Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IV - A CALABARZON
DIVISION OF LAGUNA
Sta. Cruz

School Governance and Operations Division(SGOD)– School Health (SH)

ANNUAL DENTAL EXAMINATION MASTERLIST

DISTRICT: LILIW SCHOOL: LILIW NATIONAL HIGH SCHOOL S.Y. 2022-23

Total # of School Personnel Total

Non-
Teaching
Teaching
Male 10 3 13
Female 49 15 64
Grand Total 77

No. NAME Age Sex Cleared W/ Dentures W/ Recommendations Signature

(SURNAME, FIRST NAME, MIDDLE INITIAL)

1 AGAPAY, ARGIEL L. M
2 BORGOÑOS, MARVIN O. 41 M
3 BURBOS, ALFIE M. M
4 CASTILLO, CHRISTOPHER C. 37 M
5 ESMAS, MELVIN H. M
6 GRANDEZA, EDWIN M. 41 M
7 MONFERO, JEROME S. M
8 MONTEJO, MARVIN V. 45 M
9 QUIJANO, JAN CARREL B. 33 M
10 RONDOLO, MAXIMIANO N. M
11 SOMBILLA, JIMBERT R. 27 M
12 AGAPAY, ABIGAIL M. 32 F
13 ANIÑON, NAZARENE L. 39 F
14 ARAPAN, RHIA C. 30 F
15 ARCA, ARMELA A. 50 F
16 ARCA, IRISH JANE A. 39 F
17 ARO, MARIELLE P. F
18 ASUNTO, ABIGAIL P. F
19 BACINILLO, KRISTINE T. 25 F
20 BALBALOSA, GREGORIA IVY D. 35 F
21 BARELA, TRICIA ANNE G. F
22 BORGOÑOS, MARICEL M. 39 F
23 BRENA, ANCIE CORAZON M. 40 F
24 BRUL, QUENNIE RAQUEL B. 35 F
25 BUENAVISTA, MAYLEEN M. 42 F
26 BURGOS, RECHEL G. 31 F
27 CABAGSANG, WENGIE M. F
28 CASAS, CECILIA B. F
29 COLENDRA, ELIZABETH A. 52 F
30 COLIGADO, MARIVIC A. 46 F
31 CONSIGNADO, MA. AISSA AIRENE V. 46 F
32 CORONADO, JOYCEAN P. 35 F
33 COROZA, CECILIA M. F
34 COROZA, ELMA B. 61 F
35 DAVID, FLORABELLE S. 48 F
36 DE VILLA, CHARITO M. 42 F √
37 DEL CASTILLO, EVELINA E. F
38 EDUARDO, JANET B. 38 F
 39 ENDIZA, JUVILYN P. 35 F
40 FARAON, ROXANNE V. F
41 FLORES, ANDREA E. 60 F
42 GAMBOA, KRISTINE D. 39 F
43 GONZALES, NERISSA M. F
44 GRANDEZA, CHONA M. 44 F
45 HERNANDEZ, SWEET LENIZA B. F
46 HOSTALERO, MARIA T. 30 F
47 JOYOSA, JENNY ANN A. 27 F
48 LAPITAN, KRISTHEL B. 29 F
49 LOPE, GER JOHNIKCA B. 27 F
50 MONEVA, CATHERINE E. 41 F
51 MONSALUD, LOUIZA MAY B. 31 F
52 MONTOYA, JESSICA A. 27 F
53 NUESTRO, CAROLINA B. 62 F
54 NULLEN, ANALIZA LEAH S. 43 F
55 ORTEGA, MARIE HAZEL C. F
56 PALES, MARIZ B. F
57 PANAGLIMA, JOCELYN S. F
58 PANAGLIMA, MARICRIS A. F
59 PANGAYAO, UZZIEL JOY A. F
60 PEREZ, KRISTINE P. 42 F
61 PLANTILLA, EDITHA B. F
62 QUEAÑO, RINA L. 40 F
63 REYES, MA. FHE H. F
64 ROBAS, MARIA ROWENA O. 54 F
65 ROÑA, MARISOL C. 41 F
66 SALVADOR, SHARMAINE S. 25 F
67 TUBIERA, MARHAINI A. F
68 URMA, MARILETH C. F
69 VILLANUEVA, ROMNEILEE M. F
70 VILLANUEVA, VIOLETA M. 53 F
71 BADIOLA, MANUEL R. 55 F
72 BORGOŇOS, RONALDO 59 F
73 CAPISTRANO, RUTH A. F
74 CABAGSANG, LAURA A. 56 F
75 BORGONIA, MARISOL S. 46 F
76 BORGOŇOS, MA. ZITA B. 36 F
77 MONFERO, JOY SARAH 38 F
78
Note:

