LA CONSOLACION COLLEGE MANILA #8 Mendiola St., Mendiola Manila (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.

ph Government Recognition Level IV, No. 17 on January 23, 2006

Prepared By: ARLENE CRIS A. DAMOT
No .
1.

ODC Form 1 O.R. MAJOR FORM

Signature of Student: ______________________

CASE NUMBER PROCEDURE PERFORMED
Exploratory Laparotomy (Evacuation of Retroperitoneal Hematoma) Under General Anesthesia Radical Mastectomy AS Under General Endotracheal Anesthesia Parotidectomy Right Under General Endotracheal Anesthesia Modified Radical Mastectomy Left Side Under General Endotracheal Anesthesia Open Cholecystectomy Under General Endotracheal Anesthesia

DATE PERFORMED

TIME STARTED

NAME OF PATIENT
Abigail Tailod

OR NURSE ON DUTY

SUPERVISED BY

HOSPITAL
Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila

07/04/11

11:33 AM

2329680

Yolanda C. Canlas, RN

_______________________ Mylin M. Bathan, RN, MAN _______________________ Mylin M. Bathan, RN, MAN _______________________ Mylin M. Bathan, RN, MAN _______________________ Mylin M. Bathan, RN, MAN _______________________ Mylin M. Bathan, RN, MAN

2.

07/05/11

7:28 AM

Allan Rejuso

1634102

Marjorie B. Vergara, RN

3.

07/05/11

12:40 PM

Gloria Caudilla

1614512

Marjorie B. Vergara, RN

4.

07/11/11

8:05 AM

Gonita Verdeflor

1634319

Medel A.Quilet, RN

5.

07/13/11

6:55 AM

Cherrie Ann Ong

1634688

Yolanda C. Canlas, RN

Concurred By:

Noted by:

Approved by:

_______________________________________ ASUNCION C. BALISADO Chief Nurse PRC No: 0116547 Valid Until: Aug 2012 PNA No: 14782 Valid Until: Lifetime Date signed: _________ Time: _________ Nursing Degrees: RN, MAN F-SCNU-005 (Rev1-January 01, 2010)

_______________________________________ CHRISTOPHER A. DE LUNA Clinical Coordinator PRC No: 0372099 Valid Until: Jul 2014 PNA No: 19741 Valid Until: Lifetime Date signed: _________ Time: __________ Nursing Degrees: RN, RM, MSN, MAN

_______________________________________ ALEJANDRO F. SORITA Dean, School of Nursing and Allied Sciences PRC No: 0305011 Valid Until: Dec 2012 PNA No: 2012-036301 Valid Until: 2012 ADPCN No: 11-248 Valid Until: 2012 Date signed: _________ Time: __________ Nursing Degrees: RN, MAN

LA CONSOLACION COLLEGE MANILA #8 Mendiola St., Mendiola Manila (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.ph Government Recognition Level IV, No. 17 on January 23, 2006
Prepared By: ARLENE CRIS A. DAMOT
No . DATE PERFORMED TIME STARTED NAME OF PATIENT CASE NUMBER PROCEDURE PERFORMED

ODC Form 2 O.R. MINOR FORM

Signature of Student: _____________________

OR NURSE ON DUTY SUPERVISED BY HOSPITAL

1.

07/04/11

8:07 AM

Alfredo Balaca

2327500

Hemorrhoidectomy Under Spinal Anesthesia

Yolanda C. Canlas, RN

_______________________ Mylin M. Bathan, RN, MAN

Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila Ospital ng Maynila Medical Center Ermita, Manila

2.

07/04/11

10:30 AM

Marlon Pinca

1630802

Fistulotomy Under Spinal Anesthesia

Julieta A. Quilinderino, RN

_______________________ Mylin M. Bathan, RN, MAN

3.

