Republic of the Philippines

Department of Education
Region VII, Central Visayas
DIVISION OF CARCAR CITY
Rapid Coverage Assessment Form
NATIONAL SCHOOL DEWORMING DAY

Region: VII
School: ROBERTO E. SATO MEMORIAL NATIONAL HIGH SCHOOL
Address: Calidngan, Carcar City, Cebu

No. Name of Child Age Gender Complete Address Guardian's Name

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Prepared by: Reviewed by:

MARK RIO V. QUIJANO

Classroom Adviser School Health Coordinator
e Philippines
f Education
ntral Visayas
ARCAR CITY
ssessment Form
DEWORMING DAY

Division: Carcar City

District:
Grade & Section
Consent
4Ps Response Dewormed
Contact No. Remarks
Yes No Yes No Yes No
Noted by: Accomplished by:

ROLANDO B. PANSIT
School Head Authorized Health Staff
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
DIVISION OF CARCAR CITY
Rapid Coverage Assessment Form
NATIONAL SCHOOL DEWORMING DAY

Region: VII Division: Carcar City

School: ROBERTO E. SATO MEMORIAL NATIONAL HIGH SCHOOL District:
Address: Calidngan, Carcar City, Cebu Grade & Section

Consent Response
No. Name of Child Guardian's Name Contact No.
Yes No
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Signature