Republic of the Philippines

Department of Education
Region IV- CALABARZON
Division of Rizal
District of San Mateo
GUITNANGBAYAN ELEMENTARY SCHOOL

Guidance
Notebook
SY 2015 - 2016

I. PERSONAL DATA
Name
Nickname
Birth date
Birth place
Order of Birth
Religion
Name of Guardian/Parent
Address
Contact Number
II.PHYSICAL TEST
Height and Weight
. Nutritional Status
.Visual Acuity (Snellen Test)
.Auditory Test
III. Motor and Mental Ability Test
.DIAGNOSTIC TEST
Phil-IRI
.Quarterly Test

HRPTA OFFICERS
PRESIDENT
______________________
VICE PRESIDENT
_________________
SECRETARY
______________________
TREASURER
______________________
B. MANAGER
_____________________
P.R.O
____________________________

CLASS OFFICERS
PRESIDENT
______________________
VICE PRESIDENT
_________________
SECRETARY
______________________
TREASURER
______________________
B. MANAGER
_____________________
P.R.O
____________________________

GUIDANCE COMMITTEES
DISCIPLINE
______________________
SCHOLARSHIP
___________________
ATTENDANCE
_______________________
RELIGION
______________________
CLEANLINESS
_______________________
PROGRAM
_________________________

PERSONAL
DATA


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NAME

BIRTHDATE

BIRTHPLACE

BIRTH ORDER

RELIGION


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NAME

BIRTHDATE

BIRTHPLACE BIRTH ORDER

RELIGION

NAME

GUARDIAN/PARENT

ADDRESS

CONTACT NUMBER

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NAME

GUARDIAN/PAREN
T

ADDRESS

CONTACT
NUMBER

10

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NUTRITIONAL STATUS
And PHYSICAL TEST


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NAME

HEIGHT

WEIGHT

BMI

NUT. STATUS


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NAME

HEIGHT

WEIGHT

BMI

NUT. STATUS

SUMMARY

SINGLE AGE

10 11 12 13 14 15 16 17 18

BOYS

GIRLS

TOTAL

NUTRITIONAL STATUS

SEVERELY WASTED NORMAL

WASTED
#

%#

%#

OVER

OBESE

WEIGHT

%#

%#

BOYS

GIRLS

TOTAL

SNELLEN TEST
An eye chart used by eye care professionals to measure visual acuity.
Dr. Hermann Snellen developed the eye chart in 1862. The chart
consists of 11 lines of block letters beginning with a large single letter
on the top row. The number of letters on each row increases moving
from top to bottom. The size of the letters progressively decreases,
allowing for more letters on each subsequent line. The traditional
Snellen Eye chart only makes use of the following letters: C, D, E, F, L,
O, P, T and Z. When testing for visual acuity, the patient covers one eye
and reads aloud the letters on the chart, beginning at the top and
moving toward the bottom. The smallest row of letters that the patient
reads accurately determines visual acuity in the uncovered eye. The
test is repeated with the other eye, and then with both eyes together.
Visual acuity is sometimes expressed as 20/20, or a similar number,
meaning the smallest letters accurately read on the chart.

SNELLEN TEST
Visual acuity (VA) is acuteness or clearness of vision.
Especially form vision, which is dependent on the sharpness of
the retinal focus within the eye, the sensitivity of the nervous
elements, and the interpretative faculty of the brain. VA is a
quantitative measure of the ability to identify black symbols on
a white background at a standardized distance as the size of the
symbols is varied. The VA represents the smallest size that can
be reliably identified. VA is the most common clinical
measurement of visual function.
A visual acuity of 20/20 is frequently described as meaning
that a person can see detail from 20 feet away the same as a
person with normal eyesight would see from 20 feet. If a
person has a visual acuity of 20/40, he is said to see detail
from 20 feet away the same as a person with normal eyesight
would see it from 40 feet away. Someone with 20/20 visual
acuity does not have "perfect" vision, since it is quite possible
to see better than 20/20. The maximum acuity of the human
eye without visual aids (such as binoculars) is generally
thought to be around 20/10 (6/3).


