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This website adopts the Web Content Accessibility Guidelines (WCAG 2.0) as the accessibility standard for all its related web development and services. WCAG 2.0 is also an international standard, ISO 40500. This certifies it as a stable and referenceable technical standard. WCAG 2.0 contains 12 guidelines organized under 4 principles: Perceivable, Operable, Understandable, and Robust (POUR for short). There are testable success criteria for each guideline. Compliance to these criteria is measured in three levels: A, AA, or AAA. A guide to understanding and implementing Web Content Accessibility Guidelines 2.0 is available at: https://www.w3.org/TR/UNDERSTANDING-WCAG20/ Accessibility Features Shortcut Keys Combination Activation Combination keys used for each browser. Chrome for Linux press (Alt+Shift+shortcut_key) Chrome for Windows press (Alt+shortcut_key) For Firefox press (Alt+Shift+shortcut_key) For Internet Explorer press (Alt+Shift+shortcut_key) then press (enter) On Mac OS press (Ctrl+Opt+shortcut_key) Accessibility Statement (Combination + 0): Statement page that will show the available accessibility keys. Home Page (Combination + H): Accessibility key for redirecting to homepage. Main Content (Combination + R): Shortcut for viewing the content section of the current page. FAQ (Combination + Q): Shortcut for FAQ page. Contact (Combination + C): Shortcut for contact page or form inquiries. Feedback (Combination + K): Shortcut for feedback page. Site Map (Combination + M): Shortcut for site map (footer agency) section of the page. Search (Combination + S): Shortcut for search page. Press esc, or click the close the button to close this dialog box.
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Brgy. Tarosanan
Transparency
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COVID VACCINE REGISTRATION FORM
Last Name
First Name
Middle Name
Name Suffix (Jr, Sr, etc.)
Barangay Name
--SELECT--
Dugcal
Marupit
San Francisco
San Jose - San Pablo
San Juan - San Ramon
San Lucas
San Marcos
San Mateo
San Roque
Sto. Domingo
Sto. Tomas
Sua
Tarosanan
Barangay Zone
--SELECT--
Gender
--SELECT--
Male
Female
Birth Date
Civil Status
--SELECT--
Single
Married
Divorced
Separated
Widowed
Contact Number
Are you Pregnant? (Answer No if Male)
--SELECT--
YES
NO
Occupation
Directly Interacting with COVID Patients?
--SELECT--
YES
NO
Have Drug Allergy?
--SELECT--
YES
NO
Have Food Allergy?
--SELECT--
YES
NO
Have Insect Allergy?
--SELECT--
YES
NO
Have Latex Allergy?
--SELECT--
YES
NO
Have Mold Allergy?
--SELECT--
YES
NO
Have Pet Allergy?
--SELECT--
YES
NO
Have Pollen Allergy?
--SELECT--
YES
NO
With Comorbidity?
--SELECT--
YES
NO
Have Hypertension?
--SELECT--
YES
NO
Have Heart Disease?
--SELECT--
YES
NO
Have Kidney Disease?
--SELECT--
YES
NO
Have Diabetes?
--SELECT--
YES
NO
Have Asthma?
--SELECT--
YES
NO
Have Immune Defeciency?
--SELECT--
YES
NO
Have Cancer?
--SELECT--
YES
NO
Other Disease/s
Were you diagnosed with COVID-19?
--SELECT--
YES
NO
If yes, Indicate Date of Positive Result.
If yes, Indicate the Classification of COVID-19
--SELECT--
ASYMPTOMATIC
MILD
MODERATE
SEVERE
VERY SEVERE OR CRITICAL
Are you willing to be Vacinated?
--SELECT--
YES
UNSURE
NO