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CLINIC PASS CLINIC PASS

Date: __________________________________ Date: __________________________________


Student: __________________________________ Student: __________________________________
Section: GOLD Section: GOLD
Subject Teacher: __________________________________ Subject Teacher: __________________________________
Class Adviser: ALLAN Z. ALBERTO Class Adviser: ALLAN Z. ALBERTO
Time: __________________________________ Time: __________________________________
Complaint: __________________________________ Complaint: __________________________________
___________________________________________________ ___________________________________________________
Time Checked In: __________________________________ Time Checked In: __________________________________
( ) Sent to office to go home ( ) Sent to office to go home
( ) Temperature _________ degrees ( ) Temperature _________ degrees
( ) No medical health problem found- return to class ( ) No medical health problem found- return to class
( ) Wound or scratch treated ( ) Wound or scratch treated
( ) Rested and feels better ( ) Rested and feels better
( ) Other: __________________________________ ( ) Other: __________________________________

CECELIA D. GADOR, RN CECELIA D. GADOR, RN


Clinic Staf Clinic Staf

CLINIC PASS CLINIC PASS


Date: __________________________________ Date: __________________________________
Student: __________________________________ Student: __________________________________
Section: GOLD Section: GOLD
Subject Teacher: __________________________________ Subject Teacher: __________________________________
Class Adviser: ALLAN Z. ALBERTO Class Adviser: ALLAN Z. ALBERTO
Time: __________________________________ Time: __________________________________
Complaint: __________________________________ Complaint: __________________________________
___________________________________________________ ___________________________________________________
Time Checked In: __________________________________ Time Checked In: __________________________________
( ) Sent to office to go home ( ) Sent to office to go home
( ) Temperature _________ degrees ( ) Temperature _________ degrees
( ) No medical health problem found- return to class ( ) No medical health problem found- return to class
( ) Wound or scratch treated ( ) Wound or scratch treated
( ) Rested and feels better ( ) Rested and feels better
( ) Other: __________________________________ ( ) Other: __________________________________

CECELIA D. GADOR, RN CECELIA D. GADOR, RN


Clinic Staf Clinic Staf