APCAS Campus Care

Student Health Portal

Home Health Records Announcements

Security Note: All records are encrypted and only accessible by authorized school health personnel in compliance with Data Privacy Act of 2012.

Student Health Record Form

Please fill in all required fields (*) to submit your health record

Student Information

FullName * (E.g Juan A. DelaCruz)

StudentID *

Age *

Date of Birth

Blood Type

Year *

Program *

Parent / Guardian (E.g Juan S. Dela Cruz)

Parent Contact No.

Childhood Diseases

Surgical Operations

Injuries / Illness / Hospitalizations

Medical Information

Known Allergies

Existing Medical Condition

Current Medications

Last Medical Check Up

Immunization

Yes No

BCG

Yes No

OralPolio

Yes No

DPT

Yes No

HepaA

Yes No

HepaB

Yes No

Covid-19 Vaccines

1st Dose Date

2nd Dose Date

Booster Date

Health Checklist

Family History

Heart Disease Tuberculosis Diabetes Cancer Allergy

Head

Frequent Headache Severe Head Injury

Eyes

Worn Eyeglasses Worn Contact Lenses Eye Trouble

Abdomen

Ulcer Gall bladder Jaundices Tumor Growth, Cyst, Cancer Abdominal Pain

Nervous System

Convulsion or Epilepsy Difficulty of going to sleep Previous Psychiatric Treatment Difficulty in Concentration Loss of Memory or Amnesia Excessive sleepiness

Habits/Social

Regular Exercise Smoking Alcohol Drugs

Ear, Nose & Throat

Difficulty Hearing Worn Hearing Aid Ruptured Eardrum Cleft Palate Speech Problem

Neck

Enlarge Mass

Heart and Lungs

Tuberculosis Asthma Shortness of Breath Pain/Pressure in Chest Palpitation Heart Trouble High Blood Pressure

Bone and Joint

Worn Neck or Back Brace Support Bone and Joint Disability or Deformity Loss of Arm, Leg, finger, or toe Foot Trouble

Note: The Personal Information and/or Sensitive Information contained in the medical data form that I gave to APCAS, whether manually or electronically, pursuant to School Medical Profile under the protection prescribed by the Data Privacy Act of 2012 and its implementing rules and regulations.

Review Your Information

Please check your details before final submission.

Student Health Management System v1.0