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Health Assessment Form For Student 022
Health Assessment Form For Student 022
For students in vulnerable group (VG): I fully understand that I must follow the prevailing guidelines prescribed by the
COVID-19
Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF).
I attest that all the information given above are true and correct and that I may be held liable for any misinformation
stated herein. I also authorize Our Lady of Fatima University to collect and process data indicated herein for the purpose of
effecting the control of COVID-19 infection and that my personal information are protected by RA.10173 (Data Privacy Act
of 201°C 2) and that I am required by RA.11469 (Bayanihan to Heal as One Act) to provide truthful information.
ALPHA S.KO
Student’s Signature Over Printed Name: DATE: 08-07-2022