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Or and Dr Cases

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TARLAC STATE UNIVERSITY
ROMULO BLVD. SAN VICENTE, TARLAC CITY
(045) 493-1865/ Telefax. (045) 982-0110/ www.tsu.edu.ph

SURGICAL SCRUB in TARLAC PROVINCIAL HOSPITAL, Tarlac City Hospital, Municipality/ City/ Province
Prepared by:
Name of Student: APUAN, MELANIE ANGELA Q. Signature of Student: ______________________________________

| | | | | |
|Date Performed And Time Started |Patient Name | |O.R. Nurse on Duty |SUPERVISED BY |
| | |PROCEDURE PERFORMED |(Name Only) |Clinical Instructor |
| | | | |Name and Signature |
| | | | | |
| |Case Number | | | |
| | | | | |
| |AGUILAR, KAREN | | | |
|March 18, 2009 | |Thyroidectomy Total (Left), Subtotal (Right) | | |
|01: 35 am | | |Imelda Santos |ROWENA T. QUINTOS, RN, MSN |
| | | | |PRC Number 0215002 |
| | | | | |
| |Case # 121620 | | | |
| | | | | |
| |REQUIRMAN, FREDDIE | | | |
|September 28, 2009 | |Ileal Resection with End to End Anastomosis and | | |
|08:07 am | |Herniorrhaphy Right |Nathaniel Acierto |ROWENA T. QUINTOS, RN, MSN |
| | | | |PRC Number 0215002 |
| | | | | |
| |Case # 133759 | | | |
| | | | | |
| |CUCHON, JOANNE | | | |
|September 30, 2009 | |Low Transverse Cesarean Section II |Nathaniel Acierto |ROWENA T. QUINTOS, RN, MSN |
|08:15 am | | | |PRC Number 0215002 |
| | | | | |
| |Case # 133903 | | | |
| | | | | |
| |IBE, ESMELDA | | | |
|October 07, 2009 | |Subcutaneous Mastectomy, Right Breast | | |
|09:10 am | | |Elizabeth Domingo |ROWENA T. QUINTOS, RN, MSN |
| | | | |PRC Number 0215002 |
| | | | | |
| |Case # 134045 | | | |
| | | | | |
| |CORTISANO, CHONA | | | |
|March 07, 2010 | |Exploratory Laparotomy and Salphingectomy | | |
|10:00 pm | | |Imelda Santos |ROWENA T. QUINTOS, RN, MSN |
| | | | |PRC Number 0215002 |
| | | | | |
| |Case # 144269 | | | |

TARLAC STATE UNIVERSITY
ROMULO BLVD. SAN VICENTE, TARLAC CITY
(045) 493-1865/ Telefax. (045) 982-0110/ www.tsu.edu.ph

SURGICAL SCRUB in TARLAC PROVINCIAL HOSPITAL, Tarlac City Hospital, Municipality/ City/ Province
Prepared by:
Name of Student: APUAN, MELANIE ANGELA Q. Signature of Student: ______________________________

| | | | | |
|Date Performed And Time Started |Patient Name |PROCEDURE PERFORMED |O.R. Nurse on Duty |SUPERVISED BY |
| | | |(Name Only) |Clinical Instructor |
| | | | |Name and Signature |
| | | | | |
| |Case Number | | | |
| | | | | |
| |DE LEON, VERNEL | | |ROWENA T. QUINTOS, RN, MSN |
|March 11, 2009 | |Hernioplasty, Left |Imelda Santos |PRC # 0215002 |
|03:40 am | | | | |
| | | | | |
| |Case # 121922 | | | |
| | | | | |
| |BAUTISTA, YOLANDA | | |ROWENA T. QUINTOS, RN, MSN |
|October 05, 2009 | |Dilatation and Curettage |Nathaniel Acierto |PRC # 0215002 |
|02:40 pm | | | | |
| | | | | |
| |Case # 134146 | | | |
| | | | | |
| |QUIMADO, MILAGROS | | |ROWENA T. QUINTOS, RN, MSN |
|February 10, 2010 | |Bilateral Tubal Ligation | |PRC # 0215002 |
|04:15 pm | | |Nathaniel Acierto | |
| | | | | |
| |Case # 142632 | | | |
| | | | | |
| |PELORE, ERWIN | | |ROWENA T. QUINTOS, RN, MSN |
|February 24, 2010 | |Palatoplasty |Nathaniel Acierto |PRC # 0215002 |
|09:15 am | | | | |
| | | | | |
| |Case # 143538 | | | |
| | | | | |
| |BLANCO, LAIZELLE | | |ROWENA T. QUINTOS, RN, MSN |
|February 26, 2010 | |Cheiloplasty |Nathaniel Acierto |PRC # 0215002 |
|10:10 am | | | | |
| | | | | |
| |Case # 143668 | | | |

