Republic of the Philippines

Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok,
Batangas City

SCHOOL HEALTH EXAMINATION CARD

Name: CAPISTRANO MARK GERRALD AWAT School ID: 107535

Last First Middle

LRN: 107535200062
Date of Birth: MAY 21, 2015 Region: IV – A CALABARZON
Month Day Year

Birthplace: Quilo-Quilo South, Padre Garcia, Batangas Division: BATANGAS

Parent/Guardian: GERRY CAPISTRANO Telephone No.:

Address: Quilo-Quilo South, Padre Garcia, Batangas

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/
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Date of Examination
Temperature/BP
Heart Rate/Pulse Rate/Respiratory Rate
Height (in cm)
Weight (in kg)
Nutritional Status (NS) (BMI/Wt-for-Age)
Nutritional Status (NS) (Height-for-Age)
Vision Screening using appropriate chart
Auditory Screening (Tuning Fork)
Skin/ Scalp
Eyes/Ears/Nose
Mouth/Throat/Neck
Lungs/Heart
Abdomen
Deformities
Iron Supplementation (√ or X)
Deworming (√ or X)
Immunization (Specify what kind)
SBFP Beneficiary (√ or X)
4Ps Beneficiary (√ or X)
Menarche (√ the Start)
Others, specify
Examined by:
LEGEND:
Vision/ Auditory
NS Skin/Scalp Eye/Ear/Nose Mouth/Neck/Throat Lungs/Heart Abdomen Deformities
Screening
a. Normal a. Passed a. Normal a. Normal a. Normal a. Normal a. Normal a. Acquired
Weight
b. Wasted/ b. Failed b. Presence of Lice b. Stye b. Enlarged tonsils c. Rales b. Distended b. Congenital
Underweight (Specify)
c. Severely c. Redness of Skin c. Eye Redness c. Presence of lesions d. Wheeze c. Abdomnial Pain
Wasted/Underwt
d. Overweight d. White Spots d. Ocular Misalignment d. Inflamed pharynx e. Murmur d. Tenderness

e. Obese e. Flaky Skin E. Pale Conjunctiva e. Enlarged lymphnodes h. Irregular heart rate e. Dysmenorrhea

f. Normal Height f. Impetigo/ f. Ear discharge f. Others , specify i. Others, f. Others, Specify
boil specify
g. Stunted g. Hematoma g. Impacted cerumen

h. Severely h. Bruises/ Injuries h. Mucus discharge

Stunted
i. Tall i. Itchiness i. Nose Bleeding
(Epistaxis)
j. Skin Lessions j. Eye dischrge

k. Acne/Pimple k. Matted Eyelashes

Note: Use Letter to record ailments and Place X if not examined

DEPEDBATS-HNS-F-012/R0/06-01-2018 1