National School Deworming Month for _____________

ANNEX C: Form 4b Division Level Reporting Form

Region IV - CALABARZON
Province BATANGAS Precautionar
Division Tanauan City y Measure
(seriously ill,
Children Dewormed with
abdominal
pain,
consented to Refused diarrhea,
No. of
deworming (as deworming (as who has Adverse Event Reported (type % dewormed (Total dewormed/No.
School Grade Level Sex Enrolled no. consent form return
indicate in indicate in cosent previous and number) enrolled)
Children total 4 p's +
4 p's non 4 p's consent form) form) hypersensitiv
non 4 p's ity with
deworming
drug ( annex
B MDAP
M Guide #1
KINDER page 14)
F
M
Grade 1
F
M
Grade 2
F
M
Grade 3
F
M
Grade 4
F
M
Grade 5
F
M
Grade 6
F
M
SPED
F
M
Total
F

Accomplished by: Noted by:

_____________________________
Name and Signature Name and Signature
Deworming Coordinator School Principal
Date Accomplished Date Accomplished
 National School Deworming Month for JULY
ANNEX C: Form 4b Division Level Reporting Form

Region IV-A CALABARZON

Province BATANGAS
Division TANAUAN CITY

Children Dewormed
Precautionary Measure
(seriously ill, with
consented to % dewormed
No. of abdominal pain, diarrhea,
deworming (as Refused deworming (as no. consent Adverse Event Reported (Total
School Grade Level Sex Enrolled who has previous
indicate in indicate in consent form) form return (type and number) dewormed/No.
Children total 4 p's + hypersensitivity with
4 p's non 4 p's consent form) enrolled)
non 4 p's deworming drug ( annex B
MDAP Guide #1 page 14)

M 43 7 17 24 24 9 32 56%
Grade 7
F 24 2 13 15 15 4 19 63%
M 51 14 11 25 25 13 38 49%
Grade 8
F 35 9 14 23 23 5 28 66%
DR. ALCANTARA M 34 13 9 22 22 2 24 65%
NATIONAL HIGH Grade 9
F 30 13 10 23 23 3 26 78%
SCHOOL
M 38 6 17 23 23 4 27 61%
Grade 10
F 36 12 8 20 20 11 31 56%
M 166 40 54 94 94 28 121 231%
Total
F 125 36 45 81 81 23 104 263%

Accomplished by: Noted by:

MA. KRISTINA CASSANDRA N. NON MICHAELO M. MEDALLA

Name and Signature Name and Signature
School Deworming Coordinator School Principal
Date Accomplished: September 17, 2019 Date Accomplished: September 17, 2019
 National School Deworming Month for _____________
ANNEX C: Form 4b Division Level Reporting Form

Region IV-A CALABARZON

Province BATANGAS
Division TANAUAN CITY

Children Dewormed
Precautionary Measure
(seriously ill, with
consented to % dewormed
No. of abdominal pain, diarrhea,
deworming (as Refused deworming (as no consent Adverse Event Reported (Total
School Grade Level Sex Enrolled who has previous
indicate in indicate in cosent form) form return (type and number) dewormed/No.
Children total 4 p's + non 4 hypersensitivity with
4 p's non 4 p's consent form) enrolled)
p's deworming drug ( annex B
MDAP Guide #1 page 14)

M
Grade 11
F
M
Grade 12
F
M
Total
F

Accomplished by: Noted by:

Name and Signature Name and Signature

School Deworming Coordinator School Principal
Date Accomplished Date Accomplished