TARLAC STATE UNIVERSITY
ROMULO BLVD. SAN VICENTE, TARLAC CITY
(045) 493-1865/ Telefax. (045) 982-0110/ www.tsu.edu.ph

ACTUAL DELIVERY in TARLAC PROVINCIAL HOSPITAL, Tarlac City Hospital, Municipality/ City/ Province
Prepared by:
Name of Student: APUAN, MELANIE ANGELA Q. Signature of Student: _______________________________

| |Patient Name | | | |
|Date Performed And Time Started | |PROCEDURE PERFORMED |D.R. Nurse on Duty |SUPERVISED BY |
| | | |(Name Only) |Clinical Instructor |
| | | | |Name and Signature |
| |Case Number | | | |
| |(not applicable for Birthing/Lying-In | | | |
| |Clinics/Homes) | | | |
| | | | | |
| |FERRER, MARICEL | | | |
|November 11, 2008 | |Normal Spontaneous Delivery |Gina Sunga |ADORA N. OBREGON, RN, MSN |
|04:17 am | | | |PRC # 0180170 |
| | | | | |
| |Case # 114818 | | | |
| | | | | |
| |PEREZ, ANNA MARIE | | | |
|July 27, 2009 | |Normal Spontaneous Delivery |Gina Sunga |ADORA N. OBREGON, RN, MSN |
|10:38 pm | | | |PRC # 0180170 |
| | | | | |
| |Case # 129939 | | | |
| | | | | |
| |RIARO, MICHELLE | | | |
|July 30, 2009 | |Normal Spontaneous Delivery |Karen Pangan |ADORA N. OBREGON, RN, MSN |
|11:55 pm | | | |PRC # 0180170 |
| | | | | |
| |Case # 130065 | | | |
| | | | | |
| |BRIONES, NORIZA | | | |
|December 22, 2009 | |Normal Spontaneous Delivery |Karen Pangan |ADORA N. OBREGON, RN, MSN |
|03:22 am | | | |PRC # 0180170 |
| | | | | |
| |Case # 139342 | | | |
| | | | | |
| |RIVERA, JANET | | | |
|March 16, 2010 | |Normal Spontaneous Delivery |Karen Pangan |ADORA N. OBREGON, RN, MSN |
|09:18 am | | | |PRC # 0180170 |
| | | | | |
| |Case # 144707 | | | |

TARLAC STATE UNIVERSITY
ROMULO BLVD. SAN VICENTE, TARLAC CITY
(045) 493-1865/ Telefax. (045) 982-0110/ www.tsu.edu.ph

ACTUAL DELIVERY in TARLAC PROVINCIAL HOSPITAL, Tarlac City Hospital, Municipality/ City/ Province
Prepared by:
Name of Student: APUAN, MELANIE ANGELA Q. Signature of Student: _____________________________________

| |Patient Name | | | |
|Date Performed And Time Started | |PROCEDURE PERFORMED |D.R. Nurse on Duty |SUPERVISED BY |
| | | |(Name Only) |Clinical Instructor |
| | | | |Name and Signature |
| |Case Number | | | |
| |(not applicable in Birthing/lying-In Clinics/Homes) | | | |
| | | | | |
| |DELA PEÑA, JENNYLYN | | |ADORA N. OBREGON, RN, MSN |
|November 13, 2008 | |Normal Spontaneous Delivery |Karen Pangan |PRC # 0180170 |
|12:30 am | | | | |
| | | | | |
| |Case # 114833 | | | |
| | | | | |
| |PASTIDIO, JESSICA | | |ADORA N. OBREGON, RN, MSN |
|July 28, 2009 | |Normal Spontaneous Delivery |Gina Sunga |PRC # 0180170 |
|01: 27 am | | | | |
| | | | | |
| |Case # 129938 | | | |
| | | | | |
| |SANTOS, ROWENA | | |ADORA N. OBREGON, RN, MSN |
|July 28, 2009 | |Normal Spontaneous Delivery |Gina Sunga |PRC # 0180170 |
|04:20 am | | | | |
| | | | | |
| |Case # 129963 | | | |
| | | | | |
| |BONGCALIG, JENNIFER | | |ADORA N. OBREGON, RN, MSN |
|August 02, 2009 | |Normal Spontaneous Delivery |Helen Sabado |PRC # 0180170 |
|06:20 pm | | | | |
| | | | | |
| |Case # 130235 | | | |
| | | | | |
| |VILLAFUERTE, MARIELLE | | |ADORA N. OBREGON, RN, MSN |
|October 12, 2009 | |Normal Spontaneous Delivery | |PRC # 0180170 |
|11:35 pm | | |Karen Pangan | |
| | | | | |
| |Case # 134701 | | | |

