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    Bon Jovie Araño Reyes
    This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

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    Cases

    Uploaded by

    Bon Jovie Araño Reyes
    125 views2 pages
    This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

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    This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    125 views2 pages

    Cases

    Uploaded by

    Bon Jovie Araño Reyes
    This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

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    of 2

    LA CONSOLACION COLLEGE MANILA ODC Form 1

    #8 Mendiola St., Mendiola Manila O.R. MAJOR FORM


    (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.ph
    Government Recognition Level IV, No. 17 on January 23, 2006

    Prepared By (Name of Student): SAYANA, KAYE-ANNE F. Signature of Student: ______________________

    DATE TIME CASE PROCEDURE OR NURSE ON


    No. NAME OF PATIENT SUPERVISED BY HOSPITAL
    PERFORMED STARTED NUMBER PERFORMED DUTY

    Total Abdominal Amisola Maternity Hospital


    1. 07/22/09 9:45AM Ofelia Calbayar 20015141 Hysterectomy Bilateral Darlene Presa, RN _______________________ Hermosa St., Manugid
    Salpingo Oophorectomy Agnes Anne B. Comendador, RN Tondo, Manila

    Total Abdominal Amisola Maternity Hospital


    _______________________
    2. 08/10/09 7:35AM Sheryl Lazaro 20016481 Hysterectomy Bilateral Jo Erespe, RN Hermosa St., Manugid
    Agnes Anne B. Comendador, RN
    Salpingo Oophorectomy Tondo, Manila

    Amisola Maternity Hospital


    _______________________
    3. 08/11/09 9:28AM Amor Garcia Exploratory Laparatomy Darlene Inasoriam, RN Hermosa St., Manugid
    20017538 Agnes Anne B. Comendador, RN
    Tondo, Manila

    Concurred By:
    Chief Nurse

    Rosana R. Del fonso, RN, MATNE,


    MAN,MST __________________________________ __________________________________ __________________________________
    (Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
    PRC No: 0138625 Valid Until: Nov. 2010 PRC No: _________ Valid Until: ________ PRC No: _________ Valid Until: ________ PRC No: _________ Valid Until: ________
    PNA No: 21125 Valid Until:Dec. 31,2010 PNA No: _________ Valid Until: ________ PNA No: _________ Valid Until: ________ PNA No: _________ Valid Until: ________
    Date signed: _________ Time: _________ Date signed: _________ Time: _________ Date signed: _________ Time: _________ Date signed: _________ Time: _________
    Highest Nursing Degree Earned: Highest Nursing Degree Earned: ________ Highest Nursing Degree Earned: ________ Highest Nursing Degree Earned: ________

    Noted By: Approved By:


    Notes:
    CoordinatorClinical

    Joann P. Bumanglag RN,MAN Alejandro F. Sorita RN, MAN


    (Signature Over Printed Name) (Signature Over Printed Name)
    PRC No:0239004 Valid Until: July 2011 PRC No:0305011 Valid Until:Dec. 26, 2012
    Dean

    PNA No: 007252 Valid Until: Dec. 2010 PNA No:007255 Valid Until: Oct. 31, 2010
    Date signed: _________ Time: _________ ADPCN No:0860 Valid Until: 2012
    Highest Nursing Degree Earned: Master of Date signed: _________ Time: _________
    Arts in Nursing Highest Nursing Degree Earned: Master of
    Arts in Nursing
    F-SCNU-005 Page 1 of 5
    (Rev1-January 01, 2010)

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