CASE REPORT FORM

Patient Age in Street purok / Municipality/ Date of Vit A

Full Name Date of Birth Fever Onset Rash Onset Outcome
Number Years Barangay City Admission Given?
210589 1. FERNANDEZ, NATHANIEL G. 0.58 9/12/2017 TALOY MALASIQUI 4/24/2018 4/23/2018 4/23/2018 N Alive
211269 2. FERNANDEZ, JOHN GABRIEL I. 0.58 9/5/2017 CAWAYAN BOGTONG MALASIQUI 4/27/2018 4/27/2018 4/27/2018 N Alive

213109 1. CORPUZ, JAMES EZEKIEL M. 0.67 M 9/14/2017 TAMBAC MALASIQUI 5/6/2018 5/1/2018 5/5/2018 N A
223517 1. VALDEZ, KRISTINE B. 14 F 5/30/2004 PASIMA MALASIQUI 6/28/2018 6/26/2018 6/25/2018 N Alive
231550 1. CAYABYAB, ROMARK D.R. 1 M 11/16/2016 PALONG MALASIQUI 8/2/2018 7/29/2018 8/1/2018 Y A
236976 1. NIEVA, LEONILA C. 30 F 10/5/1987 LOQUEB SUR MALASIQUI 8/24/2018 8/20/2018 8/23/2018 N Alive
241264 2. ESPINOZA, PRINCE XYRUS 7 M 12/10/2017 BOLAOIT MALASIQUI 9/12/2018 9/8/2018 9/14/2018 Y Alive
P.
242545 PARAMIO, JEGMY S. 7 M 2/12/2018 BOLAOIT MALASIQUI 9/18/18 9/18/18 9/18/18 Y Alive
245833 BUCOD, JANELLA FAITH R 6 F 4/4/2018 TALOSPATANG MALASIQUI 10/1/2018 9/28/2018 10/2/2018 N Alive
248363 ARMAS, LEONORA T 5 F 5/17/2018 LEPA MALASIQUI 10/14/2018 10/9/2018 10/13/2018 Y Alive
248261 EDGAR, PRINCE MASIGLAT 7 M 3/18/2018 MALIMPEC MALASIQUI 10/13/2018 10/8/2018 10/9/2018 Y Alive
249925 MEJIA, JOSHUA J. 9 M 1/18/2018 PAYAR MALASIQUI 10/19/2018 10/15/2008 10/17/201 N Alive
250476 EVANGELISTA, JAMAICA T. 13 F 9/3/2017 MALIMPEC MALASIQUI 10/23/2018 10/19/2018 10/23/2018 Y Alive
253916 RAMIREZ, JOAN C. 19 F 8/28/1999 BINALAY MALASIQUI 11/7/2018 11/6/2018 11/6/2018 N Alive
253256 VELASQUEZ, JOSHUA B. 20 M 9/17/1998 LOKEB ESTE MALASIQUI 11/5/2018 11/1/2018 11/3/2018 U Alive
256691 BELARMINO, MICHAEL S. 36 M 2/26/1982 LOKEB ESTE MALASIQUI 11/19/2018 11/12/2018 11/16/2018 Y Alive