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Department of Education

Region VIII
SCHOOLS DIVISION OF SAMAR
Catbalogan

_____________________________________________________________________________________

DENGUE CASE SCHOOL MONITORING REPORT


As of _________________, 2019

District Learning Center_________________________ School ID ___________________


Name of School _____________________________________________________________________

Grade & Date of Date of Discharge


No Name of Learners Section Age Confinement From the Hospital Death

Prepared by: Certified Correct:

____________________________ __________________________
Clinic Teacher School Head

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