Scribd Logo
Upload

Welcome to Scribd!

  • 9 views

    Health Examination Form

    Uploaded by

    Vangie Marikit
    This document is a school health examination card used in the Philippines to record student health information over several grades. It includes sections to record a student's name, birthdate, address and parent/guardian information. There are also tables to document annual health examinations from kindergarten through 12th grade. Examination findings are recorded for temperature, height, weight, nutrition status, vision and hearing screenings, and checks of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen and deformities. Notes sections allow recording of any illnesses, interventions/treatments and the attending medical professional.

    Copyright:

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

    Health Examination Form

    Uploaded by

    Vangie Marikit
    9 views4 pages
    This document is a school health examination card used in the Philippines to record student health information over several grades. It includes sections to record a student's name, birthdate, address and parent/guardian information. There are also tables to document annual health examinations from kindergarten through 12th grade. Examination findings are recorded for temperature, height, weight, nutrition status, vision and hearing screenings, and checks of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen and deformities. Notes sections allow recording of any illnesses, interventions/treatments and the attending medical professional.

    Copyright

    © © All Rights Reserved

    Available Formats

    XLSX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document is a school health examination card used in the Philippines to record student health information over several grades. It includes sections to record a student's name, birthdate, address and parent/guardian information. There are also tables to document annual health examinations from kindergarten through 12th grade. Examination findings are recorded for temperature, height, weight, nutrition status, vision and hearing screenings, and checks of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen and deformities. Notes sections allow recording of any illnesses, interventions/treatments and the attending medical professional.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    9 views4 pages

    Health Examination Form

    Uploaded by

    Vangie Marikit
    This document is a school health examination card used in the Philippines to record student health information over several grades. It includes sections to record a student's name, birthdate, address and parent/guardian information. There are also tables to document annual health examinations from kindergarten through 12th grade. Examination findings are recorded for temperature, height, weight, nutrition status, vision and hearing screenings, and checks of the skin, eyes, ears, nose, mouth, throat, lungs, heart, abdomen and deformities. Notes sections allow recording of any illnesses, interventions/treatments and the attending medical professional.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 4

    Republic of the Philippines

    Department of Education
    BUREAU OF LEARNER SUPPORT SERVICES- SCHOOL HEALTH DIVISION
    REGION VII - DIVISION OF CEBU PROVINCE
    SCHOOL HEALTH EXAMINATION CARD

    Name: ________________________________________________ School ID: ________________________________


    Last First Middle
    LRN: ___________________________________
    Date of Birth: ___________________________________________ Region: ________________________________
    Month Day Year
    Birthplace: _____________________________________________ Division: ________________________________
    Parent/Guardian: _________________________________________ Telephone No: ________________________________
    Address: ______________________________________________

    KINDER GRADE I GRADE II GRADE III GRADE IV GRADE V GRADE VI

    Findings Findings Findings Findings Findings Findings Findings

    Date of Examination

    Temperature/BP

    Heart Rate/Pulse Rate/Respiratory Rate

    Height (cm)

    Weight (kg)

    Nutritional Status (NS) (Height-for-Age)

    Nutritional Status (NS) (BMI/Wt-for-Age)

    Vision Screening using appropriate chart

    Auditory Screening (Tuning Fork)

    Skin/Scalp

    Eyes/Ears/Nose

    Mouth/Throat/Neck

    Lungs/Heart

    Abdomen

    Deformities

    Iron Supplementation (/ or X)

    Deworming (/ or X)

    Immunization (Specify what kind)

    SBFP Beneficiary (/ or X)

    4Ps Beneficiary (/ or X)

    Menarche (/ or X)

    Others, specify

    Examined by:

    Vision/Auditory Mouth/Neck/
    NS Skin/Scalp Eye/Ear/Nose Lungs/Heart Abdomen Deformities
    Screening Throat

    a. Normal Weight a. Passed a. Normal a. Normal a. Normal a. Abnormal a. Normal a. Acquired

    b. Wasted/ b. Failed b. Presence of Lice b. Stye b. Enlarged b. Rales b. Distended b. Congenital

