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    ANNEX B DECLARATION For CPD

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    Pasabay Transactions
    1) The document is a declaration form from Mariecon Z. Manalang applying for continuing professional development credit units. 2) It states that Mariecon is a nurse who worked at Camp Bado Dangwa Hospital in La Trinidad, Benguet from March 2020 to present during the COVID-19 pandemic. 3) Her duties included conducting temperature screenings, patient triaging, working at quarantine facilities, consolidating COVID-19 reports, and assisting with PCR swab tests and distributing aid to families.

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    ANNEX B DECLARATION For CPD

    Uploaded by

    Pasabay Transactions
    45 views1 page
    1) The document is a declaration form from Mariecon Z. Manalang applying for continuing professional development credit units. 2) It states that Mariecon is a nurse who worked at Camp Bado Dangwa Hospital in La Trinidad, Benguet from March 2020 to present during the COVID-19 pandemic. 3) Her duties included conducting temperature screenings, patient triaging, working at quarantine facilities, consolidating COVID-19 reports, and assisting with PCR swab tests and distributing aid to families.

    Original Description:

    PRC ANNEX B for EXAM

    Original Title

    ANNEX B DECLARATION for CPD.docx

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    1) The document is a declaration form from Mariecon Z. Manalang applying for continuing professional development credit units. 2) It states that Mariecon is a nurse who worked at Camp Bado Dangwa Hospital in La Trinidad, Benguet from March 2020 to present during the COVID-19 pandemic. 3) Her duties included conducting temperature screenings, patient triaging, working at quarantine facilities, consolidating COVID-19 reports, and assisting with PCR swab tests and distributing aid to families.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    45 views1 page

    ANNEX B DECLARATION For CPD

    Uploaded by

    Pasabay Transactions
    1) The document is a declaration form from Mariecon Z. Manalang applying for continuing professional development credit units. 2) It states that Mariecon is a nurse who worked at Camp Bado Dangwa Hospital in La Trinidad, Benguet from March 2020 to present during the COVID-19 pandemic. 3) Her duties included conducting temperature screenings, patient triaging, working at quarantine facilities, consolidating COVID-19 reports, and assisting with PCR swab tests and distributing aid to families.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    AB

    Annex "B"

    CPD COUNCIL OF/FOR

    DECLARATION

    I, Mariecon Z. Manalang__, of legal age, with address at __44 Paraiso St.


    Bayugo, Meyc_, and applicant for Continuing Professional Development credit units,
    hereby declare and say that:

    1. I am a registered/licensed _____Nurse_____ with Professional Identification


    Card No. __0304810__ issued on __January 16, 2018__;

    2. During the State of Public Health Emergency brought about by the Corona
    Virus Disease 2019 (COVID-19), I was assigned / rendered my services as
    ____Nurse PNCO_____ at ___Camp Bado Dangwa Hospital, Alapang, La
    Trinidad, Benguet from _March 16, 2020 up to present__;

    3. As such, I was task to do the following:


    a. Conduct of Non-Contact Thermal Scanning and Triaging to every
    individual entering Camp Bado Dangwa, La Trinidad, Benguet as part of
    the COVID 19 prevention, management and control.
    b. Conduct triaging to patient prior to consultation and treatment.
    c. Rendered duty at the PROCOR Quarantine Facility (SOQ and Camp Bado
    Dangwa Covered Court)
    d. Consolidate reports coming from the Regional Health Service Cordillera
    COVID-19 Monitoring Center prior submission to the National
    Headquarters.
    e. Assisted in the conduct of RT-PCR Swab Test of PROCOR frontliners.
    f. In support to RA 11469 “Bayanihan to Recover as One Act” and Adopt a
    Family Program of the Philippine National Police, participated in the
    distribution of goods to families affected by COVID 19 pandemic.

    4. As proof of the said services, attached hereto is the Certification in connection


    therewith from the institution/agency/entity and/or pictures during the actual
    activities.

    5. I hereby attest that all information stated herein are correct and complete, and
    that the document/s submitted herewith are true, valid and genuine. I am
    aware that any false information or fraudulent document provided may cause
    the denial of this application, or the withdrawal of CPD credit units if already
    given, as well as appropriate administrative or criminal charges.

    This _____day of ___________, 20____ at _____________________.

    _______________________
    Signature over printed name

    *Applicant may provide additional information/documents should he/she wishes to do so

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