REPUBLIC OF THE PHILIPPINES DEPARTMENT OF EDUCATION DIVISION OF OZAMIZ CITY ‘eamer Reference Number Gity of Ozamiz SCHOOL HEALTH EXAMINATION CARD lemeatary Pupils NAME, scHoOL, Tat ine Tia Date of Bin, Repion oath Day Year Bintplace Divison ParentGusrdian Telephone No E Date of Examination Heart Rate/Pulse Rat Tey Wei ‘Nutitonal Satur (NS) ‘Acuity Gaellen') a.NRLb.NLA 6 ABN RE d ABN LA acing (Ting Fork) a.NR,b.NLf © ADN RE J AULA ‘Sein Sealp 5 ioe ‘Mouth Tiroat NESE Tangent z ental ier, ‘Examined NS] SkivSeaip | EyelEaiNoes | MoulvNecdThroal] Lungatioart | — Abdomen Spinel Rerane Gonitala_| _Exvemites_| intervention =Nomal | a-nomal | @Nomaleye [a Nomalmouh Ja Nomalungs | @.Normal | a.Normal | a. Neecs abcomen | Spine Supervision T-Beow | b,Pedieuoss | 5. Norralears |b. Nomaltivoat |b. Nomalheat | b. Noma | b.NUpper | b. Needs cose Normal Genitalia Extremities | supervision = Above | Tea Fava | Nonmal nove |= Eniargod tonal [a Rabe = Nass TN Lower | 6: Neode Normal witvle exudation Extremities | “Follow-up a Rgwarm | Squing —[ Up esion [a Wheezs | d Henentoiis | & Scotosis | Serected e.ccema | €. Pale e.Eniarged onsis_|e- Murmur | e Tenderness | e.Lordosis | treated corjuncivee |" witywlo eudates| T impetigo! | Ear TTaflared pharynx {Deformed | Genital T Ryphoss | t Advised bod discharge | “witwwioenudates | Chest Discharge Counseled @ Hematoma | 9. impoctod 9. Enlarged hyroid |p. Disiart heat | @ Hemia o Bawoge | @ Referred conmen__|* Gland sounds knock knoe Tranuses |W Septal i Speech dete —R-rrequar | Tr Others, | W-Flatoot | Parents eviation hart rate spent, rtfed Tour TRasal T Dental problem [Others T Ob Toot | TOtfers, lacerations | _dscharge ‘specify spect Others, |) Oars, specky T Otten, TAtewy TF T Other, spect Note: Use letter to record ailments and place X if not examined