Republic of the Philippines

Department of Education
COTABATO DIVISION
School Health Division

NATIONAL SCHOOL DEWORMING PROGRAM

S. Y. 2019 - 2020
FORM 2
Municipaity: Makilala North Cotabato
Barangay:
School:
Enrollment (Male/Female):

No. of Pupils No. of Pupils No. of 4P's No. of 4P's

Grade Level Enrolled Dewormed Dewormed Not Dewormed Remarks
Male Female Male Female
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
TOTAL 0 0 0 0 0 0

Accomplished By: Noted By:

_______________________________ _________________________
School Clinic Teacher School Principal/Head/TIC
Date Accomplished: June 26, 2019
 Republic of the Philippines
Department of Education
COTABATO DIVISION
School Health Division

NATIONAL SCHOOL DEWORMING PROGRAM

S. Y. 2019 - 2020
School: __________________________ Grade Level:
MASTER LIST
Consent JULY 2019 JANUARY 2020
No. Name Sex Age 4P's
Yes No Yes No Absent Yes No Absent

1
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39
40

_______________________________________ Section: ____________________

Class Adviser
REMARKS
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