You are on page 1of 1

Harmonized Schedule of Mass Drug Administration

for Selected Neglected Tropical Diseases


How to fill this form:
Deworming (ALB)
Name 4Ps Feeding Beneficiary
Date IS PP AH O
1. Juan Dela Cruz X X 04/13/2022 X
SCHOOL : DON EUFEMIO F. ERIGUEL MNHS Legend:
GRADE/SECTION : 9- POSEIDON IS=In School AH=At Home
PP=Private Physician O=Others

First Dose Second Dose


NAME 4Ps Feeding Beneficiary
Date IS PP AH O Date IS PP AH O
1 CORPUZ, SANTINO CARANZO

10

11

12

TOTAL:

Prepared by: Dewormed by: N O T E D:

JEFFREY A. RIVERA _____________________________ ADELA C. LIBUNAO, Ed.D


Class Adviser Nurse School Principal IV

You might also like