TARLAC STATE UNIVERSITY
ROMULO BLVD. SAN VICENTE, TARLAC CITY
(045) 493-1865/ Telefax. (045) 982-0110/ www.tsu.edu.ph

ACTUAL DELIVERY in TARLAC PROVINCIAL HOSPITAL, Tarlac City Hospital, Municipality/ City/ Province
Prepared by:
Name of Student: APUAN, MELANIE ANGELA Q. Signature of Student: ______________________________________

| |Patient Name | | | |
|Date Performed And Time Started | |Immediate Newborn Cord Care PERFORMED |D.R. Nurse on Duty |SUPERVISED BY |
| | |Indicate where performed e.g. D.R., Nursery, NICU, or |(Name Only) |Clinical Instructor |
| | |Home | |Name and Signature |
| |Case Number | | | |
| |(not applicable in Birthing/lying-In Clinics/Homes) | | | |
| | | | | |
| |BABY BOY HANSON | | |ADORA N. OBREGON, RN, MSN |
|November 13, 2008 | |Nursery |Karen Pangan |PRC # 0180170 |
|05:22 am | | | | |
| | | | | |
| |Case # 114849 | | | |
| | | | | |
| |BABY GIRL MALONZO | | |ADORA N. OBREGON, RN, MSN |
|November 14, 2008 | |Nursery |Karen Pangan |PRC # 0180170 |
|02:05 am | | | | |
| | | | | |
| |Case # 114889 | | | |
| | | | | |
| |BABY GIRL TOLENTINO | | |ADORA N. OBREGON, RN, MSN |
|December 22, 2009 | |Nursery |Karen Pangan |PRC # 0180170 |
|02:10 am | | | | |
| | | | | |
| |Case # 139330 | | | |
| | | | | |
| |BABY BOY LACASANDILE | | |ADORA N. OBREGON, RN, MSN |
|March 16, 2010 | |Nursery |Karen Pangan |PRC # 0180170 |
|08:10 am | | | | |
| | | | | |
| |Case # 144710 | | | |
| | | | | |
| |BABY GIRL AFANTE | | |ADORA N. OBREGON, RN, MSN |
|March 16, 2010 | |Nursery |Karen Pangan |PRC # 0180170 |
|10:10 am | | | | |
| | | | | |
| |Case # 144432 | | | |

-----------------------
ODC FORM 1
O. R. SCRUB FORM
Major

ODC FORM 2
ACTUAL DELIVERY FORM

ODC FORM 1
O. R. SCRUB FORM
Minor

ODC FORM 3
D. R. ASSIST FORM

ODC FORM 4
D. R. IMMEDIATE NEWBORN CORD CARE FORM

Noted by:

APOLLO G. FACUN
(Signature over printed name of Chairman, RLE Instruction)
Date Signed: _____________________
Degree: RN, MSN__________________
PRC No.: 0207378_________________
Valid Until: December 2013__________
PNA No.: 056495_ ________________
Valid Until: October 2010____________

Approved by:

PROF. LUCILA O. SUNGA
(Signature over printed name of Dean)
Date Signed: ______________________
Degree: RN, MPA, MAN______________
PRC No.: 0135647__________________
Valid Until: September 2010__________
PNA No.: 539620 _________________
Valid Until: Lifetime_________________
ADCPN No: 535____________________
Valid Until: December 2010__________

Concurred by:

ERLINDA S. LAGONILLA
(Signature over printed name of Chief Nurse)
Degree: RN, RM, MSN____________
PRC No.: 46196_________________

