Republic of the Philippines

Department of Health
Regional Office XII
Cotabato City
MONTHLY ACCOMPLISHMENT REPORT
JULY 1-31, 2019

This is to CERTIFY that ROXETTE DONNA B. INES, RN of DOH XII – RHU PRESIDENT QUIRINO has
appeared this establishment/agency/hospital/CHO/MHO/RHU for the purpose of.
NAME & SIGNATURE OF
DATE AREA VISITED PURPOSE OF VISIT/ACTIVITIES
AUTHORIZED PERSONEL
Signature:
_____________________________
07-17-19 Name:
Designation:
Contact #:

07/18-
CA ATTACHED
19/19

Signature:
_____________________________
07-22-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-23-19 Name:
Designation:
Contact #: p
Signature:
_____________________________
07-24-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-25-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-26-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-29-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-30-19 Name:
Designation:
Contact #:
Signature:
_____________________________
07-31-19 Name:
Designation:
Contact #:

Prepared by: Noted by:

ROXETTE DONNA B. INES, RN FLORO L. DAGAANG, RN

NDP Supervisor

Verified by: Approved by:

JOCELYN T. TA DENA, MD NEDAISA N. NIŇAL, RN,

MPH
MHO DMO IV