Republic of the Philippines

Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE

SCHOOL DENTAL HEALTH CARE PROGRAM (SDHCP) MONITORING TOOL

District Monitoring Date:

Name of
Time:
School
Number of Enrolled
School ID
learners
Number of TP Number of NTP

A. PREPARATORY ACTIVITIES
EVIDENT NOT EVIDENT
I. Orientation of Key stakeholders & health personnel
II. Orientation of school heads, clinic teachers, partners,
volunteers, & other stakeholders
III. Coordination meeting with partners
IV. Engagement with partners (MOA signing, etc.)

B. IMPLEMENTATION PHASE
EVIDENT NOT EVIDENT
I. Health services delivery (medical & dental)
II. Preparation and submission of monthly report
III. Periodic meeting with health personnel
IV. Provision of technical assistance
V. Conduct of monitoring, research, and evaluation
C. POST-IMPLEMENTATION PHASE
EVIDENT NOT EVIDENT
I. Preparation and submission of final report
II. Meeting with partners
III. Post implementation conference with school officials
IV. Post implementation conference with health
personnel

HEALTH SERVICE DELIVERY

A. ESTALISHED SCHOOL CLINIC
DENTAL EVIDENT NOT EVIDENT
1. Oral Health Examination of K – Gr. 6 learners
2. Fluoride Application of K – Gr. 3 learners
DEPEDQUEZON-TM-SDS-04-025-003

“Creating Possibilities, Inspiring Innovations”

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon
Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Email Address: quezon@deped.gov.ph
Website: www.depedquezon.com.ph
 Republic of the Philippines
Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE

3. ART – Sealant / Restoration (filling)

4. OUT - (sealant, ART, extraction, filling) of selected
emergency cases
5. Referral Cases
MEDICAL / NURSING EVIDENT NOT EVIDENT
1. Health Appraisal and Profiling of K – Gr. 6 learners
2. height and weight-taking, vision-screening, auditory
screening
3. Health Appraisal/Profiling of Personnel
4. Referral Cases
B. LAST MILE SCHOOL EVIDENT NOT EVIDENT
DENTAL
1. Oral Health Examination of K – Gr. 6 learners
2. Fluoride Application of K – Gr. 3 learners
3. ART – Sealant / Restoration (filling)
4. OUT - (sealant, ART, extraction, filling) of selected
emergency cases
5. Referral Cases
MEDICAL / NURSING
1. Health Appraisal and Profiling of K – Gr. 6 learners
2. height and weight-taking, vision-screening, auditory
screening
3. Health Appraisal/Profiling of Personnel
4. Referral Cases
C. SATELLITE SCHOOL
DENTAL
1. Oral Health Examination of K – Gr. 6 learners
2. Fluoride Application of K – Gr. 3 learners
3. ART – Sealant / Restoration (filling)
4. OUT - (sealant, ART, extraction, filling) of selected
emergency cases
5. Referral Cases
MEDICAL / NURSING
1. Health Appraisal and Profiling of K – Gr. 6 learners
2. height and weight-taking, vision-screening, auditory
screening
3. Health Appraisal/Profiling of Personnel
4. Referral Cases
DEPEDQUEZON-TM-SDS-04-025-003

“Creating Possibilities, Inspiring Innovations”

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon
Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Email Address: quezon@deped.gov.ph
Website: www.depedquezon.com.ph
 Republic of the Philippines
Department of Education
Region IV-A
SCHOOLS DIVISION OF QUEZON PROVINCE

D. REMAINING SCHOOL
DENTAL EVIDENT NOT EVIDENT
1. Oral Health Examination of K – Gr. 6 learners
2. Fluoride Application of K – Gr. 3 learners
3. ART – Sealant / Restoration (filling)
4. OUT - (sealant, ART, extraction, filling) of selected
emergency cases
5. Referral Cases
MEDICAL / NURSING
1. Health Appraisal and Profiling of K – Gr. 6 learners
2. height and weight-taking, vision-screening, auditory
screening
3. Health Appraisal/Profiling of Personnel
4. Referral Cases

FINDINGS/COMMENTS/ SUGGESTIONS OF HEALTH PERSONNEL

MONITORED BY:

______________________________________
NAME (HEALTH PERSONNEL)

NOTED BY:

_______________________________________
SCHOOL HEAD
DISTRICT : ________________________

DEPEDQUEZON-TM-SDS-04-025-003

“Creating Possibilities, Inspiring Innovations”

Address: Sitio Fori, Brgy. Talipan, Pagbilao, Quezon
Trunkline #: (042) 784-0366, (042) 784-0164, (042) 784-0391, (042) 784-0321
Email Address: quezon@deped.gov.ph
Website: www.depedquezon.com.ph