ABCDEFGHIJKLMNOPQRSTUVWXYZ
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2025 SHD Form 5A
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Republic of the Philippines
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DEPARTMENT OF EDUCATION
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Region
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Division of _____________________Leave "DIVISION" BLANK in RO report; Leave "School Name/ID" BLANK in SDO/RO consolidated report
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______________________________________________
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School Name/ID
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MONTHLY / QUARTERLY HEALTH SERVICES ACCOMPLISHMENT REPORT
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MONTH/QUARTER: SYSchool - Month; SDO/RO - 1st/2nd/3rd/4th Quarter
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Name of School: School ID No.: Leave "Name of School/School ID No." BLANK in SDO/RO consolidated report
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Total No. of Elem. Schools Visited
Leave "Total No. of Elem/Sec Schools Visited" BLANK in School report
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Total No. of Sec. Schools Visited
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Number (Male)Number (Female)TOTAL
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I. General Information
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A. School Enrolment
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B. No. of School Personnel
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1. Teaching
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2. Non-Teaching
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II. Health Services
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A. Health Appraisal
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1. No. of Assessed:
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a. Learners
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b. Teachers
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c. NTP
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2. No. with Health Problems
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a. Learners
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b. Teachers
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c. NTP
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3. No. of Vision Screening (Learners)
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Kindergarten
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Grade 1
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Grade 2
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Grade 3
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Grade 7
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B. Treatment Done
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a. Learners
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b. Teachers
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c. NTP
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C. No. of Pupils Dewormed
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a. 1st Round
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b. 2nd Round
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D. No. of Pupils Given Iron Supplement
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E. No. of Pupils Immunized (Specify vaccine given)
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F. No. of Learners provided with eyeglasses
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G. No. of consultation attended
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a. Learners
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b. Teachers
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H. Referral (No. Referred to)
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a. Physician
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b. Dentist
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c. Professional eye care
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d. Other facilities
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e. RHU/ District/ Provincial Hospital
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