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Republic of the Philippines Department of Education National Capital Region DIVISION OF MUNTINlUPA CITY
DIVISION MEMORANDUM
No.
o?f1:t s.,20lS
"
To:
OIC - Asst. Schools Division Superintendent
Public Elementary/Secondary Principals/School Heads/ Officer-In-Charge
Division Nurse In-Charge/School Health &. Nutrition Personnel
From:
OIC - Office of the Division Administrative Officer V
Date:
5 May 2015
Subject:
School- Based Adolescent Immunization S.Y. 2015 -2016
Attached is a DepEd
Memorandum dated February 12, 2015 re: School -Based Adolescent
Immunization in September 2015, which is self explanatory, for information and guidance.
Advocating this activity to parents is advised through Classroom Parent Teachers Association
meeting. Parents' Consent where 'No Consent, No Immunization Policy' is slated, shall be
strictly observed.
Please see attached Forms (I, 2 &. 4), School - Based Adolescent Immunization Division Action
And be guided by Oep ~d Memorandum No.lS6, s. 2013 ; DOH
Plan S.Y. 2015-2016.
Administrative Order No. 201O-OO17-A, content of which is self-explanatory, for information
and appropriate action.
For details, please contact Mrs. Ma. Teresa S. lndap, R.N., Division Nurse In-Charge, School
Health and Nutrition Section and Mrs. Rhea T. Reforma, R.N., Alternate EPI Coordinator, City
Health Office.
issemination of this memorandum is desired.
REME
Katihan St., Poblacion, Muntinlupa City * Telefax: 861-4953, 861-4951, 861-0566 Website: www.depedmuntinlupa.iedu.ph * Email: depedmuntin@yahoo.com SCHOOL BASED ADOLESCENT IMMUNIZATION
DIVISION ACTION PLAN
S.Y. 2015-2016
~~t.~~~
General Objective: To reach the 85% target of Grade VII students for MMR (Measles- Mumps-Rubella),Td (Tetanus-diptheria) immunization. ACTIVITIESIACTION POINTS
TIME FRAME
RESOURCES NEEDED
PERSON/S RESPONSIBLE
PRE • IMPLEMENTAnON
I
I. Advocacy meeting with the following personnel:
1.1. Mayor/SDS
1.2. Sec. Principals & Oles'/Advisers (Gr.7l/School Nurses
4th week of
July, 2015
SDO-Muntinlupa
City Health Office
of School-Based Adolescent
Immunization in the NCR
1.3 City Health Office Staff/OsMun Rep.
1.4 PTA Officers/Parents/Guardian/SSG Rep.
II. Information and Dissemination
1.1. Issuance of Division Memorandum/Orientation
CHD-MM ORDER No.2013-OOS
Division Memorandum
2.1. During Flag ceremony; PTA assembly
3.1. Bulletin Board announcement
CHD-MM ORDER No.2013-00S
Guidelines in the Implementation
Post of Streamer
August, 2015
IEC Materials
I
SDO-Muntinlupa
Public Sec. Principal/OIC's
Health Personnel
Advisers (Gr.7)/SSG Rep.
III. Manpower & Logistic Management
1. Before the immunization Days
•
> Organize the vaccination teams (VT)
> Orient the vaccination teams
> Coordinate with the focal person from school
CHD-MM ORDER No.20U-OOS
- Orientation of teachers and students
- Identify the immunization center/areas
- Distribute the notification letter/consent
School Clinic /Classroom
School Nurse/CHO - EPI Managers
EPI Form 1
School Nurse/Advisers
Assign areas
Volunteer parents/teachers
during PTA assembly
- Retrieve the Signed notification letter
- Screen all women for present or absence of
pregnancy
- Additional Manpower for Marshal during
Immunization
August,201S
1. Coordinate to Advisers (Gr. 7)
2. Set-up the Immunization posts
3. Prepare the Immunization logistics
4. Screening the students w/ consent
- Inform the other students of the risk for non-vaccination
5. Monitoring of AEFI -COordination to hospital
- Management of Injection Reactions
6. Waste Disposal Management
-Schedule of Safety boxes collection
7. Vaccine Storage /Handllng/Transport
IMPLEMENTATION PHASE
5
EPI Forms 1,2 " 4
E
P
T
E
M
B
School Clinic /Classroom
Vacdnes,syrlnge,cotton,Safety Bxs.
