COVID-19 VACCINATION CARD ID COVID-19 VACCINATION CARD ID
NO NO
Please keep this record card, which includes medical information about the vaccines you have recieved. Please keep this record card, which includes medical information about the vaccines you have recieved.
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap. Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap.
Last Name First Name Middle Name Suffix Last Name First Name Middle Name Suffix
Address Contact No. Address Contact No.
Date of Birth Sex Philhealth No. Category Date of Birth Sex Philhealth No. Category
Name of Vaccinator Name of Vaccinator
Date Date
Dosage Seq. Vaccine Brand Batch NO. Lot no. Dosage Seq. Vaccine Brand Batch NO. Lot no.
(with signature) (with signature)
(mm/dd/yy) (mm/dd/yy)
1st Dose 1st Dose
Booster Booster
2nd Dose 2nd Dose
Booster Booster
3rd Dose 3rd Dose
Booster Booster
Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582 Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582
OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph
COVID-19 VACCINATION CARD ID COVID-19 VACCINATION CARD ID
NO NO
Please keep this record card, which includes medical information about the vaccines you have recieved. Please keep this record card, which includes medical information about the vaccines you have recieved.
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap. Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap.
Last Name First Name Middle Name Suffix Last Name First Name Middle Name Suffix
Address Contact No. Address Contact No.
Date of Birth Sex Philhealth No. Category Date of Birth Sex Philhealth No. Category
Name of Vaccinator Name of Vaccinator
Date Date
Dosage Seq. Vaccine Brand Batch NO. Lot no. Dosage Seq. Vaccine Brand Batch NO. Lot no.
(with signature) (with signature)
(mm/dd/yy) (mm/dd/yy)
1st Dose 1st Dose
Booster Booster
2nd Dose 2nd Dose
Booster Booster
3rd Dose 3rd Dose
Booster Booster
Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582 Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582
OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph
COVID-19 VACCINATION CARD ID COVID-19 VACCIANATION CARD ID
NO NO
Please keep this record card, which includes medical information about the vaccines you have recieved. Please keep this record card, which includes medical information about the vaccines you have recieved.
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap. Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap.
Last Name First Name Middle Name Suffix Last Name First Name Middle Name Suffix
Address Contact No. Address Contact No.
Date of Birth Sex Philhealth No. Category Date of Birth Sex Philhealth No. Category
Name of Vaccinator Name of Vaccinator
Date Date
Dosage Seq. Vaccine Brand Batch NO. Lot no. Dosage Seq. Vaccine Brand Batch NO. Lot no.
(with signature) (with signature)
(mm/dd/yy) (mm/dd/yy)
1st Dose 1st Dose
Booster Booster
2nd Dose 2nd Dose
Booster Booster
3rd Dose 3rd Dose
Booster Booster
Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582 Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582
OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph
COVID-19 VACCIANATION CARD ID COVID-19 VACCIANATION CARD ID
NO NO
Please keep this record card, which includes medical information about the vaccines you have recieved. Please keep this record card, which includes medical information about the vaccines you have recieved.
Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap. Pakitago ang record card na ito, kung saan mababasa ang impormasyong medikal tungkol sa bakunang iyong natanggap.
Last Name First Name Middle Name Suffix Last Name First Name Middle Name Suffix
Address Contact No. Address Contact No.
Date of Birth Sex Philhealth No. Category Date of Birth Sex Philhealth No. Category
Name of Vaccinator Name of Vaccinator
Date Date
Dosage Seq. Vaccine Brand Batch NO. Lot no. Dosage Seq. Vaccine Brand Batch NO. Lot no.
(with signature) (with signature)
(mm/dd/yy) (mm/dd/yy)
1st Dose 1st Dose
Booster Booster
2nd Dose 2nd Dose
Booster Booster
3rd Dose 3rd Dose
Booster Booster
Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582 Health Facility Name POLYCLINIC LIBERTAD Facility Contact No. (036) 278-1582
OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph OfficialDOHgov @DOHgoph (632)851-7800 Local 1936 covid19ceir@doh.gov.ph
