O.R.

Form 1B

Misamis University O.R. CIRCULATING FORM

Ozamiz City

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

SURGICAL SCRUB in __MAYOR HILARION A. RAMIRO SR. MEDICAL CENTER (MHARS-MC), Ozamiz City, Misamis Occidental, Philippines

(Hospital, Municipality/City/Province)

Prepared by: MAGSAYO, GWEN OSIAS T.

Date Performed Patient’s INITIALS only O.R. Nurse on Duty SUPERVISED BY Clinical Instructor
SURGICAL PROCEDURE PERFORMED
and Time Started Case Number (Name and Signature) (Name and Signature)

January 24, 2012 H.J.S.

Primary Low Segment Transverse Cesarean Section Marie Ann L. Sanchez, MAN Susan N. Santos, MAN
7:30 PM 14-16-02

February 21, 2012 M.M.A.

Exploratory Laparotomy, Gastrorrhapy Marie Ann L. Sanchez, MAN Susan N. Santos, MAN
1:50 PM 14-25-12

March 14, 2013 O.C. Marie Ann L. Sanchez, MAN

Open Reduction Internal Fixation Intramedullary Nailing, Static Locking, Right Femur Susan N. Santos, MAN
1:40 PM 15-98-52 ODC Form 1A D.R. Form

ACTUAL DELIVERY FORM

Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed: ______ Time:__________

Highest Nursing Degree Earned: Ph.D. Highest Nursing Degree Earned: MAN

ACTUAL DELIVERY in MAYOR HILARION A. RAMIRO SR., MEDICAL CENTER (MHARS-MC) Ozamiz City, Misamis Occidental , Philippines _

(Hospital, Municipality/City/Province)
Prepared by: MAGSAYO, GWEN OSIAS T.

Date Performed Patient’s INITIALS only D.R. Nurse on Duty SUPERVISED BY Clinical Instructor
SURGICAL PROCEDURE PERFORMED
and Time Started Case Number (Name and Signature) (Name and Signature)
 Misamis University
Ozamiz City

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

September 9, 2010 R.L.P.

HANDLED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
2:00 PM 12-01-41

January 31, 2011 A.E.T.

HANDLED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
10:32PM 12-56-02

February 2, 2011 W.D.R.

HANDLED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
12:55 PM 12-49-29 D.R. Form

ACTUAL DELIVERY FORM

Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed:_______ Time:____ Highest Nursing Degree Earned: Ph.D.

Highest Nursing Degree Earned: MAN

ACTUAL DELIVERY in MAYOR HILARION A. RAMIRO SR. MEDICAL CENTER, MANINGCOL, OZAMIZ CITY, MISAMIS OCCIDENTAL, PHILIPPINES

(Hospital, Municipality/City/Province)

Prepared by: MAGSAYO. GWEN OSIAS T.

Date Performed Patient’s INITIALS only D.R. Nurse on Duty SUPERVISED BY Clinical Instructor
PROCEDURE PERFORMED
and Time Started Case Number (Name and Signature) (Name and Signature)

11-24-10 D.E.G.
ASSISTED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
12:06 AM 12-26-60
 Misamis University
Ozamiz City

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

11-24-10 E.S.O.
ASSISTED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
11:00 PM 7-40-49

2-1-11 I.F.T.D.
ASSISTED DELIVERY ROLYN B. VIDAD, MN AMIE G. TOJINO, MAN
5:13 PM 12-56-36

Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed:_______ Time:__________

Highest Nursing Degree Earned: Ph.D. Highest Nursing Degree Earned: MAN
 OR Form 1A

Misamis University O.R. SCRUB FORM

Ozamiz City MAJOR

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

ACTUAL DELIVERY in MAYOR HILARION A. RAMIRO SR. MEDICAL CENTER, MANINGCOL, OZAMIZ CITY, MISAMIS OCCIDENTAL, PHILIPPINES

(Hospital, Municipality/City/Province)

Prepared by: MAGSAYO, GWEN OSIAS T.

