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  • Annex C

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    officialjackeytapao
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    This document is a report form for consultations and referrals by voting centers/precincts during the 2023 Barangay and Sangguniang Kabataan Elections (BSKE) in Region MIMAROPA. The form collects information on the name, sex, age, chief complaint, management/treatment, and referral location (if applicable) for patients seen at each voting center and precinct. It requires the signature and date of the person who prepared the report.

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    ANNEX-C

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    This document is a report form for consultations and referrals by voting centers/precincts during the 2023 Barangay and Sangguniang Kabataan Elections (BSKE) in Region MIMAROPA. The form collects information on the name, sex, age, chief complaint, management/treatment, and referral location (if applicable) for patients seen at each voting center and precinct. It requires the signature and date of the person who prepared the report.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    8 views1 page

    Annex C

    Uploaded by

    officialjackeytapao
    This document is a report form for consultations and referrals by voting centers/precincts during the 2023 Barangay and Sangguniang Kabataan Elections (BSKE) in Region MIMAROPA. The form collects information on the name, sex, age, chief complaint, management/treatment, and referral location (if applicable) for patients seen at each voting center and precinct. It requires the signature and date of the person who prepared the report.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines

    Department of Health
    CENTER FOR HEALTH DEVELOPMENT MIMAROPA

    ANNEX C
    2023 Barangay and Sangguniang Kabataan Elections (BSKE)

    Region: ___________________
    REPORT OF CONSULTATIONS AND REFERRALS BY VOTING CENTERS/PRECINCTS

    PROVINCE:_____________ MUNICIPALITY:______________ BARANGAY:______________

    VOTING NAME OF PATIENT SEX AGE CHIEF COMPLAINT MANAGEMNET (MEDS GIVEN, IF
    CENTER etc.) REFERRED,
    AND WHERE?
    PRECINCT
    1.
    2.
    3.
    4.
    5.
    6.
    7.
    8.
    9.
    10.
    Prepared by:
    ________________________
    Signature over printed name
    ________________________
    Date

    Kalusugan sa mga Isla, Kayamanan ng MIMAROPA


    Quirino Memorial Medical Center Compound, P. Tuazon St., Project 4, Quezon City *Trunkline no. (632)8- 912-0195
    Direct Line: (632)8- 913- 4650 *URL: http://www.mimaropa.doh,gov.ph; email: chd.mimaropa@mimaropa.doh.gov.ph

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