Professional Documents
Culture Documents
SCRUB FORM
SURGICAL SCRUB in New Sinai MDI Hospital, Sta Rosa, Laguna (Major) Hospital, Municipal/City/Province Prepared by: Name of Student _Jane O. Pareja_____________________________ ____________________________________ Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Carmelita Cruz 10-2799 Total Abdominal Hysterectomy
Manuel G. Almelor,MD,RN,MAN
Noted by: Chief Nurse
PRC I.D. No. Valid Until PNA No. Valid Until Date document is signed: Time Please specify Highest Nursing Degree Earned: Approved by:
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean Valid Until November 2010 PNA No. 10134 PRC I.D No. 114856 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
SURGICAL SCRUB in New Sinai, MDI Hospital, Sta. Rosa, Laguna (Major) Hospital, Municipal/City/Province Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Sheryll Maturan 2615 Repeat Low Transveres Cesarian section with Bilateral tubal ligation
Manuel Almelor,MD,RN,MAN
Noted by: Chief Nurse
PRC I.D. No. Valid Until PNA No. Valid Until Date document is signed: Time Please specify Highest Nursing Degree Earned: Approved by:
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid Until April 2011 Date document is signed: ADPCN No. 0396 Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
SURGICAL SCRUB in UPHS-Dr. Tamayo Medical Center,Binan, Laguna (Major) Hospital, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ______________________________ ____________________________________ Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Rouel Bangao 64378 Craniotomy
Cholecystectomy
Aisa Memillo,RN
Glen Daquiz,RN,MAN
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean Valid Until November 2010 PNA No. 10134 PRC I.D No. 114856 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
SURGICAL SCRUB in Concepcion District Hospital,Concepcion, Tarlac (Major) Hospital, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ______________________________ ____________________________________ Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Agnes Bucasas 10-05-252 Low Transveres Cesarian section II
Concurred by:
PRC I.D No. 0295145 PNA No. Date document is signed:
__
. . Time__ _____________
Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN De PRC I.D No. 114856 Valid Until November 2010 PNA No. 1
in
Patients Name
PROCEDURE PERFORMED
Case Number Agnes Bucasas 10-05-252 Low Transveres cesarian section II
Concurred by:
__
. .
PRC I.D No. 0295145 Valid Until August 05, 2011 PNA No. Valid Until Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid Until April 2011 Date document is signed: ADPCN No. 0396 Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Patients Name
PROCEDURE PERFORMED
Case Number
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN Dean November 2010 PNA No. 10134
Valid until
Lifetime
ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Time____________________ .
SURGICAL SCRUB in New Sinai MDI Hospital, Sta. Rosa, laguna (Minor) Hospital, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ______________________________ ____________________________________ Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Minerva Ramos 10-2775 Alar trimming with nasal bunching
Wound debridement
Mark Maniago,RN
Melissa Caliva,RN,MAN
Noted by:
Concurred by:
PRC I.D. No. Valid Until PNA No. Valid Until Time Date document is signed: Please specify Highest Nursing Degree Earned: Approved by:
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
SURGICAL SCRUB in New Sinai MDI Hospital,Sta Rosa ,Laguna (MINOR) Hospital, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ______________________________ ____________________________________ Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Albina Celada 2599 Extra Capsular Cataract Extraction with intra ocular lense (OD)
08-16-2010 7:30p.m.
Regine Ang-iko
Melissa Caliva,RN,MAN
JONATHAN R.
PRC I.D. No. Valid Until Valid Until PNA No. Date document is signed: Time Please specify Highest Nursing Degree Earned: Approved by:
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
(Minor)
SURGICAL SCRUB in FORT BONIFACIO HOSPITAL,Taguig, Manila Hospital, Municipal/City/Province Signature of Student
Patients Name
PROCEDURE PERFORMED
Case Number Gerardo Navarro 4779 Multiple Warts electrocautery
Noted by:
00071483
Concurred by:
PRC I.D. No. Valid Until 11-10-11 PNA No. 8295 Valid Until lifemember Date document is signed: Time Please specify Highest Nursing Degree Earned: Approved by: PRC I.D No. ADPCN No. 114856 0396 Valid Until Valid Until
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean November 2010 PNA No. 10134 April 2011 Date document is signed:
ACTUAL DELIVERY in Rural Health Unit, General Mariano Alvarez, Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student __________________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous Vaginal Delivery
Leoniza F. Taginad
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean Valid Until November 2010 PNA No. 10134 PRC I.D No. 114856 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ACTUAL DELIVERY in Rural Health Unit, General Mariano Alvarez, Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student __________________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous Vaginal Delivery
Regina S. Maravillo
07-27-2009
Josephine Cedollo
Thelma C. Ocampo,RN
Araceili R. AmuraoRM,RN,MAN
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid Until April 2011 Date document is signed: ADPCN No. 0396 Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ACTUAL DELIVERY in Rural Health Unit, General Mariano Alvarez, Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student __________________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous Vaginal Delivery
07-29-2009
Thelma C. Ocampo,RN
Araceili R. Amurao,RM,RN,M AN
07-28-2009
Celybeth M. Diago
Thelma C. Ocampo,RN
ACTUAL DELIVERY in Rural Health Unit, General Mariano Alvarez, Cavite Hospital/Home/L ying-In-Clinic, Municipal/City/Pr ovince Prepared by: Name of Student _______________ ___
PROCEDURE PERFORMED
Leoniza F. Taginad
Noted by: Concurred by: JONATHAN R. YANEZA, R.N., MAN __ Chief Nurse Clinical Coordinator
PRC I.D. No. Valid Until PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until PNA No. Valid Until . Date document is signed: Time Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Please specify
Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid until Lifetime . ADPCN No. 0396 Valid Until April 2011 Date document is signed: Time____________ ________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing .
