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Download DepEd School Health Record or SHD Forms (1-5)




Attached is a copy of DepEd School Health Record or SHD Form (1-5) enclosure to DepEd Order No. 33, s. 2019 dated December 09, 2019, from DepEd Secretary Leonor Magtolis Briones, DepEd-Central Office entitled “IMPLEMENTING GUIDELINES ON THE COMPREHENSIVE ORAL HEALTH PROGRAM OF THE DEPARTMENT OF EDUCATION”, the contents of which are self-explanatory, for information and strict compliance.

DepEd School Health Record Forms

All dental examination procedures and results for learners shall be entered in the Learner’s School Health Record or SHD Form 1.

All treatments done by the School Dentist shall be recorded in the Daily Treatment Record (Dental) or SHD Form 2B.




Referral of learners to dental clinic/offices shall be done using Referral Slip (Dental) or SHD Form 3B.

All dental examination procedures and results for teaching and non-teaching personnel shall be entered in the Teaching and Non-Teaching Personnel Dental Record or SHD Form 4B.




All Dentist shall submit a Monthly Dental Accomplishment Report or SHD Form 5B for submission to the Chief, Schools Governance and Operation Division. A Division Consolidated Quarterly Accomplishment Report shall be submitted to the Regional Office- Education Support Services Division (ESSD). A Regional Consolidated Quarterly Accomplishment Report shall be submitted to the BLSS-School Health Division.

DepEd SHD Form (1, 1A, 1B, 1C, 1DA, 1DB)

DepEd SHD Form (2A and 2B)

DepEd SHD Form (3A and 3B)

DepEd SHD Form (4, 4A, and 4B)

DepEd SHD Form (5A and 5B)

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