Republic of the Philippines Republic of the Philippines

Province of Surigao del Sur Province of Surigao del Sur

MARIHATAG DISTRICT HOSPITAL MARIHATAG DISTRICT HOSPITAL
Marihatag, Surigao del Sur Marihatag, Surigao del Sur

ANIMAL BITE ANIMAL BITE

Schedule: Tuesday and Friday @ 1:00PM Schedule: Tuesday and Friday @ 1:00PM

Name: Name:

Age: Date: Age: Date:

Animal Bite Injection Package: Animal Bite Injection Package:

Amount: ___________ NOD/MOD: _____________ Amount: ___________ NOD/MOD: _____________

OR #: _________________________ OR #: _________________________

Republic of the Philippines Republic of the Philippines

Province of Surigao del Sur Province of Surigao del Sur
MARIHATAG DISTRICT HOSPITAL MARIHATAG DISTRICT HOSPITAL
Marihatag, Surigao del Sur Marihatag, Surigao del Sur

ANIMAL BITE ANIMAL BITE

Schedule: Tuesday and Friday @ 1:00PM Schedule: Tuesday and Friday @ 1:00PM

Name: Name:

Age: Date: Age: Date:

Animal Bite Injection Package: Animal Bite Injection Package:

Amount: ___________ NOD/MOD: _____________ Amount: ___________ NOD/MOD: _____________

OR #: _________________________ OR #: _________________________

Republic of the Philippines Republic of the Philippines

Province of Surigao del Sur Province of Surigao del Sur
MARIHATAG DISTRICT HOSPITAL MARIHATAG DISTRICT HOSPITAL
Marihatag, Surigao del Sur Marihatag, Surigao del Sur

ANIMAL BITE ANIMAL BITE

Schedule: Tuesday and Friday @ 1:00PM Schedule: Tuesday and Friday @ 1:00PM

Name: Name:

Age: Date: Age: Date:

Animal Bite Injection Package: Animal Bite Injection Package:

Amount: ___________ NOD/MOD: _____________ Amount: ___________ NOD/MOD: _____________

OR #: _________________________ OR #: _________________________

Republic of the Philippines Republic of the Philippines

Province of Surigao del Sur Province of Surigao del Sur
MARIHATAG DISTRICT HOSPITAL MARIHATAG DISTRICT HOSPITAL
Marihatag, Surigao del Sur Marihatag, Surigao del Sur

ANIMAL BITE ANIMAL BITE

Schedule: Tuesday and Friday @ 1:00PM Schedule: Tuesday and Friday @ 1:00PM

Name: Name:

Age: Date: Age: Date:

Animal Bite Injection Package: Animal Bite Injection Package:

Amount: ___________ NOD/MOD: _____________ Amount: ___________ NOD/MOD: _____________

OR #: _________________________ OR #: _________________________