Republic of the Philippines

Department of Education
Region IV-A
Schools Division of Quezon Province
ATIMONAN I & II DISTRICT

April 3, 2024
UNNUMBERED MEMORANDUM

LEARNERS’ HEALTH SURVEY FORM

To: Elementary School Heads

Secondary School Heads
School Health Coordinators
All Concerned

1. In reference to DepEd Order No. 28, s. 2018 titled Policy and Guidelines on
Oplan Kalusugan sa Department of Education (OK sa DepEd), this office announces
the use of locally developed Learners’ Health Survey Form (LHSF) to obtain data
on learners’ past and present health conditions and health behaviors. The data
collected will allow the School Health Section in crafting Health and Nutrition
Services based on the health conditions, lifestyle and behaviors of the learners.

2. The LHSF shall be provided to learners from Kindergarten to Grade 12.

3. Printing and other supplies relative to the production and distribution of the
LHSFs may be charged to MOOE or source through partnership with stakeholders.

4. Printed LHSFs shall be answered and/or certified by the parent/guardian of the

learner.

5. Printed LHSFs shall be retrieved by the advisers for consolidation of the School
Health Coordinator.

6. Consolidated Learners’ Health Survey Report Form shall be encoded on or

before April 30, 2024 through this Google Link:

https://tinyurl.com/LHSFsy2324

7. For questions and clarifications, you may contact Nurse Aim V. Santander,
District Nurse at 09322660093 or Messenger account Aim Villamiel Santander.

8. Widest dissemination and compliance with this Memorandum is desired.

SUSANA P. NERA CARIDAD C. GRIMALDO,Phd

Public Schools District Supervisor Public Schools District Supervisor