DON MANUEL LOPEZ MEMORIAL DISTRICT HOSPITAL

Balayan, Batangas

EXPLANATION SHEET

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Date

ATTENTION:
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You are hereby given until _______________________________________________________ to submit

to this office a written explanation why _________________________________________________________________
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Noted:
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NAME NAME
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DESIGNATION DESIGNATION
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EXPLANATION:
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ACTION TAKEN / RECOMMENDATION:
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NAME
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MONITORING:
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APPROVED:
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NAME
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DESIGNATION