MAY GO HOME SLIP

Date:
Name:
Age:
Sex:
Grade/Section:
Teacher-Adviser:

This certifies that the learner has been provided initial management at the clinic, with instructions from:

Name of Doctor:

The doctor has given instruction that the learner may go home/be fetched by his/her parent/guardian.

Signed:

Clinic Teacher/Nurse:

This certifies that I have been provided important information/instructions by the clinic teacher/nurse:

Signed:

Name of fetcher:
Relation to the child:
Time fetched:

Present this May Go Home Slip and cut and leave the upper portion of the slip to the guard before leaving the school.

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This lower portion may be brought home by the parent/fetcher.

REMINDERS TO THE PARENT

_ Please monitor the following:

_ Please consult with…

_ Your child has been reported to the BHERT ( ); please coordinate with them for the next steps

_ Please inform the school immediately if your child tests positive for COVID-19.

_ Medical certificate/clearance is required before the learner is allowed to return to face-to-face classes, subject to the approval of
the DepEd Medical Officer.