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Post Examination Health Surveillance Form: Annex "C"

The document provides instructions for examinees to submit a post-examination health surveillance form to the regional PRC office 15 days after their exam. It includes a sample form for the examinee to provide their name, testing details, and health status.

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Mohaliden Nasa Esmael
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36 views1 page

Post Examination Health Surveillance Form: Annex "C"

The document provides instructions for examinees to submit a post-examination health surveillance form to the regional PRC office 15 days after their exam. It includes a sample form for the examinee to provide their name, testing details, and health status.

Uploaded by

Mohaliden Nasa Esmael
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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Annex “C”

Post Examination Health Surveillance Form

Instructions: Please continue to follow social distancing and the wearing of face mask
even after the exam. You are required to send an email at the official email address of the
Regional Office where you take your licensure examination 15 days after the last
examination date. Please provide truthful information relative to your health status.

Dear PRC,

Good day! I took the L E T licensure examination last January 30, 2022
(profession) (date)

I would like to inform you of my health status as of February 14, 2022.


(date)

Name: UDASAN, ESMAIL M.


Testing Venue: Pagadian Capitol College
Room No: 18
Seat No: 4

My health status is: (Please check () all relevant items)


 have no symptom/s.
___ am with the following symptom/s:
___ fever
___ cough
___ easy fatigability
___ other signs/ symptoms or remarks: ___________

After completing the message, you will receive an acknowledgment and/or further
instructions from PRC.

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