You are on page 1of 2

Current_Resid Date_of_first_p

ence:_Unit/Buil Directly_in_int Pregnancy_statu ositive_result_/


ding/House_Nu eraction_with_ s Immunod Patient_was_di _specimen_col Willing
Category_ID_N mber,_Street_
3824 PUROK 3 Current_Resid Current_Residence: Current_Residence: Current_Residence: Birthdate_mm/ Employment_S COVID_patient Contact_number Drug_All Food_All Insect_Al Latex_All Mold_All Pet_Aller Pollen_A With_Comorbi Hypertens Heart_Dis Kidney_Di Diabetes_ Bronchial eficiency_ agnosed_with_ lection_mm/dd/ Classification_ to_be_Vaccinat
Category* Category_ID* umber* PhilHealth_ID* PWD ID Last_Name* First_Name* Middle_Name* Suffix* Contact_No.* JOHNName*
BOSCO ence:_Region Province* Municipality/City* Barangay* Sex* dd/yyyy_* Civil_Status* tatus* * Profession* Name_of_Employer* Province/HUC/ICC_of_Employer* Address_of_Employer* _of_employer* * ergy? ergy? lergy? ergy? ergy? gy? llergy? dity? ion ease sease Mellitus _Asthma Status* Cancer Others COVID_19 yyyy_ of_COVID_19 ed?
01_Health_Care_Worker 01_PRC_number 0063244 180000251796 TAJO EXCELENTE JESUS MONTESCLAROS NA 09190664643 DIST CARAGA _1668_SURIGAO_DEL_SUR _166803_CITY_OF_BISLIG _166803009_MANGAGOY 02_Male 8/9/1961 02_Married 01_Government_Em
01_Yes 12_Physician LGU BISLIG CITY 1668 - SURIGAO_DEL_SUR NATIONAL HIGHWAY POBLACION BISLIG CITY 09190864137 02_Not_Pregnant 01_Yes 02_No 02_No 02_No 02_No 02_No 02_No 01_Yes 01_Yes 02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No 01_Yes
EXITO
NAME_OF_FACILITY_ PRC_LICENSE_NUMBER LAST_NAME FIRST_NAME MIDDLE_NAME_ POSITION ROLE

(team_lead,counseling_nurse,encoder)

You might also like