Concurred by:
PRC I.D No. 0295145 PNA No. Date document is signed:
__
. . Time__ _____________
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid Until April 2011 Date document is signed: ADPCN No. 0396 Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ASSISTED DELIVERY in Rural Health Center, General Mariano Alvarez, Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ______________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous Delivery
Joan A. Rotario
06-16-2009
Rolena A. Rarugol
Thelma C, Ocampo
Araceili R. Amurao,RM,RN,MAN
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Approved by:
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
ASSISTED DELIVERY in Rural Health in General Mariano Alvarez,Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Jane O. Pareja Prepared by: Name of Student ______________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous delivery
Maricho C. Sagaray
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN Dean November 2010 PNA No. 10134
Valid until
Lifetime
ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Time____________________ .
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
ASSISTED DELIVERY in Rural Health in General Mariano Alvarez,Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Jane O. Pareja Prepared by: Name of Student ______________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous delivery
Erlinda E. Roque
06-28-2009
Thelma C. Ocampo
Araceili R. Amurao,RM,RN,MAN
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN Dean November 2010 PNA No. 10134 April 2011 Date document is signed:
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
ASSISTED DELIVERY in Rural Health in General Mariano Alvarez,Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Jane O. Pareja Prepared by: Name of Student ______________ ____________________________________ Signature of Student
PROCEDURE PERFORMED
Normal Spontaneous delivery
Maricho C. Sagaray
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean Valid Until November 2010 PNA No. 10134 PRC I.D No. 114856 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
(Major)
Patients Name
PROCEDURE PERFORMED
Case Number
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
IMMEDIATE NEWBORN CORD CARE in Concepcion Lying In Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ____________________________________ Signature of Student
Delivery room
Eliza C. Concepcion,RM
Glenn A. Daquiz,RN,MAN
__
PRC I.D. No. Valid Until PNA No. Valid Until Date document is signed: Time Please specify Highest Nursing Degree Earned: Approved by: PRC I.D No. 114856 Valid Until
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN Dean November 2010 PNA No. 10134
Valid until
Lifetime
ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Time____________________ .
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
IMMEDIATE NEWBORN CORD CARE in Rural Health Center,General Mariano Alvarez, Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Name of Student Jane O. Pareja ____________________________________ Signature of Student
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing ZENY C. MINA, R.N., MAN
Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
IMMEDIATE NEWBORN CORD CARE in Rural Health Center, General Mariano Alvarez,Cavite Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Jane O. Pareja Name of Student ____________________________________ Signature of Student
Delivery room
Thelma C. Ocampo
Araceili R. Amurao,RM,RN,MAN
__
. . Time__ _____________
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 Valid Until April 2011 Date document is signed: ADPCN No. 0396 Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
IMMEDIATE NEWBORN CORD CARE in Hospital/Home/Lying-In-Clinic, Municipal/City/Province Prepared by: Name of Student ____________________________________ Signature of Student
Concurred by:
__
PRC I.D No. 0295145 Valid Until August 05, 2011 . PNA No. Valid Until . Date document is signed: Time__ _____________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ZENY C. MINA, R.N., MAN Dean PRC I.D No. 114856 Valid Until November 2010 PNA No. 10134 ADPCN No. 0396 Valid Until April 2011 Date document is signed: Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
Approved by:
For deliveries performed in Lying-In and Homes, ONLY THE CLINICAL INSTRUCTOR AND CLINICAL COORDINATOR are REQUIRED TO SIGN
ADPCN No. 0396 Valid Until April 2011 Date document is signed: Time____________________