391
E-mail Address: zambales@deped.gov.ph Name of Office:
website: www.depedzambales.ph SGOD – School Health and
HARMONIZED SCHOOL AND COMMUNITY MASS Nutrition Section
DRUG ADMINISTRATION – CLASSROOM LEVEL

Form 1

Region: ________III________________ Division: Zambales District: ______San Felipe_

School ID: 106934 Name of School: Maloma Community E/S Section: Betelgeuse

SEX 4Ps Dewormed Adverse Worm Migration

Name of Pupils Action Taken
(M/F) (Y or N) (Y or N) Reactions (Y or N)
1.Abrigo, Arnel M No Yes
2.Bactad, Prince Cyrus Yun M No Yes - absent
3.Bunao, Ralf Renault M No No
4.Dela Cruz, Terrence M No No
5.Eusebio,Timothy Josh M Yes No
6.Fullicido, John Lance M Yes No
7.Galope, Jan Cilfford M No No
8.Jimenez, Dwayne Aron M No Yes
9.Joaquin, Luigie Borgie M No No
10.Mario, Jovan Jean M No No
11.Marzel, Angelo D. M No Yes-absent
12.Navorn, Zeann Reen M No No
13.Rivera, Lhord Kyle M No No
14.Placido, Jerich Reen M No No

Prepared by: Noted by:

MARITES A. TRAPSI __________________________________

Class Adviser Grade Level Chairman
Date: Date:

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