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NAME

LEFT EYE

RIGHT EYE

BOTH EYES

REMARKS


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NAME

LEFT EYE

RIGHT EYE

BOTH EYES

REMARKS

AUDITORY TEST


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NAME

LEFT EAR

RIGHT EAR

BOTH EARS

REMARKS


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NAME

LEFT EAR

RIGHT EAR

BOTH EARS

REMARKS

ABILITY
TEST

DIAGNOSTIC TEST RESULT

SUBJECT

Mother
Tongue
Filipino
English
Math
Araling
Panlipunan
MAPEH
ESP
TOTAL

NO. OF
CASES

HPS

HSO

LSO

MEAN

MPS

SD

PUPILS WHO GOT

75% CRITERION
NO.

PHIL-IRI

READING PERFORMANCE
(ENGLISH - ORAL)
READING LEVELS

NON-READER
#
MALE
PRETEST

FEMAL
E
TOTAL
MALE

POST
TEST

FEMAL
E
TOTAL

FRUSTRATION
#

INSTRUCTION
AL
#

INDEPENDENT
#

READING PERFORMANCE
(ENGLISH - SILENT)
READING LEVELS

NON-READER
#
MALE
PRETEST

FEMAL
E
TOTAL
MALE

POST
TEST

FEMAL
E
TOTAL

FRUSTRATION
#

INSTRUCTION
AL
#

INDEPENDENT
#

READING PERFORMANCE
(FILIPINO - ORAL)
READING LEVELS

NON-READER
#
MALE
PRETEST

FEMAL
E
TOTAL
MALE

POST
TEST

FEMAL
E
TOTAL

FRUSTRATION
#

INSTRUCTION
AL
#

INDEPENDENT
#

READING PERFORMANCE
(FILIPINO - SILENT)
READING LEVELS

NON-READER
#
MALE
PRETEST

FEMALE
TOTAL
MALE

POSTTEST

FEMALE
TOTAL

FRUSTRATION
#

INSTRUCTIONAL
#

INDEPENDENT
#

QUARTERLY TEST

SUBJECT

Mother
Tongue
Filipino
English
Math
Araling
Panlipunan
MAPEH
ESP
EPP
SCIENCE
TOTAL

TEST RESULT
___ GRADING PERIOD

NO. OF
CASES

HPS

HSO

LSO

MEAN

MPS

SD

PUPILS WHO GOT

75% CRITERION
NO.

SUBJECT

NO. OF
CASES

Mother
Tongue
Filipino
English
Math
Araling
Panlipunan
MAPEH
ESP
EPP
SCIENCE
TOTAL

TEST RESULT
___ GRADING PERIOD
HPS

HSO

LSO

MEAN

MPS

SD

PUPILS WHO GOT

75% CRITERION
NO.

SUBJECT

Mother
Tongue
Filipino
English
Math
Araling
Panlipuna
n
MAPEH
ESP
EPP
SCIENCE
TOTAL

TEST RESULT
___ GRADING PERIOD

NO. OF
CASES

HPS

HSO

LSO

MEAN

MPS

SD

PUPILS WHO GOT

75% CRITERION
NO.

SUBJECT

Mother
Tongue
Filipino
English
Math
Araling
Panlipuna
n
MAPEH
ESP
EPP
SCIENCE
TOTAL

TEST RESULT
___ GRADING PERIOD

NO. OF
CASES

HPS

HSO

LSO

MEAN

MPS

SD

PUPILS WHO GOT

75% CRITERION
NO.

DATE

INCIDENT

ANECDOTAL
RECORD
MEDICATING

CIRCUMSTANCES

WITNESS

DATE

INCIDENT

ANECDOTAL
RECORD
MEDICATING

CIRCUMSTANCES

WITNESS

HRPTA MEETING
NAME OF CHILD

GUARDIAN/PARENT

Date: ____________
Agenda:____________________________________________________
____________________________________________________________
____________________________________________________________
__

SIGNATURE

HRPTA MEETING
NAME OF CHILD

GUARDIAN/PARENT

Date: ____________
Agenda:____________________________________________________
____________________________________________________________
____________________________________________________________
__

SIGNATURE