DepEd Form 1A.

List of SAC Enrolled Per Class and Deworming Status by MDA Round

School ID:108051 Name of School:Tulay Elementary School Type:1 1- Public 2-Private

Adress of the School: TULAY B, MARAGONDON, CAVITE District:MARAGONDON Division: CAVITE PROVI
Part 1. List of SAC Enrolled Part 2. Deworming Status During Each Roun
No. Name of SAC Address Birthday Age Sex SE Status First Round of MDA (August'2022)
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed / - with ADR,
F-Female Non4Ps write date specify
dewormed type
X - no ADR
(6) X - not
(1) (2) (3) (4) (5) (7) dewormed
(8) (9)

1 BANTIGUE,KING XYRUS, BERSABE TULAY SILANGAN 11/12/2012 9 M 2

2 BELTRAN,AHL JARED, TANTAN TULAY SILANGAN 4/1/2013 9 M 2
3 BENDO,JOSH RAVEN, TADEO TULAY SILANGAN 6/15/2013 8 M 1
4 DE TAZA,JOEL, JR SERNAT LAYONG MABILOG 3/11/2013 9 M 2
5 DELA CRUZ,ETHAN, JULATON TULAY KANLURAN 11/9/2013 8 M 1
6 DELA PAZ,KERVY ALEXIS, MARQUEZ TULAY SILANGAN 9/28/2012 9 M 2
7 DIMAPILIS,TRISTAN JAY BENEDICT, LACESTE TULAY SILANGAN 10/21/2012 9 M 2
8 FRANCISCO,MC AARON, BERBER TULAY SILANGAN 12/31/2011 10 M 2
9 GAUN,LANZ, MENDOZA TULAY SILANGAN 1/28/2013 9 M 2
10 ISO,REYMARK, LIZARDO TULAY SILANGAN 4/20/2013 9 M 2
11 MALTOS,ZYNIX PHYRO, BERENGUEL LAYONG MABILOG 10/30/2013 8 M 1
12 MARQUEZ,CARL ZAIJAN, BACURIN TULAY SILANGAN 1/11/2013 9 M 2
13 PILAPIL,KEVIN, ESPIRITU TULAY SILANGAN 10/24/2012 9 M 2
14 ROBLES,AUDRICK CLYD, CASAUL TULAY SILANGAN 3/7/2013 9 M 2
15 RONCEJERO,JHON RICK, SALORSANO LAYONG MABILOG 6/29/2013 8 M 2
16 RUFO,CHRISTIAN, DIMAPILIS MABATO 9/2/2010 11 M 1
17 SISIT,LANZE ANDREI, ACOSTA TULAY KANLURAN 4/5/2013 9 M 2
18 TROCIO,ALEXANDER, FERNANDEZ LAYONG MABILOG 9/22/2012 9 M 2
Part 1. List of SAC Enrolled Part 2. Deworming Status During Each Roun
No. Name of SAC Address Birthday Age Sex SE Status First Round of MDA (August'2022)
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR,
F-Female Non-4Ps write date specify
dewormed type
X - no ADR
(6) X - not
(1) (2) (3) (4) (5) (7) dewormed
(8) (9)

1 AJEDO,JHANNA MARIE, CATIMON TULAY SILANGAN 12/13/2012 9 F 2

2 BAUTISTA,FRENCHESKA, SOTELO TULAY SILANGAN 4/22/2013 9 F 2
3 BOLANON,KYLIE JHANE, SURBANO TULAY SILANGAN 1/14/2013 9 F 2
4 CARIDO,DEVINE MAE, ORIENDO TULAY SILANGAN 7/9/2013 8 F 2
5 DE JESUS,EDREI LEE, DIMAPILIS MABATO 11/30/2012 9 F 2
6 DE JESUS,RAIZA, ADONA TULAY SILANGAN 12/10/2012 9 F 2
7 DEL MUNDO,ANJEL HEART, PARAISO TULAY KANLURAN 2/3/2013 9 F 2
8 FRANCISCO,FRANCHESKA LORIENNE, BERBER TULAY SILANGAN 3/19/2012 10 F 2
9 GONZALES,VENICE, BENITEZ TULAY SILANGAN 2/2/2013 9 F 2
10 INIEGO,ALEXANDRA, ARANTE TULAY SILANGAN 5/31/2013 8 F 2
11 LANSANGAN,LINDSHEY, ANGUE TULAY SILANGAN 11/19/2012 9 F 2
12 LELIS,MARGAUX, CAYABYAB TOCLONG 9/1/2013 8 F 2
13 MANDASOC,PRINCESS MAE, MOGARA TULAY SILANGAN 10/14/2012 9 F 2
14 MEDINA,KIM, DE JESUS TULAY SILANGAN 10/10/2012 9 F 1
15 QUISING,SARAH MAE, RURAL TULAY SILANGAN 3/10/2013 9 F 2
16 ROSAROSO,JOHAIRA, PELO TULAY SILANGAN 12/5/2012 9 F 2
17 TAÑAG,MARIEL, CORTEZ TULAY SILANGAN 3/14/2013 9 F 1
18 TEMLOR,LYANNA MAE, TEJOR TULAY SILANGAN 1/24/2013 9 F 2
Total No. Enrolled: 36 M:18 NHTS-4Ps No. NHTS-4Ps No. w/ ADR:
F:18 6 Dewormed:
NHTS-non4Ps
30 No. NHTS non
4Ps
Dewormed:

Total:
 Total No. Enrolled: 36 M:18 NHTS-4Ps No. NHTS-4Ps No. w/ ADR:
F:18 6 Dewormed:
NHTS-non4Ps
30 No. NHTS non
4Ps
Dewormed:

Total:

Accomplished by Classroom Adviser: MARLON M. NOVISIO

Noted by Grade Level Chairman:
Date:
s by MDA Round

School Year:2022-2023 Grade Level/Section:4-EMILIANO

Division: CAVITE PROVI Region:IV-A CALABARZON

Part 2. Deworming Status During Each Round of MDA Part 3. Status of
Deworming by
nd of MDA (August'2022) Second Round of MDA (Feb. 2023) School Year
/ - dewormed, / - withADR Remarks / - received 2
Remarks write date specify type doses/year
dewormed X - received only 1
X - no ADR dose or no
X - not dose/year
dewormed (13) (14)
(10) (11)
(12)

Part 2. Deworming Status During Each Round of MDA Part 3. Status of

Deworming by
nd of MDA (August'2022) Second Round of MDA (Feb.'2023) School Year
/ - dewormed, / - with ADR Remarks / - received 2
Remarks write date specify type doses/year
dewormed X - received only 1
X - no ADR dose or no
X - not dose/year
(10) dewormed (13) (14)
(11)
(12)

No.NHTS- 4Ps No. w/ ADR: No. recvd 2 doses:

Dewormed:
No. recvd 1 or 0
No. NHTS non dose:
4Ps
Dewormed:

Total:
No.NHTS- 4Ps No. w/ ADR: No. recvd 2 doses:
Dewormed:
No. recvd 1 or 0
No. NHTS non dose:
4Ps
Dewormed:

Total:
TULAY SILANGAN
TULAY SILANGAN
TULAY SILANGAN
LAYONG MABILOG
TULAY KANLURAN
TULAY SILANGAN
TULAY SILANGAN
TULAY SILANGAN
TULAY SILANGAN
TULAY SILANGAN
LAYONG MABILOG
TULAY SILANGAN
TULAY SILANGAN
TULAY SILANGAN
LAYONG MABILOG
MABATO
TULAY KANLURAN
LAYONG MABILOG
 DepEd Form 1B. List of Adolescents Enrolled Per Class and Deworming Status by MDA Round

School ID: Name of School: Type: 1- Public 2-Private School Year: Grade Level/Section:

Adress of the School: District: Division: Region:

Part 1. List of Adolescents Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status of
Deworming by
No. Name of Adolescent Address Birthday Age Sex SE Status First Round of MDA (August'2022) Second Round of MDA (Feb.'2023) School Year
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR, Remarks / -dewormed, / - withADR Remarks / - received 2
write date specify write date specify type doses/year
F-Female Non4Ps X - received only
dewormed type dewormed X - no ADR
X - not X - no ADR 1dose or no
dewormed X - not dose/year
(6) (7)
(1) (2) (3) (4) (5) (10) dewormed (12) (13)
(8) (9) (11) (14)
 Part 1. List of Adolescents Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status
ofDeworming
No. Name of Adolescent Address Birthday Age Sex SE Status First Round of MDA (August'2022) Second Round of MDA (February'2023) by SchoolYear
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR, Remarks / - dewormed, / - with ADR, Remarks / - received 2
write date specify write date specify type doses/year
F-Female Non-4Ps X - received only
dewormed type dewormed X - no ADR
X - not X - no ADR 1 dose or no
dewormed X - not dose/year
(6) (7) (14)
(1) (2) (3) (4) (5) (10) dewormed (12)
(8) (9) (11) (13)

Total No. Enrolled: M: NHTS-4Ps No. NHTS-4Ps No. w/ ADR: No. NHTS-4Ps No. w/ ADR: No. recvd 2
F: Dewormed: Dewormed: doses:
NHTS-
non4Ps No. NHTS non No. NHTS non No. recvd 1 or 0
4Ps Dewormed: 4Ps Dewormed: dose:

Total: Total:

Accomplished by Classroom Adviser:

Noted by Grade Level Chairman:
Date:
Accomplished by Classroom Adviser:
Noted by Grade Level Chairman:
Date:
 School
DepEd Form 2. Consolidation of MDA Coverage of SAC (Kinder to Grade 12) Year: 2022-2023
School
ID: Name of School: Type: 1-Public 2-Private
Address of the
School: District: Division: Cavite Province Region: IV- A

First MDA Round (August' 2022) Second MDA Round (February' 2023) No. Given 2 doses By SY

Grade Total No. Total Number Dewormed No. w/ Total Number Dewormed No. w/ NHTS
adverse adverse NHTS- Remarks
Level Enrolled Remarks Non-
drug drug 4Ps Total (9)
(1) (2) (5) 4Ps
NHTS NHTS reactions NHTS NHTS reactions (8a)
(4) Total (7) (8b)
4Ps Non4Ps Total 4Ps Non4Ps
(3a) (3b) (6a) (6b)
Kinder
Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8
Grade 9

Grade
10
Grade
11
Grade
12
SPED
ALS
Total 0 0 0 0 0 0 0 0 0 0 0 0 0
Percent (%):
Column Total
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Divide Row Total
Multiplied by 100
Accomplished by School Clinic Teacher:
Noted by School Principal:
Date Accomplished: