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    CLENTH FLORentino
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    © All Rights Reserved
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    9 views1 page

    A Tano

    Uploaded by

    CLENTH FLORentino

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    NGCP HEALTH AND TRAVEL DECLARATION FORM GUEST roursane Tanda Ys sox M sce:28 xanonaury. FILIPINO (CaseName, First Nome, Middle Iii) (CURRENT ADDRESS IN THE PHILIPPINES: Tigre dahon Neg. Or. (douse mumble, set barangay and mong) " ‘CONTACT NO. INTHE PHILIPPINE: 040 CONTACT PERSON IN NGCP: PURPOSE OF VISIT IN NGCP: DATES OF VISIT IN NGCP: ‘TRAVEL oe ee eee Annex A_rev2 = SCREENING QUESTIONS = [¥Es_|_No- T.—ayou have foe Wat squalte orhigher than 37.050 lathe pant TO aya? = Oi have you taken antisfever medication the pat 10 days? Zave you had cough and/or dificalty of breathing in the past 10 days? t “Have you had ay close contact witha SUSPECTED COVID-19 patient (patient with over

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