Republic of the Philippines

Department of Education
Region II – Cagayan Valley
Schools Division of Nueva Vizcaya
Lamo national High School
Dupax del norte, Nueva Vizcaya

HEALTH DECLARATION SHEET DATE: _______________________

Cough & Difficulty of Fatigue or Loss of Taste
Fever Sore Throat Diarrhea Headache Body Pain
NAME Temp. Colds Breathing Tiredness or smell REMARKS
Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
1. ARAGON, Thelma T.
2. ASIS, Marilyn A.
3. BAHAL, Patricio M.
4. BASILIO, Chona L.
5. BINAY-AN, Merlie M.
6. BLANZA, Murmuray V.
7. BOADA, Teresita A.
8. BULLECER, Zoraida L.
9. CABILDO, Sharon V.
10. CADANG, Rowin I.
11. CALIBUSO, Cris V.
12. CALLA, Fayelyn B.
13. DALMACIA, Romelyn L.
14. DAQUIOAG, Princess Diana A.
15. DARAUAY, Raquel Florian M.
16. DUGAY, Shairuz Caesar B.
17. EDROZO, Michelle Anne A.
18. ESTRADA, Crizelda S.
19. ESTRADA, Rhodalyn P.
20. GAMBOA, Robert R.
21. GARCIA, Joefel J.

Address: Lamo, Dupax del Norte, Nueva Vizcaya

Telephone Nos.: (078) xxx-xxxx
Email Address: lnhs300635@yahoo.com
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Nueva Vizcaya
Lamo national High School
Dupax del norte, Nueva Vizcaya
22. HANTOC, Jemer S.

Cough & Difficulty of Fatigue or Loss of Taste

Fever Sore Throat Diarrhea Headache Body Pain
NAME Temp. Colds Breathing Tiredness or smell REMARKS
Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
23. JOSE, Vicor John D.
24. LAYNO, Rachelle Joyce M.
25. MACARAEG, Josephine E.
26. MAGLAYA, Lauro A.
27. MARTINEZ, Alex D.
28. MARTINEZ, Ferdinand
29. MARTINEZ, Melanie M.
30. MATIAS, Norbert M.
31. MIRAN, Mary Jane O.
32. NELMIDA, Luzviminda G.
33. NITAPAC, Nephtali G.
34. NUESTRO, Geneva O.
35. OCHONA, Hilda C.
36. OLIVARES, Regie B.
37. ORALLO, Wilmer V.
38. ORCALES, Guilbert R.
39. ORCALES, Peter Henry
40. ORDIZO, Jennifer C.
41. PAAS, Jenny Rose B.
42. PABIONA, Mary Jane N.
43. PABLO, Edwin Jr. C.

Address: Lamo, Dupax del Norte, Nueva Vizcaya

Telephone Nos.: (078) xxx-xxxx
Email Address: lnhs300635@yahoo.com
 Republic of the Philippines
Department of Education
Region II – Cagayan Valley
Schools Division of Nueva Vizcaya
Lamo national High School
Dupax del norte, Nueva Vizcaya
44. PACAY, Rachel V.
45. PERIA, Imelda M.
46. PUGAYAN, Robert Jr. S.

Cough & Difficulty of Fatigue or Loss of Taste

Fever Sore Throat Diarrhea Headache Body Pain
NAME Temp. Colds Breathing Tiredness or smell REMARKS
Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No
47. RAMIENTO, Cedrik Jessie S.
48. RAMIENTO, Percival S.
49. RAMOS, Ian Keith D.
50. ROMERO, Andrea Mariae A.
51. ROMERO, Zaldy E.
52. RUMBAUA, Rowann A
53. SALEM, Harry Bill Nino M.
54. SOMERA, Marivic C.
55. SUGUITAN, Cynthia N.
56. TAGAMI, Romelia C.
57. TIONGSON, Norla L.
58. VALDEZ, Edison A.
59. VALDEZ, Lester John T.

Address: Lamo, Dupax del Norte, Nueva Vizcaya

Telephone Nos.: (078) xxx-xxxx
Email Address: lnhs300635@yahoo.com