COVID-19

Vaccination Card
Please keep this record card, which includes medical information ID No. PV-UYMZ4W
about the vaccines you have received.

TANGHAL CARL IAN ROY A

Last Name First Name M.I. Suffix

Address SITIO LOMBOY, AWANG, DATU ODIN SINSUAT (DINAIG), (... Contact No. 09059752067

Date of Birth 08/28/1993 Sex Male Philhealth No. 170000888004 Category A4

Date
Dosage Seq. (mm/dd/yy) Vaccine Manufacturer Batch No. Lot No.

08/13/21 ASTRAZENECA PV46700

1st Dose
Vaccinator Name: RACHELLE ANNE V VALDEZ, RN Signature

2nd Dose
(Schedule : / / ) Vaccinator Name: Signature

Health Facility Name: RHS BAR HEALTH FACILITY Contact No: 09155652062