San Cristobal Elementary School School Clinic Logbook

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Republic of the Philippines

Department of Education
Region IV-A CALABARZON
Schools Division of Calamba City
Cluster I
SAN CRISTOBAL ELEMENTARY SCHOOL

SCHOOL CLINIC LOGBOOK


Date Time Name Age Sex Grade & Teacher Chief Complaint(s) Doctor's Order Treatment Administered By Remarks Follow-up Status [As
Admitted Section Adviser [Reason(s) for the [To be initialed by the Medical [Indicate how the instructions of the doctor needed; Date/Status]
clinic visit/reported Officer upon visit]/ Supported were followed, as well as other actions taken,
symptom(s)] by the doctor's e.g., ordered to return to classroom, what time;
Prescription/Instruction reported to BHERT, specify contact number;
Slip informed the parent about instructions, fetched
by; etc.]

_ Administer treatment Paracetamol 5ml, given at


_ Contact the parents 10:30 am
_ Refer to health facility
_ Report to BHERT

Address: Purok 3, San Cristobal, Calamba City


School ID: 109837
Telephone No: (049) 576-0897
Email Address: 109837@deped.gov.ph
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Schools Division of Calamba City
Cluster I
SAN CRISTOBAL ELEMENTARY SCHOOL

SUMMARY OF HEALTH STATUS OF PERSONNEL AND LEARNERS OF SAN CRISTOBAL ELEMENTARY SCHOOL
For the Month of: ______________________

Name Category Grade Level/Section Date Reported Symptom(s) Action Taken COVID-19 Status per
(Personnel/Learner) Observed/Reported (Referred to) Follow-Up
(Positive/Negative)

Prepared by: Noted by:


BENILDA U. ESTRELLA WILFREDO L. LAMAR
School Clinic Teacher Principal

Address: Purok 3, San Cristobal, Calamba City


School ID: 109837
Telephone No: (049) 576-0897
Email Address: 109837@deped.gov.ph
Republic of the Philippines
Department of Education
Region IV-A CALABARZON
Schools Division of Calamba City
Cluster I
SAN CRISTOBAL ELEMENTARY SCHOOL

List of symptoms (per DOH DM 2020-0512)

PMA

Address: Purok 3, San Cristobal, Calamba City


School ID: 109837
Telephone No: (049) 576-0897
Email Address: 109837@deped.gov.ph

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