This document contains forms from Centro Escolar University documenting procedures performed by nursing students such as actual deliveries, surgical scrubs, immediate newborn cord care, and operating room circulating. It provides details of the procedures such as date, time, location, patient information, and supervision provided to the students. The forms are signed by the relevant clinical instructors, coordinators and administrators to acknowledge the training and experience of the nursing students.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as XLS, PDF, TXT or read online from Scribd
This document contains forms from Centro Escolar University documenting procedures performed by nursing students such as actual deliveries, surgical scrubs, immediate newborn cord care, and operating room circulating. It provides details of the procedures such as date, time, location, patient information, and supervision provided to the students. The forms are signed by the relevant clinical instructors, coordinators and administrators to acknowledge the training and experience of the nursing students.
This document contains forms from Centro Escolar University documenting procedures performed by nursing students such as actual deliveries, surgical scrubs, immediate newborn cord care, and operating room circulating. It provides details of the procedures such as date, time, location, patient information, and supervision provided to the students. The forms are signed by the relevant clinical instructors, coordinators and administrators to acknowledge the training and experience of the nursing students.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as XLS, PDF, TXT or read online from Scribd
This document contains forms from Centro Escolar University documenting procedures performed by nursing students such as actual deliveries, surgical scrubs, immediate newborn cord care, and operating room circulating. It provides details of the procedures such as date, time, location, patient information, and supervision provided to the students. The forms are signed by the relevant clinical instructors, coordinators and administrators to acknowledge the training and experience of the nursing students.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as XLS, PDF, TXT or read online from Scribd
Download as xls, pdf, or txt
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CENTRO ESCOLAR UNIVERSITY
Manila * Malolos * Makati Address: No. 9 Mendiola St., San Miguel, Manila Tel. No.: 7356861 to 71 Loc. 219 Fax Number: 7362211 E-Mail Address: mvlocquiao@ceu.edu.ph Web-Site: www.ceu.edu.ph Accredited by: PAASCU Level II, May 13, 2011 ACTUAL DELIVERY in Dr. Jose Fabella Memorial Hospital, Ospital ng Maynila, Pasig General Hospital Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student: Date Performed and Time Started 09/15/2011 ; 3:55 am 09/11/2011 ; 7:45 pm 08/28/2011 ; 5:02 pm 07/10/2011 ; 2:01 pm 05/08/2011 ; 6:03 pm LOMEDA, RYAN ONEIL A. D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required) Milagros DJ. Canlas RN-RM
ACTUAL DELIVERY FORM
ODC Form 1A
Patient's INITIAL only Case Number (not applicable for Birthing/ Lyingin Clinics/Homes) C.J. ; 419105 J.N. ; 2361039 A.G. ; 546040 M.D. ; 536494 A.R. ; 506893
PROCEDURE PERFORMED Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Approved by:
SUPERVISED BY Clinical Instructor Name and Signature Ruby E. Santiago RN-RM, MAN Rosalinda I. Morales, RN, MAN Rosalinda I. Morales, RN, MAN Ma. Blessel L. Abelardo RN Anna Liza D. Lipana RN
Noted by: MRS. JOBBIE S. LACOPIA (Print Name and Signature) Clinical Coordinator, PRC I.D. No.: 139998 Valid Until: ###### Date document is signed: Time: Highest Nursing Degree Earned: Registerded Nurse, Certified Teacher, Master of Art's in Teaching
MS. MERLINA V. LOCQUIAO, RN, MAN, MAEd (Print Name and Signature) Dean, PRC I.D. No. 123832 Valid Until: Date document is signed: Time: Highest Nursing Degree Earned:
This part is applicable to all affiliate hospitals and maybe signed by the corresponding Chief Nurse/Head of the institution.
