DepEd Form 1A.

List of SAC Enrolled Per Class and Deworming Status by MDA Round

School ID: 108001 Name of School: TAMBO ELEMENTARY SCHOOL Type: 1 1- Public 2-Private School Year: 2023-2024 Grade LeveII-POMELO

Adress of the School: TAMBO MALAKI, INDANG, CAVITE District: INDANG Division: CAVITE Region: IV-A CALABARZON
Part 1. List of SAC Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status of
Deworming by
No. Name of SAC Address Birthday Age Sex SE Status First Round of MDA Sept-Nov.'2023) Second Round of MDA (March-May' 2024) School Year
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed / - with ADR, /- / - withADR Remarks / - received 2
write date specify Remarks dewormed, specify type doses/year
F-Female Non4Ps X - received only 1
dewormed type write date
X - no ADR dewormed X - no ADR dose or no
X - not dose/year
(6) (14)
(1) (2) (3) (4) (5) (7) dewormed X - not (13)
(8) (9) (10) dewormed
(11) (12)

1 Bolano Weslie Barron Pepito Tambo Malaki 12/26/2015 8 M 8-15-2023

2 Canastra Keith Rafael Sisik Tambo Ilaya 6/20/2016 9 M
3 Creus, John Zedric Bulquena Tambo Malaki 7/1/2016 10 M
4 Dalisay,Zadkiel Garcia Tambo Malaki 11/22/2015 8 M
5 De Borja Cyre Ludrick Demetillo Tambo Malaki 12/31/2015 8 M 8-15-2023
6 Herrera, Steven Kaizer Cosino Tambo Malaki 10/18/2016 8 M 8-19-2023
7 Lasala, Raymart Malanot Tambo Malaki 11/28/2014 8 M
8 MatelGabriel Nathan Iligan Tambo Malaki 2/14/2016 8 M 8-15-2023
9 Melencion Renzo Louie Grafi Tambo Malaki 7/28/2016 8 M
10 Mendoza Nathaniel Gabule Tambo Ilaya 5/28/2015 8 M
11 Paril Symon Gabriel Montemayor Tambo Malaki 5/27/2016 9 M 8-20-2023
12 Perigrino,Airranz Agsangre Tambo Malaki 11/20/2015 8 M
13 Rodil Edwin Jr. Matel Tambo Malaki 7/24/2015 8 M 6-18-2023
14 Rodil Jhian Xzavior Creus Tambo Malaki 11/27/2015 8 M 8-15-2023
15 Silva Jeon Matthew Tambo Malaki 1/27/2016 8 M
Part 1. List of SAC Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status of
Deworming by
No. Name of SAC Address Birthday Age Sex SE Status First Round of MDA (August'2022) Second Round of MDA (Feb.'2023) School Year
1-NHTS-4Ps / - received 2
M-Male 2-NHTS- doses/year
F-Female Non-4Ps X - received only 1
dose or no
dose/year
(6) (14)
(1) (2) (3) (4) (5) (7)
 Part 3. Status of
Deworming by
No. Name of SAC Address Birthday Age Sex SE Status School Year
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR, /- / - with ADR Remarks / - received 2
write date specify Remarks dewormed, specify type doses/year
F-Female Non-4Ps X - received only 1
dewormed type write date
X - no ADR dewormed X - no ADR dose or no
X - not dose/year
(6) (14)
(1) (2) (3) (4) (5) (7) dewormed (10) X - not (13)
(8) (9) dewormed
(11) (12)