c/o DOH -CHO Muntinlupa
R
EPI Form 1
Ambulance I Emergency Medicines
Refferal Form/EPI Form 7
Safety Collector Boxes
2015
Cold Chain> Refrigerator Inside
clinic area
E
School Nurse/Advisers
School Nurse & EPI Managers
School Nurse/Advisers
c/o School Clinic Fund/
CHO - Muntinlupa
CHO-Sanltary Inspector
School Nurse/EPI Staff
CHO - EPI Managers
School Nurse
POST IMPLEMENTATION PHASE
1. Reporting" Recording
- Consolidate the reports
- Submit the report to the next adm. Level
- Report AEFI Cases
2. Follow - up cases
- Students missed and vaccine
Daily reports
EPI Form 4
EPI Form 5" 6
EPI Form 7/AO NO. 2010-0017-A
School Nurse/EPI Staff
Division Nurse In-Charge
School Nurse
EPI Form 2
School Nurse
As needed
Prepared by:
<I
MA~R.N.
Nurse II/Division Nurse In-Charge
Noted by:
for:
by:
Schools AdrTttm:{rative Officer V Officer - I~Charge Republika ng Pitipinas
(Repubiicorthe Philippines)
q'
KAGAWARAN NO EDUKASYON
(DEPARTMENT OF EDUCATION)
PAMBANSANO PUNONO REHIYON
(NATIONAL CAPITAL REGION)
Daang Misamis, Bago Bantay, Lungsod Quezon
(Misamis St., Bago Bantay, Quezon City)
.
MEMORANDUM
TO
',,;'cpartment of Education
National Capital Region
RECORDS AND PUBLI
ION UNIT
: Schools Division Superintendents
:LU~A
FROM
Director IV
SUBJECT
: School-Based Adolescent Immunization
DATE
: February 12, 2015
1. Attached is the communication from Director Ariel I. Valencia, Department
of Health - National Capital Regional Office (DOH - NeRO) dated February 3,
2015 re: School-Based Adolescent Immunization, which is self-explanatory,
for information and guidance.
2. The DOH will conduct School-Based Adolescent Immunization activity, this
st
time covering all grade 7 (1 year high school students) and will be
implemented routinely in all public secondary schools.
3. In this connection, your continued support and participation is hereby
enjoined.
"
February 3 20 1 5
DR lUZ S. ALMEDA
Director IV
OepartmElnt of Education
Nationai Capital Region
Attentjon; Dr. I,.ucila S. Pl)regrina
HeEH:i, Schoa! Hea!th and
hlL~tnt~c:n t.}nl~
Dear Dr. Almada
The Adolescent Health Development Program LA.HDP) of the. Department of Health (DOH}
includes immunization as one of its corr,vetJE:nslve r.ea!tb seroicfl3. for adolescents
10­
19 years old Thus, tile DOH in collaboration wittr the DepS!1:f1'lsnt of Educatbn (DepEd) has
c')nducted the Schoo!-8ased ,Il..doiescent Immunization Act.vity.in selected cities in Metro
Maniia last January 2 to March
2014
nnH
In lintl! fif ihr '1! IrrfYi nf ihf rnn:~i! nif"fi ArT!ViYlf irlf'
inftf'thff lNiih nfnF1wiil "irAl!" i In
and routinely implement the SchooiftBased Adolescent Immunization. this time cClVenng
an grade 7 students in all public high schools !.l Metro MF.:lnila.
Hence, the DOH-NeRO wouid like to reque~t DepEd-NCRs full support b\{ enjoining the
participation of the sixteen (i
Schools Div!f:.ion Offices in order to ensure high coverage
and a successfuilmplernel1tahOr. of tt1is a;;!"'!J~~! <:\cttvity.
Thank you for your continued support in the DOH-NeRO's endeavors to improve the
implementation and management of the Adolescent Health Development Program in NCR.
Very truly yours.
L I VALENCIA. MD, MPH, CESQ !I!
~ctor
IV
Republika ng Pilipinas KAGAWARAN NG EDUKASYON REHIYON Lungsod ng'c---::-:-_ Tanggapang Panrehiyon NOTIFICATION I£JTER.
DIVISION:
Muntinlupa SCHOOL: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ DATE: ADDRESS:
.