Date Performed Patient’s INITIALS only O.R. Nurse on Duty SUPERVISED BY Clinical Instructor
PROCEDURE PERFORMED
and Time Started Case Number (Name and Signature) (Name and Signature)

February 20, 2012 P.V. Marie Ann L. Sanchez, MAN Susan N. Santos, MAN
Open Reduction Internal Fixation Intramedullary Nailing, Static Locking, Right Tibia
9:15 AM 14-22-54

February 20, 2012 E.O.D. Prostatectomy Supra Pubic, Cystostomy Pre-vesical Drain Marie Ann L. Sanchez, MAN Susan N. Santos, MAN

1:35 PM 02-07-47

February 8, 2013 S.R. Repeat Cesarean Section and Bilateral Tubal Ligation Marie Ann L. Sanchez, MAN ORMAN
Susan N. Santos, Form 1A

9:30 AM 15-38-34 O.R. SCRUB FORM

MAJOR
Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed: _______ Time: __________

Highest Nursing Degree Earned: Ph.D. Highest Nursing Degree Earned: MAN

ACTUAL SCRUB in MISAMIS OCCIDENTAL PROVINCIAL HOSPITAL, OROQUIETA CITY, MISAMIS OCCIDENTAL, PHILIPPINES

(Hospital, Municipality/City/Province)

Prepared by: MAGSYO, GWEN OSIAS T.

Patients’ INITIALS only SURGICAL PERFORMED O.R. NURSE ON DUTY SUPERVISED BY CLINICAL INSTRUCTOR

Date Performed and Time started Case Number (Name and Signature) (Name and Signature)
 Misamis University
Ozamiz City

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

R.S.Q. MIKULICZ PROCEDURE SUSAN NG SANTOS, MAN

January 31, 2012 20-12-67 MELUCHI LYNN R. LAWOAGON. MN

10:12 AM

Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed: _______ Time: __________

Highest Nursing Degree Earned: Ph.D. Highest Nursing Degree Earned: MAN
 ICNB FORM

IMMEDIATE CARE OF THE NEWBORN

FORM
Misamis University
Ozamiz City

College of Nursing and Midwifery

Tel Nos. (088) 521-0367, 521-0431/ Telefax No.: (088) 521-2917

Email Address: [email protected]

Accreditation: PACUCOA Level II Second Reaccredited Status Inclusive Date of Accreditation: December 2019- December 2024

Certification: ISO 9001: 2015 Quality Management System – DNV-GL, Pty Ltd.

IMMEDIATE NEWBORN CORD CARE in MAYOR HILARION A. RAMIRO SR. MEDICAL CENTER, MANINGCOL, OZAMIZ CITY, MISAMIS OCCIDENTAL, PHILIPPINES

(Hospital, Municipality/City/Province)

Prepared by: DIANA CANDATU SALINDING

Date Performed Patient’s INITIALS only D.R. Nurse on Duty SUPERVISED BY Clinical Instructor
PROCEDURE PERFORMED
and Time Started Case Number (Name and Signature) (Name and Signature)

08-10-10 D.S.B. ROLYN B. VIDAD, MN

IMMEDIATE NEWBORN CARE AMIE G. TOJINO, MAN
10:15 AM 04-70-89

08-10-10 R.B.M. IMMEDIATE NEWBORN CARE ROLYN B. VIDAD, MN

AMIE G. TOJINO, MAN
1:25 PM 11-89-14

11-25-10 J.O.P IMMEDIATE NEWBORN CARE ROLYN B. VIDAD, MN

AMIE G. TOJINO, MAN
4:05 AM 09-31-02

Noted by: Approved by:

SAMMY B. TAGHOY CHRISTOPHER A. ABELLANA

Clinical Coordinator Dean

PRC ID No. 0363504 Valid Until: SEPTEMBER 2, 2023 PRC ID No. 0377966 Valid Until: July 13,2023

Date document is signed: Time: _______ Date document signed: _______ Time: __________

Highest Nursing Degree Earned: Ph.D. Highest Nursing Degree Earned: MAN