16 Arcenal, Mary Joy Cielo Tambo Malaki 9/11/2014 8F

17 Arquilla,Hanna Akira Hernandez Tambo Ilaya 11/27/2015 8F
18 Austria, Messie Jaden Besenio Tambo Malaki 11/11/2015 9F 8-15-2023
19 Caringal, Ma. Ana Tambo Malaki 1/26/2015 9F
20 CELESTINO,LERICH JANE, GARAIS Tambo Malaki 7/16/2016 8F
21 CREUS,ANGELICA, - Tambo Malaki 11/29/2015 8F
22 HERRERA,ZYRENE SHANE, LLAMADO Tambo Malaki 9/28/2016 8F 8-24-2023
23 MASBATE,PRINCES, CALDA Tambo Malaki 9/27/2014 8F
24 Notario,Ashanty Czarine Norcio Tambo Malaki 9/22/2015 9F
25 OYALES,ASHLEY MAE, DEGALA Tambo Malaki 11/5/2015 8F
26 OYALES,CRISTAL JANE, MANDOCDOC Tambo Malaki 12/12/2014 8F
27 RICAFRENTE,AIRA, SILVESTRE Tambo Malaki 10/10/2015 10 F
28 TALAVERA,SHARMAINE, MATEL Tambo Malaki 1/16/2016 8F 8-15-2023
29 VERDAN,MITCH IZHA, AMIGABLE Tambo Ilaya 7/7/2016 8F
Total No. Enrolled: 29 M: 15 NHTS-4Ps: 6 No. NHTS-4Ps No. w/ ADR: No.NHTS- 4Ps No. w/ ADR: No. recvd 2 doses:
F: 14 Dewormed: 6 Dewormed:
NHTS-non4Ps: No. recvd 1 or 0
27 No. NHTS non No. NHTS non dose:
4Ps 4Ps
Dewormed: 20 Dewormed:

Total: 26 Total:

Accomplished by Classroom Adviser: MYLA SHARON A. MATILLA

Noted by Grade Level Chairman:
Date:
 DepEd Form 1B. List of Adolescents Enrolled Per Class and Deworming Status by MDA Round

School ID: Name of School: Type: 1- Public 2-Private School Year: Grade Level/Section:

Adress of the School: District: Division: Region:

Part 1. List of Adolescents Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status of
Deworming by
No. Name of Adolescent Address Birthday Age Sex SE Status First Round of MDA (August'2022) Second Round of MDA (Feb.'2023) School Year
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR, Remarks / -dewormed, / - withADR Remarks / - received 2
write date specify write date specify type doses/year
F-Female Non4Ps X - received
dewormed type dewormed X - no ADR
X - not X - no ADR only 1dose or
dewormed X - not no dose/year
(6) (7)
(1) (2) (3) (4) (5) (10) dewormed (12) (13)
(8) (9) (11) (14)
 Part 1. List of Adolescents Enrolled Part 2. Deworming Status During Each Round of MDA Part 3. Status
ofDeworming
No. Name of Adolescent Address Birthday Age SexSE Status First Round of MDA (August'2022) Second Round of MDA (February'2023) by SchoolYear
1-NHTS-4Ps
M-Male 2-NHTS- / - dewormed, / - with ADR, Remarks / - dewormed, / - with ADR, Remarks / - received 2
write date specify write date specify type doses/year
F-Female Non-4Ps X - received
dewormed type dewormed X - no ADR
X - not X - no ADR only 1 dose or
dewormed X - not no dose/year
(6) (7) (14)
(1) (2) (3) (4) (5) (10) dewormed (12)
(8) (9) (11) (13)

Total No. Enrolled: M: NHTS-4Ps No. NHTS-4Ps No. w/ ADR: No. NHTS-4Ps No. w/ ADR: No. recvd 2
F: Dewormed: Dewormed: doses:
NHTS-
non4Ps No. NHTS non No. NHTS non No. recvd 1 or 0
4Ps Dewormed: 4Ps Dewormed: dose:

Total: Total:

Accomplished by Classroom Adviser:

Noted by Grade Level Chairman:
Date:
Accomplished by Classroom Adviser:
Noted by Grade Level Chairman:
Date:
 School
DepEd Form 2. Consolidation of MDA Coverage of SAC (Kinder to Grade 12) Year: 2022-2023
School Name of
ID: School: Type: 1-Public 2-Private
Address of the
School: District: Division: Cavite Province Region: IV- A

First MDA Round (August' 2022) Second MDA Round (February' 2023) No. Given 2 doses By SY

Grade Total No. Total Number Dewormed No. w/ Total Number Dewormed No. w/ NHTS
adverse adverse NHTS- Remarks
Level Enrolled Remarks Non-
drug drug 4Ps Total (9)
(1) (2) (5) 4Ps
NHTS NHTS reactions NHTS NHTS reactions (8a)
(4) Total (7) (8b)
4Ps Non4Ps Total 4Ps Non4Ps
(3a) (3b) (6a) (6b)
Kinder
Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Grade 8
Grade 9

Grade
10
Grade
11
Grade
12
SPED
ALS
Total 0 0 0 0 0 0 0 0 0 0 0 0 0
Percent (%):
Column Total
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
Divide Row Total
Multiplied by 100
Accomplished by School Clinic Teacher:
Noted by School Principal:
Date Accomplished: