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CATEGORY A4.

11 FRONTLINE PERSONNEL IN BASIC EDUCATION AND HIGHER EDUCATION INSTITUTIONS AND AGENCIES
(18 to 59yrs old)

Current_Residence:_ Pregnancy
Unit/Building/House_ _status Immunod Patient_was_di Date_of_first_positive_res Provided_Elect WILLING TO
Category_ID_Nu Number,_Street_Na Current_Residence:_R Current_Residence: Current_Residence: Current_Residence: Birthdate_mm/ Directly_in_interaction_wi Contact_number Drug_All Food_All Insect_Al Latex_All Mold_All Pet_Aller Pollen_A With_Comorbi Hyperten Heart_Dis Kidney_D Diabetes_ Bronchial eficiency_ agnosed_with_ ult_/_specimen_collection Classification_ ronic_Informed BE
Category* Category_ID* mber* PhilHealth_ID* PWD ID Last_Name* First_Name* Middle_Name* Suffix* Contact_No.* me* egion Province* Municipality/City* Barangay* Sex* dd/yyyy_* Civil_Status* Employment_Status* th_COVID_patient* Profession* Name_of_Employer* Province/HUC/ICC_of_Employer* Address_of_Employer* _of_employer* * ergy? ergy? lergy? ergy? ergy? gy? llergy? dity? sion ease isease Mellitus _Asthma Status* Cancer Others COVID_19 _mm/dd/yyyy_ of_COVID_19 _Consent? VACCINATED?
NAME_OF_FACILITY_ PRC_LICENSE_NUMBER LAST_NAME FIRST_NAME MIDDLE_NAME_ POSITION ROLE

(team_lead,counseling_nurse,encoder)

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