Republic of the Philippines

Region I
Schools Division Office
Vigan City
VIGAN NATIONAL HIGH SCHOOL WEST
Paratong, Vigan City

STUDENTS RECORDS OF DAILY TREATMENT

STUDENTS ID NUMBER NAME OF PATIENT/LEARNER AGE GRADE LEVEL SECTION SCHOOL YEAR

HOMEROOM ADVISER ADVISER CONTACT NUMBER ADVISER PRESENT ADDRESS

TIME DATE YEAR

CHIEF COMPLAINT VITAL SIGNS TREATMENT / NURSING INTERVENTION MEDICATION

BLOOD PRESSURE

PULSE RATE

CARDIAC RATE

OXYGEN
SATURATION

LEARNERS CONTACT NUMBER CLINIC INCHARGE CONTACT NUMBER

LEARNERS COMPLETE NAME/SIGNATURE CLINIC INCHARGE

MEDICAL HISTORY
DATE/TIME CHIEF COMPLAINT REMARKS

INCASE OF EMERGECNY

PARENTS NAME

ADDRESS

CONTACT NUMBER
STUDENTS ID NUMBER LEARNERS or PATIENTS NAME
2 WEST 2

HOMEROOM ADVISER

ADVISER CONTACT NUMBER 997

CHIEF COMPLAINT VITAL SIGN

YEAR DATE TIME BP PR CR

0 0 0 0 0 0
0 0 0 0 0 0

LEARNERS CONTACT NUMBER

90000002
 90000002

LEARNERS COMPLETE NAME / SIGNATURE

WEST 2
PATIENTS NAME AGE GRADE LEVEL SECTION SCHOOL YEAR
EST 2 16 G-10 MAYA 2019-2020

GLENDA RICOLCOL

9977048422

TREATMENT or NURSING INTERVENTION MEDICATION

0 0
0 0

MBER
CLINIC INCHARGE CONTACT NUMBER
SIGNATURE CLINIC INCHARGE
 1 2 3 4

STUDENTS ID NUMBER TIME MONTH YEAR

0.1 8:00 JUNE,4 2020
2 9:00 JULY,5 2020
3 10:00 AUG,6 2020
4 11:00 SEPT,7 2020
5 12:00 OCT,8 2020
6 1:00 NOV,9 2020
7 2:00 DEC,10 2020
8 3:00 JAN,11 2020
9 4:00 FEB,12 2020
10 MAR,23
11 APR,24
12
13
14
15
16
17
18
19
20
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
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
 88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
 5 6 7 8 9

NAME OF PATIENT / LEARNER AGE GRADE LEVEL SECTION SCHOOL YEAR

WEST 1 15 G-9 ADARNA 2019-2020
WEST 2 16 G-10 MAYA 2019-2020
WEST 3 17 G-12 EARTH 2019-2020
WEST 4 18 G-11 JUPITER 2019-2020
WEST 5 19 G-9 DIAMOND 2019-2020
WEST 6 20 G-10 GRADE 2019-2020
WEST 7 21 G-12 NARRA 2019-2020
WEST 8 22 G-11 EINSTEIN 2019-2020
WEST 9 23 G-9 ARISTOTLE 2019-2020
WEST 10
WEST 11
WEST 12
WEST 13
WEST 14
WEST 15
WEST 16
WEST 17
WEST 18
WEST 19
WEST 20
WEST 21
WEST 22
WEST 23
WEST 24
WEST 25
WEST 26
WEST 27
WEST 28
WEST 29
WEST 30
WEST 31
WEST 32
WEST 33
WEST 34
WEST 35
WEST 36
WEST 37
WEST 38
WEST 39
WEST 40
WEST 41
WEST 42
WEST 43
WEST 44
WEST 45
WEST 46
WEST 47
WEST 48
WEST 49
WEST 50
WEST 51
WEST 52
WEST 53
WEST 54
WEST 55
WEST 56
WEST 57
WEST 58
WEST 59
WEST 60
WEST 61
WEST 62
WEST 63
WEST 64
WEST 65
WEST 66
WEST 67
WEST 68
WEST 69
WEST 70
WEST 71
WEST 72
WEST 73
WEST 74
WEST 75
WEST 76
WEST 77
WEST 78
WEST 79
WEST 80
WEST 81
WEST 82
WEST 83
WEST 84
WEST 85
WEST 86
WEST 87
WEST 88
WEST 89
WEST 90
WEST 91
WEST 92
WEST 93
WEST 94
WEST 95
WEST 96
WEST 97
WEST 98
WEST 99
WEST 100
WEST 101
WEST 102
WEST 103
WEST 104
WEST 105
WEST 106
WEST 107
WEST 108
WEST 109
WEST 110
WEST 111
WEST 112
WEST 113
WEST 114
WEST 115
WEST 116
 20 22 23 24
MEDICAL HISTOR
LEARNERS CONTACT NUMBER CLINIC INCHARGE CONTACT NUMBER CLINIC INCHARGE DATE
90000001
90000002
90000003
90000004
90000005
90000006
90000007
90000008
90000009
90000010
90000011
90000012
90000013
90000014
90000015
90000016
90000017
90000018
90000019
90000020
90000021
90000022
90000023
90000024
90000025
90000026
90000027
90000028
90000029
90000030
90000031
90000032
90000033
90000034
90000035
90000036
90000037
90000038
90000039
90000040
90000041
90000042
90000043
90000044
90000045
90000046
90000047
90000048
90000049
90000050
90000051
90000052
90000053
90000054
90000055
90000056
90000057
90000058
90000059
90000060
90000061
90000062
90000063
90000064
90000065
90000066
90000067
90000068
90000069
90000070
90000071
90000072
90000073
90000074
90000075
90000076
90000077
90000078
90000079
90000080
90000081
90000082
90000083
90000084
90000085
90000086
90000087
90000088
90000089
90000090
90000091
90000092
90000093
90000094
90000095
90000096
90000097
90000098
90000099
90000100
90000101
90000102
90000103
90000104
90000105
90000106
90000107
90000108
90000109
90000110
90000111
90000112
90000113
90000114
90000115
90000116
 25 26 27 28 29
MEDICAL HISTORY INCASE OF EMERGENCY
CHIEF COMPLAINT REMARKS
PARENTS NAMEADDRESS CONTACT NUMBER
GRADE LEVEL ADVISER HOMEROOM ADVISER CONTACT NUMBER
ADARNA JENNIFER AGCAMARAN
MAYA GLENDA RICOLCOL 9977048422
EARTH LIZETTE GARCIA
JUPITER CHRISTINE PALACPAC 9167449289
DIAMOND MARICOR ANYOG 9459604694
GRADE MARICAR LOPEZ 90694477310
NARRA EMILY PIGAO 9278299113
EINSTEIN JOVELYN FAVO
ARISTOTLE MONETTE REFUERZO 9069370651