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Deworming

The document is an official masterlist form for West Dalurong, specifically for a program related to endemic health issues. It includes fields for personal information such as name, sex, age, address, and participation in a program, along with remarks on health status and treatment. The form is designed to track individuals' enrollment and any adverse effects related to medication administration.

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jamesmagdadaro33
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13 views2 pages

Deworming

The document is an official masterlist form for West Dalurong, specifically for a program related to endemic health issues. It includes fields for personal information such as name, sex, age, address, and participation in a program, along with remarks on health status and treatment. The form is designed to track individuals' enrollment and any adverse effects related to medication administration.

Uploaded by

jamesmagdadaro33
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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MONTH OF _______________________

OFFICIAL MASTERLIST FORM WEST DALURONG STH ENDEMIC ONLY

No. Surname Given Name Sex Age Address Member 4P’s Given Albendazole Remarks
M F Yes No
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REMARKS
(R) refused Prepared By: Approved By: Endorsed By:
(CO) Contraindicated
(E) Enrolled
EO (Enrolled in other Barangay
(M) with mild AE
(MM) with Moderate AE
(S) with Severe AE
(SS) with serious AE Date of Submission ________________________________
(O) other (Explain)
MONTH OF _______________________
OFFICIAL MASTERLIST FORM WEST DALURONG STH ENDEMIC ONLY

REMARKS
(R) refused Prepared By: Approved By: Endorsed By:
(CO) Contraindicated
(E) Enrolled
EO (Enrolled in other Barangay
(M) with mild AE
(MM) with Moderate AE
(S) with Severe AE
(SS) with serious AE Date of Submission ________________________________
(O) other (Explain)

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