Republic of the Philippines

Department of the Education

Region VIII (Eastern Visayas)
Baybay City Division

National School Deworming (SY: 2022-2023)

Name of School:__AMBACAN ELEMENTARY Grade Level/Section: __ONE___
Adviser: Rosalie M. Nopal

1st Round REMARKS 2nd Round REMARKS

4Ps
With Date With Date
NO. NAME OF LEARNERS 1. ABSENT 1. ABSENT
consent 9-21-22 2. ALLERGY consent 03-09-23 2. ALLERGY
Y/N
Y/N / X 3. OTHERS Y/N / X 3. OTHERS
1 ALTIVO,ALTHEA MAY, C.
2 CEBALDA,JERICHO, S.
3 CUTAMORA,CRIS NIñO, -
4 MIEGO,ARIANA HERALYN JADE, P.
5 MARTINEZ,BILLY, JR P.
6 MORETE,JEFFREY, -
7 OMILLON,MAIN, RAMAL
8 PASTORIL,JOBINELL, C.
9 POJARAS,JAY MICHAEL, P.

Grade Level/Section: __TWO___

1st Round REMARKS 2nd Round REMARKS

4Ps
Date Date
With 9-21-22 With
NO. NAME OF LEARNERS 03-09-23
consent 1. ABSENT consent / 1. ABSENT
Y/N 2. ALLERGY 2. ALLERGY
Y/N Y/N
/ X 3. OTHERS X 3. OTHERS
1 ALTIVO,CARL PHILIP CELESTE
2 DELCORO,JERREY LEE CASTAÑAS
3 DIASNES,ALY G VICTORAMA
4 FERNANDICO,JORGE MARIO REQUIOMA
5 KUIZON,MARJORIE ZABALA
6 OMILLON,SOPIA COMPUESTO
7 POLO,JIM VEE OMILLON
8 TOLEDO,VINCE IAN CALAGO

1st Round Total No. of Enrollees: _______ : Total Enrolled Male: _______ : Total Enrolled Female: ________
Total No. of Dewormed: ______ : Total Dewormed Male: ______ : Total Dewormed Female: _____
Total 4P’s Dewormed: ____ __ : Total Non-4P’s Dewormed: _____

2nd Round Total No. of Enrollees: _________ : Total Enrolled Male: _________ : Total Enrolled Female: __________
Total No. of Dewormed: ________ : Total Dewormed Male: ________ : Total Dewormed Female: _______
Total 4P’s Dewormed: ________ : Total Non-4P’s Dewormed: _______
Prepared By:
____________________________
Signature Over Printed Name –
Teacher 1
 Republic of the Philippines
Department of the Education
Region VIII (Eastern Visayas)
Baybay City Division

Name of School:__AMBACAN ELEMENTARY Grade Level/Section: __Kindergarten___

Adviser: __________________________

1st Round REMARKS 2nd Round REMARKS

4Ps
With Date With Date
NO. NAME OF LEARNERS 1. ABSENT 1. ABSENT
consent 9-21-22 2. ALLERGY consent 03-09-23 2. ALLERGY
Y/N
Y/N / X 3. OTHERS Y/N / X 3. OTHERS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

1st Round Total No. of Enrollees: _______ : Total Enrolled Male: _______ : Total Enrolled Female: ________
Total No. of Dewormed: ______ : Total Dewormed Male: ______ : Total Dewormed Female: _____
Total 4P’s Dewormed: ____ __ : Total Non-4P’s Dewormed: _____

2nd Round Total No. of Enrollees: _________ : Total Enrolled Male: _________ : Total Enrolled Female: __________
Total No. of Dewormed: ________ : Total Dewormed Male: ________ : Total Dewormed Female: _______
Total 4P’s Dewormed: ________ : Total Non-4P’s Dewormed: _______
Prepared By:
____________________________
Signature Over Printed Name –
Teacher 1