Scribd Logo
Upload

Welcome to Scribd!

  • 51 views

    Tuazon, Ella Mae I PDF

    Uploaded by

    Wonie boo
    Ella Mae I. Tuazon completed a health assessment form for students attending Our Lady of Fatima University. She indicated "yes" to having experienced body pain, headache, fever, cough, colds, tiredness, and loss of taste/smell in the past 14 days. She also indicated "yes" to having contact with someone experiencing fever, cough, colds, or sore throat in the past 14 days. Ella Mae attested that the information provided is true and correct, and understands the university's policies regarding COVID-19 protocols and restrictions for vulnerable students.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Tuazon, Ella Mae I PDF

    Uploaded by

    Wonie boo
    51 views1 page
    Ella Mae I. Tuazon completed a health assessment form for students attending Our Lady of Fatima University. She indicated "yes" to having experienced body pain, headache, fever, cough, colds, tiredness, and loss of taste/smell in the past 14 days. She also indicated "yes" to having contact with someone experiencing fever, cough, colds, or sore throat in the past 14 days. Ella Mae attested that the information provided is true and correct, and understands the university's policies regarding COVID-19 protocols and restrictions for vulnerable students.

    Original Title

    TUAZON, ELLA MAE I..pdf

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Ella Mae I. Tuazon completed a health assessment form for students attending Our Lady of Fatima University. She indicated "yes" to having experienced body pain, headache, fever, cough, colds, tiredness, and loss of taste/smell in the past 14 days. She also indicated "yes" to having contact with someone experiencing fever, cough, colds, or sore throat in the past 14 days. Ella Mae attested that the information provided is true and correct, and understands the university's policies regarding COVID-19 protocols and restrictions for vulnerable students.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views1 page

    Tuazon, Ella Mae I PDF

    Uploaded by

    Wonie boo
    Ella Mae I. Tuazon completed a health assessment form for students attending Our Lady of Fatima University. She indicated "yes" to having experienced body pain, headache, fever, cough, colds, tiredness, and loss of taste/smell in the past 14 days. She also indicated "yes" to having contact with someone experiencing fever, cough, colds, or sore throat in the past 14 days. Ella Mae attested that the information provided is true and correct, and understands the university's policies regarding COVID-19 protocols and restrictions for vulnerable students.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    HEALTHASSESSMENT FORM FOR STUDENTS HWC 044-20-02

    NAME Ella Mae I. Tuazon CAMPUS Antipolo

    AGE 18 GENDER F CONTACT NOS. 09693028324 YEAR/SECTION 1-B-23 COLLEGE/STRAND. BSN

    Answer each question by placing a check (✓) mark. YES NO


    1.Have you been fully vaccinated for COVID-19 during the last 2 weeks? (2 doses, except for Janssen ✓
    vaccine which requires only 1 dose)
    2.Have you experienced any of the following in the past 14 days ✓
    Sore throat ✓
    Body pain ✓
    Headache ✓
    Fever ✓
    Cough ✓
    Colds ✓
    Difficulty of breathing ✓
    Diarrhea ✓
    - Nausea/vomiting ✓
    Tiredness ✓
    Loss of taste and/or smell ✓
    Skin rash ✓
    Red eyes ✓
    Loss of movement and/or speech ✓
    Chest pain or pressure ✓
    3. Have you worked together or stayed in the same close environment with a confirmed COVID-19 case ✓
    or PUI who is under self-quarantine in your house or in your neighborhood?
    4. Did you have any contact with anyone with fever, cough, colds, and sore throat in the past 14 days? ✓

    5. Have you travelled outside of the Philippines in the last 14 days? ✓

    6. Do you have any of the following conditions: ✓

    60 years old and above ✓


    Ongoing pregnancy ✓
    Hypertension ✓
    Heart disease ✓

    Diabetes mellitus ✓
    Recurrent asthma attacks ✓
    Chronic lung disease- ongoing PTB treatment ✓
    COPD ✓
    Cancer ✓
    Blood dyscrasias ✓
    Chronic liver and kidney diseases ✓
    Currently undergoing dialysis treatment ✓
    Immunocompromised status ✓
    Autoimmune disease ✓
    Other Illnesses ✓
    I fully understand that it is the policy of the Our Lady of Fatima University that no students regardless of status shall be
    allowed to report for school on campus if any of the abovementioned conditions are present. A student may only report back to
    school after following the 14-day quarantine protocol and submit a medical clearance/fit to school certificate from the School
    Physician before reporting on campus.

    For students in vulnerable group (VG): I fully understand that I must follow the prevailing guidelines prescribed by the COVID-
    19
    Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF).
    I attest that all the information given above are true and correct and that I may be held liable for any misinformation stated
    herein. I also authorize Our Lady of Fatima University to collect and process data indicated herein for the purpose of effecting
    the control of COVID-19 infection and that my personal information are protected by RA.10173 (Data Privacy Act of 201°C 2)
    and that I am required by RA.11469 (Bayanihan to Heal as One Act) to provide truthful information.

    Student’s Signature Over Printed Name:

    Date 13/01/2023

    You might also like