    Underweight c. Redness of skin c. Eye redness tonsils c. Wheeze c. Abdominal pain (Specify)

    c. Severely wasted/ d. White spots d. Ocular Misalignment c. Presence of d. Murmur d. Tenderness

    Underweight e. flaky skin e. Pale conjunctiva lesions e. Irregular heart e. Dysmenorrhea

    d. Overweight f. impetigo/boil f. Ear Discharge d. Inflamed phar rate f. Others (specify)

    e. Obese g. Hematoma g. Impacted Cerumen e. Enlarged f. Cough

    f. Normal Weight h. Bruises/Injuries h. Mucus Discharge lymphnodes g. Colds


    g. Stunted i. Itchiness i. Nose Bleeding f. Others (specify h. others, Specify

    h. Severely Stunted j. skin lessions (Epistaxis)


    i. Tall k. Acne/Pimple j. Eye Discharge

    k. Matted Eyelashes

    Note: Use letter to record ailments


    Attended by
    Date Chief Complaint Intervention/Treatment Done Remarks
    (Name/Position)
    Republic of the Philippines
    Department of Education
    BUREAU OF LEARNER SUPPORT SERVICES- SCHOOL HEALTH DIVISION
    REGION VII - DIVISION OF CEBU PROVINCE
    SCHOOL HEALTH EXAMINATION CARD

    Name: ________________________________________________ School ID: ________________________________


    Last First Middle
    LRN: ___________________________________
    Date of Birth: ___________________________________________ Region: ________________________________
    Month Day Year
    Birthplace: _____________________________________________ Division: ________________________________
    Parent/Guardian: _________________________________________ Telephone No: ________________________________
    Address: ______________________________________________

    VII VIII IX X XI XII

    Findings Findings Findings Findings Findings Findings

    Date of Examination

    Temperature/BP

    Heart Rate/Pulse Rate/Respiratory Rate

    Height (cm)

    Weight (kg)

    Nutritional Status (NS) (Height-for-Age)

    Nutritional Status (NS) (BMI/Wt-for-Age)

    Vision Screening using appropriate chart

    Auditory Screening (Tuning Fork)

    Skin/Scalp

    Eyes/Ears/Nose

    Mouth/Throat/Neck

    Lungs/Heart

    Abdomen

    Deformities

    Iron Supplementation (/ or X)

    Deworming (/ or X)

    Immunization (Specify what kind)

    SBFP Beneficiary (/ or X)

    4Ps Beneficiary (/ or X)

    Menarche (/ or X)

    Others, specify

    Examined by:

    Vision/Auditory Mouth/Neck/
    NS Skin/Scalp Eye/Ear/Nose Lungs/Heart Abdomen Deformities
    Screening Throat

    a. Normal Weight a. Passed a. Normal a. Normal a. Normal a. Abnormal a. Normal a. Acquired

    b. Wasted/ b. Failed b. Presence of Lice b. Stye b. Enlarged b. Rales b. Distended b. Congenital

    Underweight c. Redness of skin c. Eye redness tonsils c. Wheeze c. Abdominal pain (Specify)

    c. Severely wasted/ d. White spots d. Ocular Misalignment c. Presence of d. Murmur d. Tenderness

    Underweight e. flaky skin e. Pale conjunctiva lesions e. Irregular heart e. Dysmenorrhea

    d. Overweight f. impetigo/boil f. Ear Discharge d. Inflamed pharynx rate f. Others (specify)

    e. Obese g. Hematoma g. Impacted Cerumen e. Enlarged f. Cough

    f. Normal Weight h. Bruises/Injuries h. Mucus Discharge lymphnodes g. Colds


    g. Stunted i. Itchiness i. Nose Bleeding f. Others (specify) h. others, Specify
    h. Severely Stunted j. skin lessions (Epistaxis)
    i. Tall k. Acne/Pimple j. Eye Discharge

    k. Matted Eyelashes

    Note: Use letter to record ailments


    Attended by
    Date Chief Complaint Intervention/Treatment Done Remarks
    (Name/Position)

    You might also like