Noted by: (Print Name and Signature) Chief Nurse, PRC I.D. No.: Date document is signed: Highest Nursing Degree Earned: Valid Until: Time: (STRICTLY NO DESIGNATES)
(As per PRC BON Memorandum No. 02 s. 2009 dated June 15, 2009) Page 1 of 5
No. 02 s. 2009 dated June 15, 2009) Page 1 of 5
CENTRO ESCOLAR UNIVERSITY
Manila * Malolos * Makati Address: No. 9 Mendiola St., San Miguel, Manila Tel. No.: 7356861 to 71 Loc. 219 Fax Number: 7362211 E-Mail Address: mvlocquiao@ceu.edu.ph Web-Site: www.ceu.edu.ph Accredited by: PAASCU Level II, May 13, 2011 SURGICAL SCRUB in
O.R. SCRUB FORM Major
ODC Form 2A
Quezon City General Hospital, Dr. Jose Fabella Memorial Hospital, President Diosdado Macapagal Memorial Medical Center, East Avenue Medical Center Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student: LOMEDA, RYAN ONEIL A. Date Performed and Time Started 2/7/2012 11/3/2011 5/14/2011 4/6/2011 4/5/2011 Patient's INITIAL only Case Number J.V. ; 015384 M.M. ; 429520 V.S. ; 149280 M.P. ; 37604 L.F. ; 37428 SURGICAL PROCEDURE PERFORMED Open Cholecystectomy with Completion Cholangiogram
O.R. Nurse On Duty (Name and Signature) Not Required)
SUPERVISED BY Clinical Instructor Name and Signature Katherine Mapulla RN
Veronica P. Cristobal RN-RM Aida T. Oliveros RN, MAN Roberto P. Martires RN,MAN Roberto P. Martires RN,MAN
Noted by: MRS. RAQUEL C. CRISTOBAL (Print Name and Signature) Clinical Coordinator, PRC I.D. No.: 276811 Valid Until: ###### Date document is signed: Time: Highest Nursing Degree Earned: Registered Nurse, Master of Arts in Nursing
MS. MERLINA V. LOCQUIAO, RN, MAN, MAEd (Print Name and Signature) Dean, PRC I.D. No. 123832 Valid Until: Date document is signed: Time: Highest Nursing Degree Earned:
This part is applicable to all affiliate hospitals and maybe signed by the corresponding Chief Nurse/Head of the institution.
Noted by: (Print Name and Signature) Chief Nurse, PRC I.D. No.: Date document is signed: Highest Nursing Degree Earned: Valid Until: Time: (STRICTLY NO DESIGNATES)
(As per PRC BON Memorandum No. 02 s. 2009 dated June 15, 2009) Page 2 of 5
No. 02 s. 2009 dated June 15, 2009) Page 2 of 5
CENTRO ESCOLAR UNIVERSITY
Manila * Malolos * Makati Address: No. 9 Mendiola St., San Miguel, Manila Tel. No.: 7356861 to 71 Loc. 219 Fax Number: 7362211 E-Mail Address: mvlocquiao@ceu.edu.ph Web-Site: www.ceu.edu.ph Accredited by: PAASCU Level II, May 13, 2011 ACTUAL DELIVERY in Prepared by: Printed Name and Signature of Student: Date Performed and Time Started 09/15/11 ; 11:00 pm 09/15/11 ; 12:10 am 09/14/11 ; 11:55 pm 07/09/11 ; 1:11 pm 05/08/11 ; 10:28 am Patient's INITIAL only Case Number (not applicable for Birthing/ Lyingin Clinics/Homes) M.A. ; 421778 M.B. ; 405067 R.O. ; 417015 J.B. ; 541578 N. R. ; 574519 PROCEDURE PERFORMED Assisted Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Approved by: D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required) Milagros DJ. Canlas RN-RM Milagros DJ. Canlas RN-RM Milagros DJ. Canlas RN-RM Dr. Jose Fabella Memorial Hospital, Pasig City General Hospital Hospital/Home/Lying-in Clinic, Municipality/City/Province
ASSISTED DELIVERY
ODC Form 1B
SUPERVISED BY Clinical Instructor Name and Signature Ruby E. Santiago, RN-RM, MAN Ruby E. Santiago, RN-RM, MAN Ruby E. Santiago, RN-RM, MAN Ma. French Lyn C. Pascual RN Anna Liza D. Lipana RN
Noted by: MRS. JOBBIE S. LACOPIA (Print Name and Signature) Clinical Coordinator, PRC I.D. No.: 139998 Valid Until: ###### Date document is signed: Time: Highest Nursing Degree Earned: Registerded Nurse, Certified Teacher, Master of Art's in Teaching
MS. MERLINA V. LOCQUIAO, RN, MAN, MAEd (Print Name and Signature) Dean, PRC I.D. No. 123832 Valid Until: Date document is signed: Time: Highest Nursing Degree Earned:
This part is applicable to all affiliate hospitals and maybe signed by the corresponding Chief Nurse/Head of the institution.
