(Enclosure No. 9 to DepEd Memorandum No. 015, s.

2020)

Republic of the Philippines

Department of Education
2019-nCoV ARD HEALTH SITUATION REPORT TEMPLATE

Region: REGION VII

School Division
TALISAY CITY
Office:
Report for the Week
February 10-15, 2020
of:

I. Summary of Referrals of Persons with Respiratory Symptoms

Number of Referrals
School Name School ID
Learners Personnel
TABUNOK NATIONAL HIGH
303111 0 0
SCHOOL

Total

II. Activities Undertaken (Brief)

Participants
Date Title of Activities
(Number / Profile)
Feb. 8, 2020 Organization of CARE Task Force
Supervised hand washing 1,128 students/37 Teachers
NCOV Information dissemination
1. Classroom Discussion
1,128 students/37 Teachers
2. Posting of Preventions and
Symptoms
I requested 70% Alcohol
and Antibacterial Liquid Soap 1,128 students
to be distributed in each classroom

III. Needs and Recommendation

70% alcohol
Antibacterial
Liquid soap

Prepared by: Noted by:

MARY JOSEPHINE L. BAWIGA MATEO F. PARDILLO

Health Aid Teacher Principal

Address: Rizal St., Poblacion, City of Talisay, Cebu

Telephone Nos.: (032) 491 - 5593
Email Address: talisaycity.division@deped.gov.ph
(Enclosure No. 8 to DepEd Memorandum No. 015, s. 2020)

Republic of the Philippines

Department of Education
DIVISION OF TALISAY CITY
Rizal St., Poblacion, City of Talisay, Cebu

TABUNOK NATIONAL HIGH SCHOOL 303111

School Name School ID

MEDICAL REFERRAL FORM

To: Date:
(Agency)
Address:

This is to refer to you:

Name: Age: Sex:
Address /School: Grade:
Chief Complaint:

Impression:

Remarks:

Name & Signature

Designation

To be detached from the upper portion and sent back to the school

Name of Institution

MEDICAL TREATMENT RETURN SLIP

Returned to:
Name of Patient: Date Referred:
Chief Complaint:
Findings:
Action Recommendations:

Date Name & Signature

Designation

Address: Rizal St., Poblacion, City of Talisay, Cebu

Telephone Nos.: (032) 491 - 5593
Email Address: talisaycity.division@deped.gov.ph