GRADE & SECTION: _ _ _ _ _ _ _ _ _ __
ADDRESS:_ _ _ _ _ _ _ _ _ _ _ _ _ __
STUDENT'S NAME:
NAME OF PARENT:
Dear Mr. & Mrs.:
The Department of Education~ Division Mugtinl.... in coordination with the City/Municipal Health Office and the
Department of Health - National Capital Regional Office, shall conduct free immunization against Measles, Rubella (MR) and
Tetanus, Diphtheria (Td) among all Grade 7 public secondary students on [DATE]. This activity is one of the identified
components in the Department of Health~Nationai Capital Regional Office's (DOH~NCRO) Adolescent Health and Development
Program.
The Adolescent age group makes up a significant proportion of each country's population. In the Philippines, they
comprise about 21.5 percent or almost 20 million of the 92 million Filipinos counted in the 2010 census (NSO, 2010) as cited by
the University of the Philippines Population Institute. They are the major contributors to the labor force and thus form the
backbone of each country's economy.
There were 1,383 reported measles cases in 2011 among age group 10-19 years nationwide. For Neonatal Tetanus,
there was an increase reported cases of 147 in 2010 to 186 in 2011. Thus, the conduct of School- Based Immunization among
Adolescents is essential in eradicating vaccine- preventable diseases.
This Notification is being issued to you as information of the activity that will be conducted on Awmst. 2015. Should
you have further questions/clarifications on this matter, please get in touch with the School Head/Principal or School Health
Personnel.
Attached is a copy of DepEd Memo No. 156 s. 2013. For further inquiries, please approach the principal at the
Principal's office.
Thank you.
Very truly yours,
(Name of School Head/Principal)
ACKNOWLEDGEMENT AND CONSENT
This is to acknowledge receipt of the Notification Letter regarding the conduct of School- based Immunization.
I have read and understood the information regarding the MMRand Td Vaccination among Adolescents.
(Please check the box provided)
[J
Yes, I anow my child to be vaccinated with MR and Td.
[J
No, I don't allow my child to be vaccinated with MR and Td.
Reason (please specify): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Name and Signature of Parent! Guardian
Date
Reporting Form 2: Masterlist of Students
MASTERLIST OF ADOLESCENTS FOR IMMUNIZATION
ADOLESCENTS HEALTH AND DEVELOPMENT PROGRAM
40
(GRADE 7)
Distrlct: _ _ _ _ _ _ _ _ __
Region: NCR
Province/City: MuntinluPl City
Name of School: _ _ _ _ _ _ __
Dam: ________________
Year Level: _____
Section: _ _ _ __
To be filled up by the school'
-­
_m",
No.
Name
Complem Address
Data of Birth
(MMlDDIYY) I Age
I
Sex
I
HIIIo!y of
AIIIr;l..
(mods. Al:IIve UntruIIId
food, pn!'Iioua
T8
'
oIIIIIRI!d)
'"""
To be filed u
Blood
- IIIoodIng(II.
_ _, l.1li .....11_
(For FEIIALE OHly)
HlOIOIy of ­
the vac:cination learn
SICI<!ocIty?
_III
poot ~
COIIQII.I
V8C1:iile Give!!
_ _!lit
(for
_
,
FEIIALE ..Iy,
REMARKS (Any Yet mponse. defer
immunization. Refer to Medical
OffIcer)
~-,--+-,-;---,--j
Td
{1. ...,
.'y.I.IYI
·c
,.
.
10
Total.
Note;
AJpltOMtlaJl., separate ma'e/~m,,/e
6 """;_Ion
'. Reporting Form 4: School Consolidated Accomplishment
'.
IMMUNIZATON FOR ADOLESCENTS
ADOLESCENT HEALTH AND DEVELOPMENT PROGRAM
(GRADE 7)
Name of School: _ _ _ _ _ _ __
Region:
Division:
Province! City: Muntinlupa City
Muntinlupa
Total..ElIglble
Given MR
,/
Male
Female
GivenTd
Number
Number
Total
Year Level
Total
Male
Female
NCR
%
Number
Deferred
"
Reasons for Refusals
Number
Total
Male
Female
%
Number
Deferred
Possibly
P,egnont
Absent
.\
Grade 7
<I
lit>
Se"e,e
Allergy
TolrIlA ~l'I
No Consent