Republic of the Philippines

Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE
2nd District, Quezon City, Metro Manila

DEWORMING FORM
PAYATAS B ELEMENTARY SCHOOL
Name of School
School Year: 2019 -2020
Grade and Section: VI Date Dewormed : JULY , 2019
Section: ARA Time Dewormed:
Adviser: MELANIE S. OBENZA Total Dewormed:
Total Enrollment: 45 Absent:
First Dose Second Dose
Name of Students Age
Dewormed (/)
Not Dewormed Reason for Adverse
Age Dewormed (/) Not Reason for
Refusal Effect/s Dewormed (x) Refusal Adverse Effect/s
(x) Remarks Remarks
1 ARRIESGADO, AARON 10:08
2 ASUCRO, JAYSON 10:09
3 BACAY, JEREMIE 11:04
4 BALAN, MUK JOSEPH 11:11
5 BALORO, ROLAN 11:11
6 BASMAYOR, MARK LAURENCE 11:00
7 BEROL, M-JAY 11:08
8 CAMINGUE, MARK CARL 11:11
9 CARRANZA, NEIL JOHN G. 11:09
10 CONEJOS, JOHN BERT 11:08
11 CUDAL, KIM JAMES L. 12:04
12 DABON, FERNAND JR. C. 10:10
13 LUMBAD, JUNWELL B. 11:04
MALICDEM, CHARLES ANDREW
14 12:02
P.
15 MAPANO, JOHN PAUL 11:07
16 MONTANO, GIAN PATRICK C. 11:01
17 OLEGARIO, RIZALDE N. 11:05
18 PAGUE, JOHN PAUL R. 11:11
19 PARONE, RYAN JAY 12:05
20 PATAUEG, MELQUIZEDEC S. 11:06
21 SININING, RENZ 11:04
22 TOLENTINO, RANEIL C. 11:07
23 WALONDRE, KIER R. 11:11
24 ZOILO, CHRIATIAN REY M. 11:03

1 ACURAM, PRITCHZ S. 10.07

2 ALDAVE, RICHWELL SHANIKA 11.08
3 ANCHETA, KACEY MARGARETH 10.08
4 ARIENZA, ELIEZA MAE 12.10
5 ARRIESGADO, MIA B. 11.00
6 BACALLA, PRINCESS 10.09
7 BALANA, SOFIA CASSANDRA 10.08
8 DAYRIT, JONALYN B. 11.00
9 DELA TORRE,MARIAN P. 11.05
10 DUMLAO, GLENICE JOY 10.10
11 GARCIA, ANNA A. 11.05
12 IRINCO, PAULA M. 11.09
13 MABUNGA, JANNA MAE 10.09
14 MANAGAYTAY, ANNA NICOLE S. 11.00
15 MANAGO, LORRAINE 10.06
16 RICARDO, MARIAN 11.01
17 SAMBO, PRECIOUS 11.06
18 SANCHEZ, CLARA 11.06
19 PATTAUI, MA. CRISTINA 11.06
20 TORTOLES, MARY CLAIRE 11.00
21 RONDINA, ANRONDINA, ANGEL JOY 11.05

Total Dewormed: Total Dewormed:

Not Dewormed: Not Dewormed:

Assisted by: Dewormed by:

MELANIE S. OBENZA ________________________________ ________________________________

Teacher Nurse Medical Officer