Republic of the Philipp

DEPARTMENT OF EDUC
Region XI
City Schools Division of Dig
City of Digos

SCHOOL-BASED DEWO
July 18, 2018
Region : XI
City/Province : Digos City/Davao del Sur

Sex Date of
No. Name of Students Age H W
Birth
M F

10

11

12

13

14

15
16

17

18

19

20

Accomplished by: JERYN RITZ MARA A. HERAMIZ Verified by: _____________________________

Class Adviser City Health Nurse

Sex Date of
No. Name of Students Age H W
Birth

M F

21

22

23

24
25

26

27
28

29

30

31

32

33

34

35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

Accomplished by: JERYN RITZ MARA A. HERAMIZ Verified by: _____________________________

Class Adviser City Health Nurse
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region XI
City Schools Division of Digos City
City of Digos

SCHOOL-BASED DEWORMING
July 18, 2018
School : MATTI NATIONAL HIGH SCHOOL
Grade Level and Section :12 - HEPHAESTUS/PROMETHEUS

Parent’s
4 P’s
Response Number of
Beneficiary
Address Slip Drugs Date Given Remarks
Yes No Yes No Given

______________________________________ Date Accomplished : ____________________________

City Health Nurse

Parent’s
4 P’s
Response
Beneficiary Number of
Slip
Address Drugs Date Given Remarks
Given
Yes No Yes No

/
/
/
/
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/
/
/
/
/
/
/
/
/
/

______________________________________ Date Accomplished : ____________________________

City Health Nurse