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    School Health Examination Card: Nutritional Status (NS) (BMI/Weight-for-Age)

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    April Rose Caballero
    This document contains a school health examination card and oral health examination card. The school health examination card collects information such as the student's name, date of birth, parent/guardian, address, religion, school ID, LRN, height, weight, nutritional status, vision and auditory screenings, physical examination notes of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen, deformities, immunization history, 4Ps beneficiary status, iron supplementation, deworming, menarche and exams by the health professional. The oral health examination card collects information on the student's oral health conditions, dft/DMFT index, oral health interventions and treatments.

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    School Health Examination Card: Nutritional Status (NS) (BMI/Weight-for-Age)

    Uploaded by

    April Rose Caballero
    45 views4 pages
    This document contains a school health examination card and oral health examination card. The school health examination card collects information such as the student's name, date of birth, parent/guardian, address, religion, school ID, LRN, height, weight, nutritional status, vision and auditory screenings, physical examination notes of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen, deformities, immunization history, 4Ps beneficiary status, iron supplementation, deworming, menarche and exams by the health professional. The oral health examination card collects information on the student's oral health conditions, dft/DMFT index, oral health interventions and treatments.

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    This document contains a school health examination card and oral health examination card. The school health examination card collects information such as the student's name, date of birth, parent/guardian, address, religion, school ID, LRN, height, weight, nutritional status, vision and auditory screenings, physical examination notes of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen, deformities, immunization history, 4Ps beneficiary status, iron supplementation, deworming, menarche and exams by the health professional. The oral health examination card collects information on the student's oral health conditions, dft/DMFT index, oral health interventions and treatments.

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    Download as docx, pdf, or txt
    45 views4 pages

    School Health Examination Card: Nutritional Status (NS) (BMI/Weight-for-Age)

    Uploaded by

    April Rose Caballero
    This document contains a school health examination card and oral health examination card. The school health examination card collects information such as the student's name, date of birth, parent/guardian, address, religion, school ID, LRN, height, weight, nutritional status, vision and auditory screenings, physical examination notes of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen, deformities, immunization history, 4Ps beneficiary status, iron supplementation, deworming, menarche and exams by the health professional. The oral health examination card collects information on the student's oral health conditions, dft/DMFT index, oral health interventions and treatments.

    Copyright:

    © All Rights Reserved
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    of 4

    SCHOOL HEALTH EXAMINATION CARD

    Name: ______________________________________________________________________ School I.D. _________________________________


    Last First Middle
    LRN : ________________________________________________
    Date of Birth: ______________________________________________________________ Religion: ___________________________________
    Month Day Year
    Birthplace:_________________________________________________________________ Division: ___________________________________

    Parent/Guardian: ________________________________________________________ Telephone No: ____________________________


    Address : ____________________________________________________________________________________________________________________
    Kinder Grade Grade Grade Grade Grade Grade Grade Grade Grade Grade Grade Grade
    /SPED 1 2 3 4 5 6 7 8 9 10 11 12
    /SPED / SPED /SPED /SPED /SPED /SPED /SPED /SPED /SPED /SPED /SPED /SPED
    Date of Examination
    Temperature /BP
    Heart Rate/Pulse Rate/ Respiratory Rate
    Height
    Weight
    Nutritional Status (NS) (BMI/Weight-for-Age)
    Nutritional Status (NS) (Height-for-Age)
    Vision Screening using appropriate chart
    Auditory Screening (Tuning Fork)
    Skin/ Scalp
    Eyes/ Ears / Nose
    Mouth / Throat/ Neck
    Lungs / Heart
    Abdomen
    Deformities
    Iron Supplementation (√ or X )
    Deworming (√ or X )
    Immunization (Specify what kind)
    SBFP Beneficiary (√ or X )
    4Ps Beneficiary (√ or X )
    Menarche (√ the start)
    Others, specify
    Examined by:
    LEGEND:
    VISION/AUDITORY MOUTH/ NECK/
    NS SKIN / SCALP EYE/ EAR / NOSE LUNGS/ HEART ABDOMEN DEFORMITIES
    SCREENING THROAT
    a.Normal Weight a. Passed a. Normal a. Normal a. Normal a. Normal a. Normal a. Acquired
    b.Wasted b. Failed b. Presence of Lice b. Style b. Enlarged tonsils b. Rales b. Distended b. Congenital
    Underweight (specify)
    c. Severely wasted c. Redness of Skin c. Eye Redness c. Presence of c. Wheeze c. Abdominal Pain
    underweight lessions
    d.Overweight d. White Spots d. Ocular d. Inflamed pharynx d. Murmur d. Tenderness
    Misalignment
    e. Obese e. Flaky Skin e. Pale Conjunctiva e. Enlarged e. Irregular heart e. Dysmenorrhea
    lympnhodes rate
    f. Normal Weight f. Impetigo/boll f. Ear discharge f. Others, specity f. Others, Specify f. Others, specify
    g. Stunted g. Hermatome g. Impacted Cerumen
    h. Severely Stunted h. Bruises/ Injuries h. Mucus discharge
    i.Tall i.Itchiness i. Nose Bleeding
    (Epistaxis)
    j.Skin Lessions j. Eye discharge
    k.Acne / Pimple k. Matted Eyelashes

    INTERVENTION / TREATMENT RECORD


    Intervention/ Treatment Attended by
    Date Chief Complaint Remarks
    Done (Name/Position)
    SCHOOL ORAL HEALTH EXAMINATION CARD
    KINDER S.Y._________________________________________________ GRADE 1 S.Y.________________________________________________

    GRADE 2 S.Y.________________________________________________ GRADE 3 S.Y.________________________________________________


    GRADE 4 S.Y.______________________ GRADE 5 S.Y. _______________________

    GRADE 6 S.Y.______________________ GRADE 7 S.Y. _______________________

    GRADE 8 S.Y.______________________ GRADE 9 S.Y. _______________________

    GRADE 10 S.Y.______________________ GRADE 11 S.Y. _______________________

    Kinder 1 2 3 4 5 6
    7 8 9 10 11 12
    Gingivitis
    Periodontal Disease
    Malocclussion
    Supernumerary teeth
    Retained deciduous teeth
    Decubital ulcer
    Calculus
    GRADE 12 S.Y.______________________ Cleft lip/ palate
    ORAL HEALTH CONDITION
    Root fragment
    Fluorosis
    Others, Specify
    dft index
    TEMPORARY TEETH Kinder 1 2 3 4 5 6 PERMANENT TEETH Kinder 1 2 3 4 5 6
    Index d.f.t. 7 8 9 10 11 12
    Index D.M.F.T.
    No. T/ decayed No. T/ decayed
    No. T. filled No. T. filled
    Total d.f.t. Total d.f.t.
    For Extraction For Extraction
    For Filling For Filling
    Total Sound teeth Total Sound teeth

    SYMBOLS FOR MOUTH EXAMINATION

    PFS – Pontic
    X- Carious tooth indicated for extraction
    RPD – Removable Partial Denture
    D- Carious tooth indicated for filling
    FB – Fixed Bridge
    RF- Root Fragment
    CD – Complete Denture
    M - Missing tooth
    GI – Glass Ionomer
    F2- Permanently filled tooth with recurrence of decay
    CO – Composite
    ( √ ) - Sound/erupted Permanent tooth
    AM - Amalgan

    INTERVENTION / TREATMENT RECORD


    Attended by
    Date Chief Complaint Intervention / Treatment Done Remarks
    (Name/Position)

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