final prc forms(3)
TRANSCRIPT
-
8/6/2019 Final Prc Forms(3)
1/4
WESTERN MINDANAO STATE UNIVERSITYNormal Road, Baliwasan, Zamboanga City, Philippines
Telephone No. (062) 992-0315 / Fax No. (062) 992-4238 / E-mail: [email protected] / Web-Site: www.wmsu.edu.phAccredited by: Accrediting Agencies of Chartered Colleges and Universities in the Philippines / Level II Re-accredited / February 2SURGICAL SCRUB in ______________________________________________________
Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name with Signature of Student: JABARANI, ARLEINE MHAR FRANCISCO
Date Performed
and
Time Started
Patients INITIALS only
SURGICAL PROCEDURE
PERFORMED
O.R. Nurse On Duty
(Name and Signature)
SUPERVISED BY
Clinical Instructo
Name and SignatuCase Number
(not applicable for Birthing /Lying In
Clinics / Homes)
Noted by: SARAH S. TAUPAN, R.N., M.N. ,D.P.A Approved by: GLORIA G. FLORENDO, R.N
Clinical Coordinator,PRC I.D. No. 0150766 Valid Until: January 17, 2012 Dean,PRC I.D. No. 0054293 Valid Until: JDate document is signed: Time: Date document is signed: T
Please specify Highest Nursing Degree Earned: Master in Nursing Specify Highest Nursing Degree Earned: M
O.O.R. CIRC
-
8/6/2019 Final Prc Forms(3)
2/4
WESTERN MINDANAO STATE UNIVERSITYNormal Road, Baliwasan, Zamboanga City, Philippines
Telephone No. (062) 992-0315 / Fax No. (062) 992-4238 / E-mail: [email protected] / Web-Site: www.wmsu.edu.phAccredited by: Accrediting Agencies of Chartered Colleges and Universities in the Philippines / Level II Re-accredited / February 2IMMEDIATE NEWBORN CORD CARE in __________________________________________________________
Hospital/Home/Lying-in Clinic, Municipality/City/Province
Printed Name with Signature of Student: JABARANI, ARLEINE MHAR FRANCISCO
Date Performed
and
Time Started
Patients INITIALS (only)Immediate Newborn Cord Care
PERFORMEDIndicate where performed e.g. D.R.,
Nursery, NICU, or Home
D.R. Nurse On Duty
(Name and Signature)(If Midwife on Duty,
Signature is not Required)
SUPERVIS
Clinical Ins
Name and SCase Number
(not applicable for Birthing /Lying In
Clinics / Homes)
Noted by: SARAH S. TAUPAN, R.N., M.N. ,D.P.A Approved by: GLORIA G. FLORENDO, R.N
Clinical Coordinator,PRC I.D. No. 0150766 Valid Until: January 17, 2012 Dean,PRC I.D. No. 0054293 Valid Until: JDate document is signed: Time: Date document is signed: T
Please specify Highest Nursing Degree Earned: Master in Nursing Specify Highest Nursing Degree Earned: M
ICIMMEDIA
NEW
-
8/6/2019 Final Prc Forms(3)
3/4
WESTERN MINDANAO STATE UNIVERSITYNormal Road, Baliwasan, Zamboanga City, Philippines
Telephone No. (062) 992-0315 / Fax No. (062) 992-4238 / E-mail: [email protected] / Web-Site: www.wmsu.edu.phAccredited by: Accrediting Agencies of Chartered Colleges and Universities in the Philippines / Level II Re-accredited / February 2ACTUAL DELIVERY in ______________________________________________________
Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name with Signature of Student: JABARANI, ARLEINE MHAR FRANCISCO
Date Performed
and
Time Started
Patients INITIALS (only)
PROCEDURE
PERFORMED
D.R. Nurse On Duty
(Name and Signature)(If Midwife on Duty,
Signature is not Required)
SUPERVISED BY
Clinical Instructo
Name and SignatuCase Number
(not applicable for Birthing /Lying In
Clinics / Homes)
Noted by: SARAH S. TAUPAN, R.N., M.N.,D.P.A Approved by: GLORIA G. FLORENDO, R.N
Clinical Coordinator,PRC I.D. No. 0150766 Valid Until: January 17, 2012 Dean,PRC I.D. No. 0054293 Valid Until: JDate document is signed: Time: Date document is signed: T
Please specify Highest Nursing Degree Earned: Master in Nursing Specify Highest Nursing Degree Earned: M
D.ACTUAL D
-
8/6/2019 Final Prc Forms(3)
4/4
WESTERN MINDANAO STATE UNIVERSITYNormal Road, Baliwasan, Zamboanga City, Philippines
Telephone No. (062) 992-0315 / Fax No. (062) 992-4238 / E-mail: [email protected] / Web-Site: www.wmsu.edu.phAccredited by: Accrediting Agencies of Chartered Colleges and Universities in the Philippines / Level II Re-accredited / February 2SURGICAL SCRUB in ______________________________________________________
Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name with Signature of Student: JABARANI, ARLEINE MHAR FRANCISCO
Date Performed
and
Time Started
Patients INITIALS only
SURGICAL PROCEDURE
PERFORMED
O.R. Nurse On Duty
(Name and Signature)
SUPERVISED BY
Clinical Instructo
Name and SignatuCase Number
(not applicable for Birthing /Lying In
Clinics / Homes)
Noted by: SARAH S. TAUPAN, R.N., M.N. ,D.P.A Approved by: GLORIA G. FLORENDO, R.N
Clinical Coordinator,PRC I.D. No. 0150766 Valid Until: January 17, 2012 Dean,PRC I.D. No. 0054293 Valid Until: JDate document is signed: Time: Date document is signed: T
Please specify Highest Nursing Degree Earned: Master in Nursing Specify Highest Nursing Degree Earned: M
O.O.R. SCRU