IV Therapy Training Requirements Document

Jeinard Blake Cabang Vertudazo, a registered nurse, completed a 3-day basic intravenous therapy training program from June 23-25, 2011 at Cotabato Provincial Hospital. The training program covered initiating and maintaining peripheral IV infusions, administering IV drugs, and administering and maintaining blood and blood components. Upon completion, Vertudazo submitted documentation of the training which was received and approved by hospital administrators.

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IV Therapy Training Requirements Document

Uploaded by

Jeinard Blake Cabang Vertudazo

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Download as DOC, PDF, TXT or read online on Scribd

IVT FORM 09 s 09 3+3+1 ACCOMPLISHED REQUIREMENTS of 3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES Name of Registered

d Nurse: Jeinard Blake Cabang Vertudazo, RN February 7, 2014 Name of Hospital Offering IV Training: COTABATO PROVINCIAL HOSPITAL April 18, 2014 Amas, Kidapawan City Date of IV Training Program Attended: June 23-25, 2011 Amas, Kidapawan City I. Initiating Maintaining Peripheral I.V. Infusion
Patient No. Name of Patient Age Date Time Kind of Infusion Site Type of Cannula Dose Rate Signature over Printed Name of Certified Trainer/ Perceptor/ M.D., R.N. License No.

PRC No.

Expiry Date:

Provider No. IVT 163 / Venue: Capitol Rooftop,

II. Administering I.V. Drugs

Patient No. Name of Patient Age Date Time Drug Incorporated Dose Diagnosis Signature over Printed Name of Certified Trainer/ Perceptor/ M.D., R.N. License No.

III. Administering and Maintaining Blood and Blood Components

Patient No. Name of Patient Age Date Time Volume/ Blood Type/ Components/ Rate IV insertion Type of Cannu la Diagnosis Signature over Printed Name of Certified Trainer/ Perceptor/ M.D., R.N. License No.

Submitted by: Jeinard Blake C. Vertudazo, RN FELINA M. HERNANDEZ Chief Nurse

Date Submitted: _______________ Received by: Mrs. JOSEPHINA V. LIBRE Approved by: Mrs. Asst. Chief Nurse CHLC 205 / 9-29-2013 CHLC 206 / 6-01-2013

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