HEALTH CHECKLIST
SELF-DECLARATION (Adopted to DTI-DOLE Interim Guidelines Health Checklist)
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Data Privacy Policy
Before providing your personal information, we would like to understand that personal information to be collected from you,the purpose of collecting such information, the parties whom your personal information may be shared are for health assessment purposes only. We care for your right as Data Subject under the Data Privacy Act.
I hereby authorized Dr. Yanga's Colleges, Inc., to collect and process the data indicated herein for the purpose of effecting control of the COVID-19 infection. I understand that my personal information  is protected by RA 10173, Data Privacy Act of 2012, and that I am  required by RA 11469 Bayanihan to Heal as One Act, to provide truthful information. *
Seat No.: (EX: A1) *
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