No : 039/IS/SEC/XI/2023 Date : 16 November 2023

Re : Health & Anemia (Hemoglobin) Screening

Dear Parents,

We are writing to inform you that our school is collaborating with Puskesmas Cilandak to conduct
an anemia and hemoglobin screening program for girls in grade 7 and 10, and health screening for
all students of G7 to G10. The program aims to identify and prevent anemia, which is a condition
that affects the red blood cells and reduces the oxygen-carrying capacity of the blood.

Anemia is a common health problem among adolescent girls, especially in developing countries. It
can cause fatigue, weakness, dizziness, headache, poor concentration, and increased susceptibility
to infections. Anemia can also affect the growth and development of girls and their future
reproductive health. Therefore, it is important to detect and treat anemia early.

The screening program will involve a simple finger-prick blood test to measure the level of
hemoglobin, which is the protein that carries oxygen in the blood. The test will be done by trained
doctors from Puskesmas Cilandak, who will also provide counseling and treatment for girls who
are found to have anemia. The test results will be confidential and will only be shared with the
parents and the school health staff.

The screening program will take place on Tuesday, 28 November 2023, from 8:00 am at Ichthus
secondary study room. We request your consent and cooperation to allow your daughter to
participate in this program. Please fill out the attached consent form and return it to the school by
Monday, 20 November 2023
We appreciate your support and involvement in this program, which will benefit the health and
well-being of your child and our school community.

Sincerely, Acknowledged by,

Nurani Kasanah Martha Surjanto Wendy Armunando

Kepala SMP Kepala SMA Principal
 Consent Form

I (Parents’/Guardian’s Name)………………………………….…….….Allow / Not Allow *,

mychild (Student’s Name)……………………………………………...... Grade :…. ...........
to get Hemoglobin check using HB tool which will be held at Ichthus School in the collaboration
with Cilandak Barat Puskesmas or district Health Center.

Parents/Guardian’s Signature : _______________________________

Date : _______________________________

Note : * Please circle the correct chosen