City Health Department

DATA NEED FOR THE ISSUANCE OF DOCUMENTS

A. HEALTH CERTIFICATES

1. COMPLETE NAME

2. PLACE OF WORK AND NAME OF ESTABLISHMENT

3. ADDRESS

4. NATIONALITY

5. AGE

6. GENDER

7. CIVIL STATUS

B. LABORATORY

1. URINALYSIS AND FECALYSIS

a. NAME

C. RADIOLOGY/X-RAY

1. NAME

2.AGE

3. GENDER

4. BIRTHDATE

D. CERTIFICATE OF INSPECTION FOR OCCUPANCY

1. NAME OF ESTABLISHMENT

2.NAME OF OWNER

3. ADDRESS

4. BIRTHDATE

E. SANITARY PERMIT

1. NAME OF ESTABLISHMENT

2.NAME OF OWNER

3. ADDRESS

4. BIRTHDATE

F. TRANSFER PERMIT

1. NAME OF THE DISEASED

G. SOCIAL HYGIENE CLINIC

1. PINK AND BLUE CARD

a. NAME

b. AGE

c. SEX

d. NATIONALITY

e. CIVIL STATUS

f. ADDRESS

H. PRE-MARRIAGE COUNSELING INFORMATTON SHEET FOR CERTTFTCATE OF COMPLIANCE (SECTION 15 OF RA 10354)

1. NAME

2. AGE

3. ADDRESS

4. EDUCATIONAL ATTAINMENT

I. ANIMAL BITE CENTER

1. COMPLETE NAME

2. ADDRESS

3. BIRTHDATE

4. AGE

5. SEX

6. CONTACT NUMBER