07/06/11

10:10 AM

Bernardino Waje

2327165

Debridement Cellulitits L Foot Under Local Anesthesia Extra Capsular Cataract Extraction Under Local Anesthesia Hernioplasty L Under Spinal Anesthesia

Marjorie B. Vergara, RN

_______________________ Mylin M. Bathan, RN, MAN

4.

07/13/11

7:45 AM

Gina De Tablan

2321919

Julieta A. Quilinderino, RN

_______________________ Mylin M. Bathan, RN, MAN

5.

07/13/11

10:55 AM

Manuel Conche

1630971

Timothy Francis Lerma, RN

_______________________ Mylin M. Bathan, RN, MAN

Concurred By:

Noted by:

Approved by:

_______________________________________ ASUNCION C. BALISADO Chief Nurse PRC No: 0116547 Valid Until: Aug 2012 PNA No: 14782 Valid Until: Lifetime Date signed: _________ Time: _________ Nursing Degrees: RN, MAN

_______________________________________ CHRISTOPHER A. DE LUNA Clinical Coordinator PRC No: 0372099 Valid Until: Jul 2014 PNA No: 19741 Valid Until: Lifetime Date signed: _________ Time: __________ Nursing Degrees: RN, RM, MSN, MAN

_______________________________________ ALEJANDRO F. SORITA Dean, School of Nursing and Allied Sciences PRC No: 0305011 Valid Until: Dec 2012 PNA No: 2012-036301 Valid Until: 2012 ADPCN No: 11-248 Valid Until: 2012 Date signed: _________ Time: __________ Nursing Degrees: RN, MAN

LA CONSOLACION COLLEGE MANILA #8 Mendiola St., Mendiola Manila (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.ph Government Recognition Level IV, No. 17 on January 23, 2006
Prepared By: ARLENE CRIS A. DAMOT
No .
1.

ODC Form 3 ACTUAL DELIVERY

Signature of Student: ______________________

CASE NUMBER PROCEDURE PERFORMED
Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

DATE PERFORMED

TIME STARTED

NAME OF PATIENT
Liezel Luna

DR NURSE / MIDWIFE ON DUTY

SUPERVISED BY

HOSPITAL
Dr. Montano G. Ramos General Hospital Bago Bantay, Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay, Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay, Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay, Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay, Quezon City

01/31/11

7:05 PM

20680

Myra A. Mantula , RN

_________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN

2.

01/31/11

1:01 PM

Khezel Dumlao

20681

Aileen T. Vesperas, RN

3.

07/18/11

2:30 PM

Maricel Isanan

20578

Dearly Gumapos, RN

4.

07/19/11

3:36 PM

Lorelyn Gaan

20576

Dearly Gumapos, RN

5.

10/19/11

3:36 PM

Cristy Gabriel

21717

May S. Jandumon, RM

Concurred By:

Noted by:

Approved by:

_______________________________________ Tonnette E. dela Rea Chief Nurse PRC No: 0311700 Valid Until: Nov 2014 PNA No: 17983 Valid Until: Lifetime Date signed: _________ Time: _________ Nursing Degrees: RN, MAN

_______________________________________ CHRISTOPHER A. DE LUNA Clinical Coordinator PRC No: 0372099 Valid Until: Jul 2014 PNA No: 19741 Valid Until: Lifetime Date signed: _________ Time: __________ Nursing Degrees: RN, RM, MSN, MAN

_______________________________________ ALEJANDRO F. SORITA Dean, School of Nursing and Allied Sciences PRC No: 0305011 Valid Until: Dec 2012 PNA No: 2012-036301 Valid Until: 2012 ADPCN No: 11-248 Valid Until: 2012 Date signed: _________ Time: __________ Nursing Degrees: RN, MAN

LA CONSOLACION COLLEGE MANILA #8 Mendiola St., Mendiola Manila (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.ph Government Recognition Level IV, No. 17 on January 23, 2006
Prepared By: ARLENE CRIS A. DAMOT
No .
1.

