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Deworming Form 1

The document is a form from the Department of Education in the Philippines documenting the deworming of students at Juan Sumulong Elementary School. It shows that all students were dewormed and consent was given as indicated on the consent forms. No students refused deworming or had adverse events. The form was completed by the class adviser and noted by the school deworming coordinator.

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Rosalie Ariola
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254 views2 pages

Deworming Form 1

The document is a form from the Department of Education in the Philippines documenting the deworming of students at Juan Sumulong Elementary School. It shows that all students were dewormed and consent was given as indicated on the consent forms. No students refused deworming or had adverse events. The form was completed by the class adviser and noted by the school deworming coordinator.

Uploaded by

Rosalie Ariola
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Department of Education
Region IV - A CALABARZON
Form 1 - Classroom Level
National School Deworming Month (NSDM) Round 1
July 12, 2019
District: II-A
Name of School: JUAN SUMULONG ELEMENTARY School ID: 109327
Enrolment: MALE - __ , FEMALE - __ , TOTAL = __ Grade /Section: ____________
Dewormed Consented to Not Dewormed
Deworming
No. Name of Child Refused No consent Precautionary
4Ps Non - 4Ps (as indicated in
consent form) deworming form returned Measure

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Accomplished by:
PURIFICACION A. ABAD
Class Adviser N O T E D:
MANUEL V. BRUDO JR.
School Deworming Coordinator
_________

Adverse
Event

UDO JR.
Coordinator

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