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Vaccination Calendar
Category
Category
Health_Care_Worker
Senior_Citizen
Indigent
Uniformed_Personnel
Essential_Worker
Others
Category ID
PRC_number
OSCA_number
Facility_ID_number
Other_ID
Category ID Number
PhilHealth ID
PWD ID
Personal Details
Last Name
First Name
Middle Name
Suffix
II
III
IV
JR
NA
SR
V
Contact Number
Birthday
Civil Status
Single
Married
Widow/Widower
Separated/Annulled
Living_with_Partner
Sex
Male
Female
Pregnant
Yes
No
Address
Unit/Building/House No./Street/Subdivision
Region
Province
Municipality
Barangay
Employment Details
Employment Status
Government_Employed
Private_Employed
Self_Employed
Private_Practitioner
Others
Profession
Dental_Hygienist
Dental_Technologist
Dentist
Medical_Technologist
Midwife
Nurse
Nutrionist_Dietician
Occupational_Therapist
Optometrist
Pharmacist
Physical_Therapist
Physician
Radiologic_Technologist
Respiratory_Therapist
X_Ray_Technologist
Barangay_Health_Worker
Maintenance_Staff
Administrative_Staff
Others
Name of Employer
Contact No. of Employer
Province/HUC/ICC of Employer
Address of Employer
Health Details
Directly in interaction with COVID patient
Yes
No
Allergy
Yes
None
Drug
Food
Insect
Latex
Mold
Pet
Pollen
Others
Comorbidity
Yes
None
Hypertension
Heart Disease
Kidney Disease
Diabetes Mellitus
Bronchial Asthma
Cancer
Immunodeficiency State
Others
Patient Diagnosed with COVID 19
Yes
No
Date of First Positive Result / Specimen Collection
Classification of COVID 19
Asymptomatic
Mild
Moderate
Severe
Critical
Willing to be vaccinated
Yes
No
Undecided