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BHW Covid Form

The document is a COVID-19 Vaccination Masterlist Form detailing vaccination status for various age groups in a specified barangay. It includes sections for recording vaccinated and unvaccinated individuals, reasons for unvaccination, and a summary of eligible inhabitants for vaccination and booster doses. The form is prepared by local officials and includes a monthly inventory of the vaccinated population.

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sangguniankalubakis
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37 views4 pages

BHW Covid Form

The document is a COVID-19 Vaccination Masterlist Form detailing vaccination status for various age groups in a specified barangay. It includes sections for recording vaccinated and unvaccinated individuals, reasons for unvaccination, and a summary of eligible inhabitants for vaccination and booster doses. The form is prepared by local officials and includes a monthly inventory of the vaccinated population.

Uploaded by

sangguniankalubakis
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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COVID-19 VACCINATION MASTERLIST FORM

Province:
City/Municipality:
Name of Barangay:
Sitio/Purok:
Place of Vaccination Vaccinated Age Group Unvaccinated Age Group Status of Vaccination Reason for Contact
NO. NAME AGE DATE OF BIRTH Detailed Address w/in the w/in the 60 and above 18-59 60 Fully unvaccinated Number
12 to 17 5 to 11 18-59 12 to 17 5 to 11
region* province** NCR*** A1 A2 A3 A4 A5 A1 A2 A4 Above Vaccinated 1sr dose Booster

Prepared/Accomplished by: __________________________________________________________


Noted by :__________________________________________________________
Date :__________________________________________________________
*If within the Religion,please indicate the province(Cavite,Laguna, Batangas)
REASON FOR UNVACCINATED **If within the province,please indicate the city/municipality
a. Vaccine post too foe away ***If in NCR,please indicate the city/municipality
b. Religious beliefs ****If in other regions, please indicate the region (1,2,3 etc)
c. Fear of Vaccine
d. Hesitancy
e. Bedridden
f. Others
MASTER LIST OF COVID-19 VACINATION FOR THE MONTH OF
FEB. 2023

PRIMARY SERIES OF COVID- 19 VACINNE Partially Fully Fully Fully BOOSTER DOSE
Vaccinated Vaccinated Vaccinated Vaccinated Indiviaduals Indiviaduals BRAND
( Type 1 if yes ; 5-11years 12-17 years 18 years 18 years old 12 -17 years old
NO NAME
1st Dose 2nd Dose Brand ( ;0 if No) old and above old and above old and above and above and above
( Type 1 if yes ; ( Type 1 if yes ; ( Type 1 if yes ;
( ;0 if No) ( ;0 if No) ( ;0 if No)

JENNIFER GENOBIO / PRIZER /


JOLLIBEE NAVARRO / PRIZER /
JENNY BASICAL / PRIZER /
MARK OLIVA / PRIZER /
JASON OLIVA / PRIZER /
ROVICK ASIACAAN / PRIZER /

Prepared by :

CATHERINE F. VIRREY Noted by


Barangay Secretary GIZELLE F. REGENCIA

HON. LAILA MALABONGA


Barangay Captain
BARANGAY MONTHLY INVENTORY OF VACCINATED POLULATION
FOR THE MONTH OF NOVEMBER

SUMMARY

A. TOTAL NO OF BARANGAY INHABITANT AGED OF


5-11 YEARS OLD ELIGEBLE FOR VACCINATION 0

B. TOTAL NO OF BARANGAY INHABITANT AGED OF


12 -17 YEARS OLD ELIGEBLE FOR VACCINATION 0

C. TOTAL NO OF BARANGAY INHABITANT AGED OF


18 YEARS OLD AND ABOVE ELIGEBLE FOR VACCINATI 0

D. TOTAL NO OF BARANGAY INHABITANT AGED OF


18 YEARS OLD AND ABOVE ELIGEBLE FOR BOOSTER 0

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