SNSU Subay App

Type of Declaration

Priority Group

Important Note for A2. Senior Citizen

Please bring your Senior Citizen [OSCA] ID during your vaccination schedule.

Important Note for A3. Adult with Comorbidities

Bring any required proof documents like: Medical Certificate, Doctor's Prescription for your maintenance, Hospital Records (discharge summary, Medical Abstract, Surgical Record or Pathology Report and others) during your vaccination schedule.

Important Note for A4. Frontline Personnel in Essential Sector

Present your work ID and Complied Certification during your vaccination schedule.
[Click here to download the Certification Sample]

Important Note for Pediatric A3

Download and Comply the Medical Certificate for Pediatric A3 ages 5-17.
[Click here to download the form.]

Subgroup

First Name

Middle Name

Last Name

Name Ext.

Contact Number

Sex

Birth Date

Civil Status

Parent/Guardian [LASTNAME, First_Name Middle_Name]

Relationship

Residence

Barangay

Occupation

Facility/Office/Business

With Comorbidity

Pregnancy Status

Allergy to vaccines or component of vaccines

With Allergy

Name of Allergy

Kidney Disease

Hypertension

Cancer

Heart Disease

Diabetes Mellitus

Asthma

Are you willing to be Vaccinated?

Patient was diagnosed with COVID-19?

Date of first positive result/specimen collection

Classification of COVID_19

By clicking "Submit," I hereby attest that the above information is true and hereby authorize the City Government of Surigao to collect and process the data indicated herein for the purpose of vaccination pre-registration. I understand that my personal information is protected by RA 10173, the Data Privacy Act of 2012.

Vaccination Pre-Registration

Personal Information

Important Note for A2. Senior Citizen

Important Note for A3. Adult with Comorbidities

Important Note for A4. Frontline Personnel in Essential Sector

Important Note for Pediatric A3

Current Address

Clinical Information