Valid Until: February 2011________

PNA No.: 2410 ________________

Valid Until: Lifetime______________

ANSAP No.: 0106________________

Valid Until: Lifetime ______________

Approved by:

PROF. LUCILA O. SUNGA
(Signature over printed name of Dean)
Date Signed: ______________________
Degree: RN, MPA, MAN______________
PRC No.: 0135647__________________
Valid Until: September 2010__________
PNA No.: 539620 _________________
Valid Until: Lifetime_________________
ADCPN No: 535____________________
Valid Until: December 2010__________

Noted by:

APOLLO G. FACUN
(Signature over printed name of Chairman, RLE Instruction)
Date Signed: _____________________
Degree: RN, MSN__________________
PRC No.: 0207378_________________
Valid Until: December 2013__________
PNA No.: 056495_ ________________
Valid Until: October 2010____________

Concurred by:

ERLINDA S. LAGONILLA
(Signature over printed name of Chief Nurse)
Degree: RN, RM, MSN____________
PRC No.: 46196_________________

Valid Until: February 2011________

PNA No.: 2410 ________________

Valid Until: Lifetime______________

ANSAP No.: 0106________________

Valid Until: Lifetime ______________

Approved by:

PROF. LUCILA O. SUNGA
(Signature over printed name of Dean)
Date Signed: ______________________
Degree: RN, MPA, MAN______________
PRC No.: 0135647__________________
Valid Until: September 2010__________
PNA No.: 539620 _________________
Valid Until: Lifetime_________________
ADCPN No: 535____________________
Valid Until: December 2010__________

Noted by:

APOLLO G. FACUN
(Signature over printed name of Chairman, RLE Instruction)
Date Signed: _____________________
Degree: RN, MSN__________________
PRC No.: 0207378_________________
Valid Until: December 2013__________
PNA No.: 056495_ ________________
Valid Until: October 2010____________

Concurred by:

ERLINDA S. LAGONILLA
(Signature over printed name of Chief Nurse)
Degree: RN, RM, MSN____________
PRC No.: 46196_________________

Valid Until: February 2011________

PNA No.: 2410 ________________

Valid Until: Lifetime______________

ANSAP No.: 0106________________

Valid Until: Lifetime ______________

Approved by:

PROF. LUCILA O. SUNGA
(Signature over printed name of Dean)
Date Signed: ______________________
Degree: RN, MPA, MAN______________
PRC No.: 0135647__________________
Valid Until: September 2010__________
PNA No.: 539620 _________________
Valid Until: Lifetime_________________
ADCPN No: 535____________________
Valid Until: December 2010__________

Noted by:

APOLLO G. FACUN
(Signature over printed name of Chairman, RLE Instruction)
Date Signed: _____________________
Degree: RN, MSN__________________
PRC No.: 0207378_________________
Valid Until: December 2013__________
PNA No.: 056495_ ________________
Valid Until: October 2010____________

Concurred by:

ERLINDA S. LAGONILLA
(Signature over printed name of Chief Nurse)
Degree: RN, RM, MSN____________
PRC No.: 46196_________________

Valid Until: February 2011________

PNA No.: 2410 ________________

Valid Until: Lifetime______________

ANSAP No.: 0106________________

Valid Until: Lifetime ______________

Approved by:

PROF. LUCILA O. SUNGA
(Signature over printed name of Dean)
Date Signed: ______________________
Degree: RN, MPA, MAN______________
PRC No.: 0135647__________________
Valid Until: September 2010__________
PNA No.: 539620 _________________
Valid Until: Lifetime_________________
ADCPN No: 535____________________
Valid Until: December 2010__________

Noted by:

APOLLO G. FACUN
(Signature over printed name of Chairman, RLE Instruction)
Date Signed: _____________________
Degree: RN, MSN__________________
PRC No.: 0207378_________________
Valid Until: December 2013__________
PNA No.: 056495_ ________________
Valid Until: October 2010____________

Concurred by:

ERLINDA S. LAGONILLA
(Signature over printed name of Chief Nurse)
Degree: RN, RM, MSN____________
PRC No.: 46196_________________

Valid Until: February 2011________

PNA No.: 2410 ________________

Valid Until: Lifetime______________

ANSAP No.: 0106________________

Valid Until: Lifetime ______________…...

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