Noted by: (Print Name and Signature) Chief Nurse, PRC I.D. No.: Date document is signed: Highest Nursing Degree Earned: Valid Until: Time: (STRICTLY NO DESIGNATES)
(As per PRC BON Memorandum No. 02 s. 2009 dated June 15, 2009) Page 3 of 5
No. 02 s. 2009 dated June 15, 2009) Page 3 of 5
CENTRO ESCOLAR UNIVERSITY
Manila * Malolos * Makati Address: No. 9 Mendiola St., San Miguel, Manila Tel. No.: 7356861 to 71 Loc. 219 Fax Number: 7362211 E-Mail Address: mvlocquiao@ceu.edu.ph Web-Site: www.ceu.edu.ph Accredited by: PAASCU Level II, May 13, 2011 SURGICAL SCRUB in Dr. Jose Fabella Memorial Hospital, Ospital ng Maynila, East Avenue Medical Center Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student: LOMEDA, RYAN ONEIL A. Date Performed and Time Started 2/6/2012 2/6/2012 10/16/2011 9/14/2011 8/10/2011 Patient's INITIAL only Case Number C.M. ; 439052 L.N. ; 420233 R. L. ; 2375277 A.D. ; 414160 J. N. ; 48665 SURGICAL PROCEDURE PERFORMED Post-partum with Sterilization with Bilateral Pomeroy Post-partum with Sterilization with Bilateral Pomeroy
O.R. CIRCULATING FORM
ODC Form 2B
O.R. Nurse On Duty (Name and Signature) Leticia M. Gollayan Leticia M. Gollayan
SUPERVISED BY Clinical Instructor Name and Signature Teresa B. Talon RN-RM Teresa B. Talon RN-RM Rosalinda I. Morales RN, MAN
Appendectomy Dilatation and Curettage Emergency Apendectomy Approved by: Socorro S. Arcinas RN-RM
Ruby E. Santiago RN-RM, MAN Roberto P. Martires RN,MAN
Noted by: MRS. RAQUEL C. CRISTOBAL (Print Name and Signature) Clinical Coordinator, PRC I.D. No.: 276811 Valid Until: ###### Date document is signed: Time: Highest Nursing Degree Earned: Registered Nurse, Master of Arts in Nursing
MS. MERLINA V. LOCQUIAO, RN, MAN, MAEd (Print Name and Signature) Dean, PRC I.D. No. 123832 Valid Until: Date document is signed: Time: Highest Nursing Degree Earned:
This part is applicable to all affiliate hospitals and maybe signed by the corresponding Chief Nurse/Head of the institution.
Noted by: (Print Name and Signature) Chief Nurse, PRC I.D. No.: Date document is signed: Highest Nursing Degree Earned: Valid Until: Time: (STRICTLY NO DESIGNATES)
(As per PRC BON Memorandum No. 02 s. 2009 dated June 15, 2009) Page 4 of 5
No. 02 s. 2009 dated June 15, 2009) Page 4 of 5
CENTRO ESCOLAR UNIVERSITY
Manila * Malolos * Makati Address: No. 9 Mendiola St., San Miguel, Manila Tel. No.: 7356861 to 71 Loc. 219 Fax Number: 7362211 E-Mail Address: mvlocquiao@ceu.edu.ph Web-Site: www.ceu.edu.ph Accredited by: PAASCU Level II, May 13, 2011 IMMEDIATE NEWBORN CORD CARE in Pasig City General Hospital, Ospital ng Maynila Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student: Date Performed and Time Started 8/28/2011 ; 11:35 pm 8/26/2011 ; 8:30 pm 8/19/2011 ; 9:02 pm 7/9/2011 ; 11:42 am 5/08/2011 ; 7:12 am Patient's INITIAL only Case Number (not applicable for Birthing/ Lyingin Clinics/Homes) Bb. Boy S.A. Bb. Boy C. Bb. Girl L.T. Bb. Boy L. Bb. Girl M. IMMEDIATE NEWBORN CORD CARE PERFORMED Indicate where performed e.g. D.R., Nursery, NICU, or Home Nursery Nursery Nursery Nursery Nursery Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)
CORD CARE FORM
ODC Form 1C
SUPERVISED BY Clinical Instructor Name and Signature Grenda M. Ugalde RN Rosalinda I. Morales, RN, MAN Rosalinda I. Morales, RN, MAN Ma. French Lyn C. Pascual RN Anna Liza D. Lipana RN
Noted by: MRS. JOBBIE S. LACOPIA (Print Name and Signature) Clinical Coordinator, PRC I.D. No.: 139998 Valid Until: ###### Date document is signed: Time: Highest Nursing Degree Earned: Registerded Nurse, Certified Teacher, Master of Art's in Teaching
Approved by: MS. MERLINA V. LOCQUIAO, RN, MAN, MAEd (Print Name and Signature) Dean, PRC I.D. No. 123832 Valid Until: Date document is signed: Time: Highest Nursing Degree Earned:
This part is applicable to all affiliate hospitals and maybe signed by the corresponding Chief Nurse/Head of the institution.
Noted by: (Print Name and Signature) Chief Nurse, PRC I.D. No.: Date document is signed: Highest Nursing Degree Earned: Valid Until: Time: (STRICTLY NO DESIGNATES)
