OfficialDOHgov DOHgovph doh.gov.

ph (632) 8561 – 78

COVID-19 Vaccination Card

Please keep this record card, which includes medical
ID No.
Information about the vaccines you have received.

ADRES CARMELA L.
Surname First Name M.I Suffix

Address 463 PUROK 4 STA.INES, MABALACAT PAMPANGA Contact No. 09650663050

Date of Birth NOVEMBER 30, 1983 PhilHealth No. __________________ Category _______________________

Dosage Seq. Date Vaccine Manufacturer Batch No. Lot No.

(mm/dd/y)
SINOVAC J20216035

11/25/2021
1st Dose
Vaccination Name Signature
Sarah Marie G. Sugihara RM/BSM
PRC #0170511

12/16/2021 SINOVAC J47381218

2nd Dose
(Schedule: 12 /16 / 21)
Vaccination Name Signature
Reina P. Deang, RM
LIC #0110056

MABALACAT CITY
Health Facility Name__________________________________________________ Contact No.___________________

OfficialDOHgov DOHgovph doh.gov.ph (632) 8561 – 78

COVID-19 Vaccination Card

Please keep this record card, which includes medical
ID No.
Information about the vaccines you have received.

SAN JOSE JONABELL L.

Surname First Name M.I Suffix

Address 463 PUROK 4 STA.INES, MABALACAT PAMPANGA Contact No. 09650663050

Date of Birth JUNE 3, 1986 PhilHealth No. __________________ Category _______________________

Dosage Seq. Date Vaccine Manufacturer Batch No. Lot No.

(mm/dd/y)
11/25/2021 SINOVAC J20216035

1st Dose
Vaccination Name Signature
Sarah Marie G. Sugihara RM/BSM
PRC #0170511

12/16/2021 SINOVAC J47381218

2nd Dose
 (Schedule: 12 /16 / 21) Vaccination Name Signature
Reina P. Deang, RM
LIC #0110056

MABALACAT CITY
Health Facility Name__________________________________________________ Contact No.___________________