Workers in Frontline Health Services
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Category *
Category_ID (If there's none, please type NA) *
Category_ID_Number
Philhealth_ID (If there's none, please type NA) *
PWD_ID (If there's none, please type NA) *
Last_Name *
First_Name *
Middle_Name *
Suffix *
Contact_Number *
Current_Residence:_Unit/Building/House_Number,_Street_Name *
Current_Residence:_Region *
"Current_Residence:Province*" *
"Current_Residence:Municipality/City*" *
"Current_Residence:Barangay*" *
Sex* *
Birthdate_mm/dd/yyyy_* *
MM
/
DD
/
YYYY
Civil_Status* *
Employment_Status* *
Directly_in_interaction_with_COVID_patient* *
Profession* *
Name_of_Employer* *
Province/HUC/ICC_of_Employer* *
Address_of_Employer* *
Contact_number_of_employer* *
"Pregnancy_status*" *
Drug_Allergy? *
Food_Allergy? *
Insect_Allergy? *
Latex_Allergy? *
Mold_Allergy? *
Pet_Allergy? *
Pollen_Allergy? *
With_Comorbidity? *
Hypertension *
Heart_Disease *
Kidney_Disease *
Diabetes_Mellitus *
Bronchial_Asthma *
Immunodeficiency_Status* *
Cancer *
Others *
Patient_was_diagnosed_with_COVID_19 *
Date_of_first_positive_result_/_specimen_collection_mm/dd/yyyy_
MM
/
DD
/
YYYY
Classification_of_COVID_19
Willing to_be_Vaccinated? *
Data Consent Form *
Required
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