* Please write your full name in CAPITAL LETTERS, Surname First, and in alphabetical order

Prepared by:

CHARITO M. DE VILLA
School Health Coordinator Noted:

KRISTINE P. PEREZ
School Principal/School Head
 ORAL HEALTH EXAMINATION RECORD FOR TEACHING AND NON-TEACHING PERSONNEL

FEMALE
Name: DE VILLA, CHARITO M. Age: 42 Sex:
Date of Birth: JAN. 18 1980 Civil Status: MARRIED
Region: IV A - CALABARZON Division: LAGUNA District: LILIW School: LILIW NATIONAL HIGH SCHOOL

Designation: TEACHER II Employee Number 5486491

Telephone/Mobile No.:__ 639499201355 Email add charito.devilla@deped.gov.ph
Facebook/ Messenger Name: PICTURE
Medical History:

NO Hypertension NO Epilepsy NO Allergies

NO Diabetes NO Bleeding Disorder Others
NO Cardio Vascular Disease NO Asthma
Please Specify
DENTITION STATUS
INDEX : DMFT
X-
No. of T/Decayed
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 F-
No. of T/Missing
No. of T/Filled
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Total

TREATMENT RECORD
DATE TOOTH NO. NATURE OF OPERATION REMARKS DENTIST

Periodontal Condition: DENTAL PROSTHESES

YES Normal
Denture wearer:
Remarks:
NO Gingivitis
Please Specify:
NO Periodontal Disease
Need for Denture:
Remarks:
Other Abnormal Conditions
Please Specify: Remarks:
Please Specify

SYMBOLS FOR MOUTH EXAMINATION Artificial Restoration: SYMBOLS FOR ACCOMPLISHMENT

Carious tooth indicated Permanently filled tooth with Oral Zinc Oxide
X- F2 - JC - Jacket Crown OP - ZnOF -
for extraction recurrence of decay Prophylaxis Filling

Carious tooth indicated tooth with permanent Extracted Amalgam

F- Heavy Shade - AB - Abutment Xt - permanent AgF -
for filling filling Filling
tooth

Outline of tooth with temporary Synthetic

RF - Root Fragment P- Pontic R- SyF -
filing - filling Referred to porcelain filling
private dentist
Glass Ionomer
M- I- Inlay GIC -
Missing Tooth Filling
Removable Partial
RPD - FB - Fixed Bridge CD - Complete Denture
Denture
 Date
To District Supervisor
District of LILIW

Sir/Madam:
This is to certify thatCHARITO M. DE VILLA of
LILIW NATIONAL HIGH SCHOOL school has complied with the
Annual Dental Examination required for School Personnel (Teaching, non-Teaching).

School Dentist
Note: Should be required/collected
By the Public Schools District Supervisor
every first monday of June

(Date)
To District Supervisor
District of LILIW

Sir/Madam:
This is to certify that CHARITO M. DE VILLA of
LILIW NATIONAL HIGH SCHOOL school has complied with the
Annual Dental Examination required for School Personnel (Teaching, non-Teaching).

School Dentist
Note: Should be required/collected
By the Public Schools District Supervisor
every first monday of June