Republic of the Philippines

Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE-MALABON CITY
POTRERO ELEMENTARY SCHOOL
4 PINAGTIPUNAN CIRCLE, POTRERO, MALABON CITY

DENGUE CASE REPORT FORM

S. Y. 2023-2024
PATIEN PATIENT’S FULL AGE SEX DATE OF COMPLETE ADDRESS ADMITTE PLACE OF OUTCOME
T NO. NAME BIRTH D CONFINEMENT
A-ALIVE
(MM/DD/YY) (Y/N)
D-DIED

U-
UNKNOWN

1 Shairah Erich D. 9 F 07-7-2013 ● 65 Banana Rd. Potrero, No A

Simangan Malabon City

Rengie N. San Juan ● 105 Pineapple Rd. Potrero,

2. 8 M 03-14-2015 Associated Marine Officers
Malabon City and Seamen Union of the
Yes Philippines (AMOSUP) A
Seamen’s Hospital
Chrizha Faye L.
Marticio ● 62 East Riverside, Potrero,
Malabon City
3. 10 F 12-07-2012
No A

4 Pinagtipunan Circle, Potrero Malabon City

Telephone No. (02) 8478-3166
Email: potreroes.malaboncity@deped.gov.ph
 Republic of the Philippines
Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE-MALABON CITY
POTRERO ELEMENTARY SCHOOL
4 PINAGTIPUNAN CIRCLE, POTRERO, MALABON CITY

Prepared by:

JHONAZEL A. SANDOVAL
Noted: School Dengue Coordinator

VICENTE B. VICENTE
Principal

DENGUE CASE REPORT FORM

PATIEN PATIENT’S FULL AGE SEX DATE OF COMPLETE ADDRESS ADMITTE PLACE OF OUTCOME
T NO. NAME BIRTH D CONFINEMEN
A-ALIVE
T
(MM/DD/YY) (Y/N)
D-DIED

U-UNKNOWN

1 EJ Jonnelle Salas 11 M 11-13-2010 ● 139 Lapu-Lapu St. Brgy 79, No A

Caloocan City

● Pisaca Sitio 6, Catmon,

2. Maica M. Saoy 10 F 11-11-2011

4 Pinagtipunan Circle, Potrero Malabon City

Telephone No. (02) 8478-3166
Email: potreroes.malaboncity@deped.gov.ph
 Republic of the Philippines
Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE-MALABON CITY
POTRERO ELEMENTARY SCHOOL
4 PINAGTIPUNAN CIRCLE, POTRERO, MALABON CITY

Malabon City No A

3. Carlo V. Caberto 11 M 03-6-2011 ● 103 B Natividad St. Caloocan Jose Reyes

City Memorial
Yes Hospital A
● 48 Orange Rd. Potrero,
4. Prince Gian Arroyo 12 M 06-22-2010 Malabon City
No A

Prepared by:

Noted: JHONAZEL A. SANDOVAL

School Dengue Coordinator
GINA S. ONG
PSDS, OIC Principal

4 Pinagtipunan Circle, Potrero Malabon City

Telephone No. (02) 8478-3166
Email: potreroes.malaboncity@deped.gov.ph