ODC Form 4 ASSIST DELIVERY

Signature of Student: ______________________

CASE NUMBER PROCEDURE PERFORMED
Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

DATE PERFORMED

TIME STARTED

NAME OF PATIENT
Rowena Cadag

DR NURSE / MIDWIFE ON DUTY

SUPERVISED BY
_________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN

HOSPITAL
Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City

01/28/11

5:50 PM

20668

Aileen T. Vesperas, RN

2.

02/05/11

1:39 PM

Johan Bautista

20694

Imelda D. Espiritu, RM

3.

07/19/11

10:50 PM

Rose Pimentel

20579

Dearly Gumapos, RN

4.

07/27/11

5:18 PM

Mary Rose Rando

20632

Dearly Gumapos, RN

5.

10/20/11

1:12 PM

Gracelle Tordillo

22259

Sheryl Ferran, RM

Concurred By:

Noted by:

Approved by:

_______________________________________ Tonnette E. dela Rea Chief Nurse PRC No: 0311700 Valid Until: Nov 2014 PNA No: 17983 Valid Until: Lifetime Date signed: _________ Time: _________ Nursing Degrees: RN, MAN

_______________________________________ CHRISTOPHER A. DE LUNA Clinical Coordinator PRC No: 0372099 Valid Until: Jul 2014 PNA No: 19741 Valid Until: Lifetime Date signed: _________ Time: __________ Nursing Degrees: RN, RM, MSN, MAN

_______________________________________ ALEJANDRO F. SORITA Dean, School of Nursing and Allied Sciences PRC No: 0305011 Valid Until: Dec 2012 PNA No: 2012-036301 Valid Until: 2012 ADPCN No: 11-248 Valid Until: 2012 Date signed: _________ Time: __________ Nursing Degrees: RN, MAN

LA CONSOLACION COLLEGE MANILA #8 Mendiola St., Mendiola Manila (02) 736-02035 / (02) 313-0513 / http://www.lccm.edu.ph Government Recognition Level IV, No. 17 on January 23, 2006
Prepared By: ARLENE CRIS A. DAMOT
No .
1.

ODC Form 5 NEWBORN CARE

Signature of Student: ______________________

CASE NUMBER NEWBORN CORD CARE PERFORMED DR NURSE / MIDWIFE ON DUTY SUPERVISED BY
_________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN _________________________ Concemarcia V. Bacon, RN, MAN

DATE PERFORMED

TIME STARTED

NAME OF PATIENT

HOSPITAL
Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City Dr. Montano G. Ramos General Hospital Bago Bantay Quezon City

02/11/11

9:41 PM

Baby Girl Fernandez

20678

Nursery

Aileen Vesperas, RN

2.

07/26/11

9:15 PM

Baby Boy Laje

20626

Nursery

Dearly Gumapos, RN

3.

10/19/11

9:41 PM

Baby Girl Arreza

16878

Nursery

May S. Jandumon, RM

4.

10/20/11

3:40 PM

Baby Boy Carpio

22256

Nursery

Myra Mantala, RM

5.

10/20/11

4:15 PM

Baby Girl Gorgonio

22058

Nursery

Myra Mantala, RM

Concurred By:

Noted by:

Approved by:

_______________________________________ Tonnette E. dela Rea Chief Nurse PRC No: 0311700 Valid Until: Nov 2014 PNA No: 17983 Valid Until: Lifetime Date signed: _________ Time: _________ Nursing Degrees: RN, MAN

_______________________________________ CHRISTOPHER A. DE LUNA Clinical Coordinator PRC No: 0372099 Valid Until: Jul 2014 PNA No: 19741 Valid Until: Lifetime Date signed: _________ Time: __________ Nursing Degrees: RN, RM, MSN, MAN

_______________________________________ ALEJANDRO F. SORITA Dean, School of Nursing and Allied Sciences PRC No: 0305011 Valid Until: Dec 2012 PNA No: 2012-036301 Valid Until: 2012 ADPCN No: 11-248 Valid Until: 2012 Date signed: _________ Time: __________ Nursing Degrees: RN, MAN