beth prc form
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Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
SURGICAL SCRUB LANAO DEL NORTE PROVINCIAL HOSPITAL, Baroy, Lanao del Norte (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Date Performedand
Time Started
Patient’s Initials (only) SURGICAL PROCEDUREPERFORMED
OR Nurse on Duty(Name and Signature)
Supervised byClinical Instructor
(Name and Signature)Case Number
November 23, 201003:00PM
PB Extracapsular Cataract Lens Extraction Aida G. Sagal, RN Mrs. Merasol O. Duyag, MAN00-81-30
Noted by: Approved by:
LORELEI D. PROCIANOS CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2AO.R. SCRUB FORM
Major
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
SURGICAL SCRUB LANAO DEL NORTE PROVINCIAL HOSPITAL, Baroy, Lanao del NOrte (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Date Performedand
Time Started
Patient’s Initials (only) SURGICAL PROCEDUREPERFORMED
OR Nurse on Duty(Name and Signature)
Supervised byClinical Instructor
(Name and Signature)Case Number
August 12, 201010:35PM
AA Suturing Kristoffer Alexius F. Birondo, RN Mrs. Merasol O. Duyag, MAN01-16-88
Noted by: Approved by:
LORELEI D. PROCIANOS CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
ODC Form 2AO.R. SCRUB FORM
Major
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
SURGICAL SCRUB MISAMIS OCCIDENTAL PROVINCIAL HOSPITAL, Oroquieta City (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Noted by: Approved by:
LORELEI D. PROCIANOS CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
Date Performedand
Time Started
Patient’s Initials (only) SURGICAL PROCEDUREPERFORMED
OR Nurse on Duty(Name and Signature)
Supervised byClinical Instructor
(Name and Signature)Case Number
February 01, 201108:00AM
ARCesarean Section Rovi Jan Huertas, RN Mr. Christopher A. Abellana, MAN19-40-51
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
SURGICAL SCRUB MISAMIS OCCIDENTAL PROVINCIAL HOSPITAL, Oroquieta City (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Noted by: Approved by:
LORELEI D. PROCIANOS CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
SURGICAL SCRUB MAYOR HILARION A. RAMIRO SR. REGIONAL TRAINING AND TEACHING HOSPITAL, Ozamiz City (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Date Performedand
Time Started
Patient’s Initials (only) SURGICAL PROCEDUREPERFORMED
OR Nurse on Duty(Name and Signature)
Supervised byClinical Instructor
(Name and Signature)Case Number
February 08, 201109:45AM
CRRemoval of Debris at the Right Hand Alma Fanilag, RN Mr. Christopher A. Abellana, MAN
03-45-21
Noted by: Approved by:
LORELEI D. PROCIANOS CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
ACTUAL DELIVERY in Lanao del Norte Provincial Hospital, Baroy, Lanao del Norte (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Date Performedand
Time Started
Patient’s Initials (only) SURGICAL PROCEDUREPERFORMED
OR Nurse on Duty(Name and Signature)
Supervised byClinical Instructor
(Name and Signature)Case Number
January 18, 201001:20PM
MCJDilation and Curettage Ma.Chuchie C. Dela Pena, RM Mrs. Denise Katherine A. Amora,
MN 11-00-49
ODC Form 1AACTUAL DELIVERY FORM
Noted by: Approved by:
MARIA CARIDAD L. MUTIA CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
ACTUAL DELIVERY in Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital, Ozamiz City (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH A. DAGATAN Student
Date Performedand
Time of Delivery
Patient’s Initials (only)PROCEDURE PERFORMED
DR Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature not Required)
Supervised byClinical Instructor
(Name and Signature)Case Number
August 11, 201001:08PM
AEHandled Delivery Josefina F. Apat, MN Mrs. Merasol O. Duyag, MAN00-39-91
August 17, 201008:20AM
ORHandled Delivery Josefina F. Apat, MN Mrs. Merasol O. Duyag, MAN 00-40-10
ODC Form 1AACTUAL DELIVERY FORM
Noted by: Approved by:
MARIA CARIDAD L. MUTIA CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
ACTUAL DELIVERY in Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital, Ozamiz City (Hospital, Municipality/City/Province)
Prepared by:
MARIBETH . DAGATAN Student
Date Performedand
Time of Delivery
Patient’s Initials (only)PROCEDURE PERFORMED
DR Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature not Required)
Supervised byClinical Instructor
(Name and Signature)Case Number
August 4, 200911:50AM
MJSHandled Delivery Ma. Chuchie C. Dela Pena, RM Mrs. Denise Katherine A. Amora,
MN04-15-93January 27, 2010
08:46AMKM
Handled Delivery Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora, MN01-56-18
April 09, 201003:24PM
MCTHandled Delivery Ma. Chuchie C. Dela Pena, RM Mrs. Denise Katherine A. Amora,
MN11-33-62
ODC Form 1BASSISTED DELIVERY FORM
Noted by: Approved by:
MARIA CARIDAD L. MUTIA CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Misamis UniversityOzamiz City
College of Nursing & School of MidwiferyTel. Nos.: (088) 521-0367, 521-0431 / Telefax No.: (088) 521-2917
E-mail Address: [email protected]
Accreditation: PACUCOA Level II First Reaccredited Status Inclusive Date of Accreditation: October 2009-October 2014Certification: ISO 9001: 2008 Quality Management System – Det Norske Veritas, The Netherlands
IMMEDIATE NEWBORN CORD CARE in Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital, Ozamiz City (Hospital, Municipality/City/Province)
Prepared by: MARIBETH A. DAGATAN Student
Date Performedand
Time of Delivery
Patient’s Initials (only)PROCEDURE PERFORMED
DR Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature not Required)
Supervised byClinical Instructor
(Name and Signature)Case Number
July 29, 200910:18AM
GMJAssisted Delivery
Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,MN10-32-18
January 19, 201011:49AM
OMAssisted Delivery
Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,MN11-00-88
January 25, 20107:44AM
PMAssisted Delivery Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN09-71-09April 9, 2010
6:45AMDV
Assisted Delivery Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,MN07-06-88
May 31, 20102:09PM
NAAssisted Delivery Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN11-56-92
ODC Form 1CCORD CARE FORM
Noted by: Approved by:
MARIA CARIDAD L. MUTIA CYNTHIA S. SUPERABLEClinical Coordinator DeanPRC ID No. 0382092 Valid Until : May 19, 2014 PRC ID No. 0135575 Valid Until : October 24, 2013Date document is signed: ___________________ Time: __________________ Date document is signed: ___________________Time: __________________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
Date Performedand
Time of Delivery
Patient’s Initials (only)
PROCEDURE PERFORMED
DR Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature not Required)
Supervised byClinical Instructor
(Name and Signature)Case Number
July 28, 200912:01PM
PMCCord Care Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN10-02-12August 3, 2009
2:01PMGTA
Cord Care Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora, MN10-33-42
January 20, 20109:08AM
GICord Care Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN08-80-82
January 26, 201008:30AM
ALCord Care Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN11-03-55
January 27, 20108:46AM
MKCord Care Ma. Chuchie C. Dela Pena,RM Mrs. Denise Katherine A. Amora,
MN01-56-18