Download - Sample- Or Dr Case 2013
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : CECILLE INNA M. ANDAYA( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZ
Clinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477
Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )
Level : 2
Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: Lifetime
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Date document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZ
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Clinical Coordinator Chief Nurse DeanPRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
O.R. Form 1-AMAJOR- O.R. CIRCULATING FORM -
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : CATHERINE JOY R. BAUTISTA( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
01/03/12, 3:18pm N.C.R 175752 Emergency Low Cervical Cesarean Section Levie G. Roncal, RN Benjamin G. Kinney, MAN
01/04/12, 5:10pm L.A.R 175533 Total Mastectomy Right Maria Victoria T. Datu, RN Benjamin G. Kinney, MAN
01/11/12, 6:38pm J.M.C 176190 Emergency Exploratory Laparotomy; Appendectomy Levie G. Roncal, RN Benjamin G. Kinney, MAN
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: Lifetime
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
Date document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
SURGICAL SCRUB in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Name & Signature
Noted by: Concurred by: Approved by:
O.R. Form 1-A MAJOR - O.R. SCRUB FORM
MA. FLORINDA O. RUBIANO EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0296587 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: November 4, 2013 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 2012 - 024049 PNA No. : 7845 PNA No. : 14374Valid Until: December 2012 Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : CECILLE INNA M. ANDAYA( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
11/16/12, 8:24 pm BB R. 176768 Delivery Room Leonora Fernandez, RMSylvia Pangilinan, MAN
11/17/12, 9:24 pm BB M. 176778Delivery Room
Leonora Fernandez, RMSylvia Pangilinan, MAN
11/23/12, 8:21 pm BB S. 176791Delivery Room
Grace Tamayo, RMSylvia Pangilinan, MAN
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: Lifetime
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Date document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
PRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON CAMILO D. DOMINGUEZ
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
Clinical Coordinator Chief Nurse DeanPRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
IMMEDIATE NEWBORN CORD CARE in( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ICNB FormIMMEDIATE CARE OF THE NEWBORN FORM
ROSITA D. VIANZON CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: Valid Until: July 18, 2012PNA No. : 13062 PNA No. : PNA No. : 14374Valid Until: Lifetime Valid Until: Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : CECILLE INNA M. ANDAYA( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
11/16/12 3:55 pm A.M. 176773 Normal Spontaneous DeliveryLeonora Fernandez, RM Sylvia Pangilinan, MAN
13/01/12 9:39: pm C.S. 176813 Normal Spontaneous Delivery Leonora Fernandez, RM Sylvia Pangilinan, MAN
12/15/12 04:43 pm M.R. 176771 Normal Spontaneous Delivery Cecille Barion, RM Sylvia Pangilinan, MAN
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
D. R. FormACTUAL DELIVERY
FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
D. R. FormACTUAL DELIVERY
FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
D. R. FormACTUAL DELIVERY
FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
D. R. FormACTUAL DELIVERY
FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
D. R. FormACTUAL DELIVERY
FORM
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
D. R. FormACTUAL DELIVERY
FORM
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in ORANI DISTRICT HOSPITAL, ORANI, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON FERMINA Q. MERCADO CAMILO D. DOMINGUEZClinical Coordinator Senior Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 0082691 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 8, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 11595 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
D. R. FormACTUAL DELIVERY
FORM
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: BSN, with MAN units Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: Lifetime
D. R. FormACTUAL DELIVERY
FORM
Date document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in JOSE C. PAYUMO JR. MEMORIAL HOSPITAL, DINALUPIHAN, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON IMELDA P. DAVID CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 062530 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: February 1, 2013 Valid Until: July 18, 2012
D. R. FormACTUAL DELIVERY
FORM
PNA No. : 13062 PNA No. : 4118 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Master Arts in Nursing Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012
D. R. FormACTUAL DELIVERY
FORM
PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477
D. R. FormACTUAL DELIVERY
FORM
Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
D. R. FormACTUAL DELIVERY
FORM
PRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZ
D. R. FormACTUAL DELIVERY
FORM
Clinical Coordinator Chief Nurse DeanPRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
D. R. FormACTUAL DELIVERY
FORM
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing
BATAAN PENINSULA STATE UNIVERSITYCOLLEGE OF NURSING & MIDWIFERY
Don Manuel H. Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )Level : 2Date of Accreditation: December 16, 2009
ACTUAL DELIVERY in BATAAN GENERAL HOSPITAL, BALANGA CITY, BATAAN( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student :( Printed Name & Signature of Student )
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BYand Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature
Noted by: Concurred by: Approved by:
D. R. FormACTUAL DELIVERY
FORM
ROSITA D. VIANZON EVELYN R. RUBIA CAMILO D. DOMINGUEZClinical Coordinator Chief Nurse Dean
PRC I.D. No. : 0086977 PRC I.D. No. : 98006 PRC I.D. No. : 0206477Valid Until: May 13, 2012 Valid Until: October 22, 2014 Valid Until: July 18, 2012PNA No. : 13062 PNA No. : 7845 PNA No. : 14374Valid Until: Lifetime Valid Until: Lifetime Valid Until: LifetimeDate document is signed: Date document is signed: Date document is signed:
Time: Time: Time:
Highest Degree Earned: Master of Arts in Nursing Highest Degree Earned: Doctor of Philosophy Highest Degree Earned: Master of Arts in Nursing