ST.
SCHOLASTICAS COLLEGE TACLOBAN
COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / [Link]/sschs
CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
Hospital, Municipality / City / Province
O.R. FORM 1A
MAJOR SURGERY
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.
Patients
INITIALS
Case Number
PROCEDURE PERFORMED
O.R. Nurse On Duty
(Name and Signature) If Midwife on Duty,
Signature not Required
September 04, 2014
11:23 AM- 12:50 PM
M. R.
226083
1st Degree Low Transverse Cesearean Section
(Pregnancy Uterine Weeks Age of Gestation Non-Reassuring Fetal
Status, Persistent Fetal Bradycardia Delivere By 1 st Degree Low
Transverse To A Live Baby Girl, Meconium Stain Amniotic fluid,
Apgar Score 9, Body Weight 2.8 Kilogram, Body Lenght 49
Centimeter)
MS. MICHELLE ANN V. BACIERRA, RN
July 02, 2014
10:00 AM- 12:40PM
T. P.
233108
Open Reduction And Internal Fixation Lock Plating Tibia Fibula
Right
(Fracture Closed Comminuted Distal Third Tibia Fibula Right)
MR. FRANCIS JAMIL S. OCADO, RN
July 07, 2015
9:23 AM- 10:40 AM
M. M.
233188
Laparatomy Cholecystectomy
(Cholecystolithiasis, Liver Cirrhosis)
MS. JENNY G. DEGORIO, RN
Date Performed and
Time Started
MS. CHRISTINE MARIE N. TORRES, RN, MAN
Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership
SUPERVISED BY
Clinical Instructor
(Name and Signature)
[Link] [Link], RN,MAN
PRC No.:
Valid until:
PNA No.:
Valid until:
MR. RODERICK R. LABICANE, RN, MAN
PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:
MR. RODERICK R. LABICANE, RN, MAN
PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:
MRS. CAROLINA D. BARROT, RN, MAN, PhD
DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN:_____________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015
ST. SCHOLASTICAS COLLEGE TACLOBAN
COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / [Link]/sschs
SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
Hospital, Municipality / City / Province
O.R. FORM 1A
MAJOR SURGERY
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.
Date Performed and
Time Started
Patients
INITIALS
Case Number
February 28, 2014
1:45 PM- 3:25 PM
C. R.
220079
Abdominal Myomectomy
(Multiple Myoma Uteri Intramural And Subserous)
MS. FRANCIS ARIANE V. ALBESA, RN
September 14, 2014
2:00 PM- 3:15 PM
P. L.
225342
Debridement, Repair of Scalp Avulsion Parieto Occipital Left And
Lateral Cantus Left
(Scalp Avulsion, Parieto Occipital Left And Lateral Cantus)
MR. VALERIANO S. PRINCILLO III, RN
July 04, 2014
9:35 AM-
D. R.
226702
Removal Of Implant
(Status Post open Reduction Plating Left Clavicle)
MR. VALERIANO S. PRINCILLO III, RN
SURGICAL PROCEDURE PERFORMED
MS. CHRISTINE MARIE N. TORRES, RN, MAN
Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership
O.R. Nurse On Duty
(Name and Signature) If Midwife on Duty,
Signature not Required
SUPERVISED BY
Clinical Instructor
(Name and Signature)
[Link] [Link], RN,MAN
PRC No.:
Valid until:
PNA No.:
Valid until:
:
[Link] [Link], RN,MAN
PRC No.:
Valid until:
PNA No.:
Valid until:
MR. RODERICK R. LABICANE, RN, MAN
PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:
MRS. CAROLINA D. BARROT, RN, MAN, PhD
DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: _____________
Valid until: _________________
ADPCN:_______________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015
ST. SCHOLASTICAS COLLEGE TACLOBAN
COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / [Link]/sschs
CORD CARE in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality / City / Province
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.
Date Performed and Time
Started
Patients
INITIALS
Case Number
August 25, 2014
11:31 AM
Bb. Girl M.
008244
Neonatal Intensive Care Unit Essential Intrapartum
Newborn Care Anthropometrics, Vaccines
MS. ROSALIE R. UY, RN
October 14, 2014
7:10 PM
Bb. Boy E.
002854
Neonatal Intensive Care Unit Essential Intrapartum
Newborn Care Anthropometrics, Vaccines
MRS. SARAH MEL B. ABAD, RN
October 14, 2014
10:59 PM
Bb. Girl B.
009336
Neonatal Intensive Care Unit Essential Intrapartum
Newborn Care Anthropometrics, Vaccines
MRS. SARAH MEL B. ABAD, RN
PROCEDURE PERFORMED
MS. CHRISTINE MARIE N. TORRES, RN, MAN
Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership
Nurse On Duty
(Name and Signature) If Midwife on Duty,
Signature not Required
IMMEDIATE NEW BORN
CORD CARE FORM
SUPERVISED BY
Clinical Instructor
(Name and Signature)
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
MRS. CAROLINA D. BARROT, RN, MAN, PhD
DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN.:_____________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015
ST. SCHOLASTICAS COLLEGE TACLOBAN
COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / [Link]/sschs
ASSISSTED DELIVERY in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality / City / Province
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.
Date Performed and Time
Started
Patients
INITIALS
(only)
Case Number
PROCEDURE PERFORMED
Nurse On Duty
(Name and Signature) If Midwife on Duty, Signature
not Required
SUPERVISED BY
Clinical Instructor
(Name and Signature)
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
August 25. 2014
8:10 AM
C. J.
008163
Actual Delivery Assisted
Gravida 9 Para 8 (9009) Pregnancy Uterine Full Term Cephalic
Delivered Normal Spotaneous Vaginal Delivery To A Term Alive
Bb. Boy Apgar Score of 8-9 Meconium Stain
MS. ROSALIE R. UY, RN
October 14, 2014
10:30 AM
V. L.
009141
Actual Delivery Assisted
Gravida 1 Para 1 (1001) Pregnancy Uterine Full Term
Spotaneous Vaginal Delivery Apgar Score 9 Clear Amniotic
Fluid Body Weight 2.98 Kilograms
MRS. ANA RETHCIE M. LUSICO-LAGADAY, RN
October 25, 2015
1:11 PM
S. K.
030170
Actual Delivery Assisted
Gravida 1 Para 1 (1001) Pregnancy Uterine Transverse Cephalic
Bb. Girl Apgar Score 9 Clear Amniotic Fluid Delivered By
Spontaneous Vaginal Delivery
MS. MARIAN B. NADERA, RN
MS. CHRISTINE MARIE N. TORRES, RN, MAN
Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership
ASSISSTED
DELIVERY FORM
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:
MRS. CAROLINA D. BARROT, RN, MAN, PhD
DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN:_____________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015
