3 + 3 + 1 ACCOMPLISHED REQUIREMENTS OF3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES

Name of Registered Nurse:JOHN HENRY O. VALENCIAPRC Number:0768411Name of Hospital Offering IV Training:BATAAN GENERAL HOSPITALProvider No.:106Date of IV Training Program Attended:November 30, 2012 December 02, 2012Venue:Louis Restaurant, City of Balanga, Bataan

I. Initializing / Maintaining Peripheral IV Infusions

Patient No.Name of PatientAgeDateTimeKind of InfusionSiteType of CannulaDoseRateSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

31-94-61Marissa Tapang43December 14, 201209:10amD5LRR Metacarpal Veing. 221L31-32gtts/minArlene C. Navarro, RN, MAN0163411

19-11-97Ryuken Macarilay07December 14, 201210:00amD5 0.3NaClR Metacarpal Veing. 241L31-32gtts/minArlene C. Navarro, RN, MAN0163411

19-11-98Samuel Quitaleg57December 14, 201210:15amPNSSL Basilic Veing. 221L31-32gtts/minArlene C. Navarro, RN, MAN0163411

II. Administering Intravenous Drugs

Patient No.Name of PatientAgeDateTimeDrug IncorporatedDoseDiagnosisSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

09-56-71Ruben Opina Jr.36December 14, 201208:00amTramadol1ccHPN; CRDArlene C. Navarro, RN, MAN0163411

19-11-69Harry Pollojan15December 14, 201210:40amDiphenhydramine1ampAnemiaArlene C. Navarro, RN, MAN0163411

19-11-98Samuel Quitaleg57December 14, 201211:15amNicardipine1mgHPN; CVAArlene C. Navarro, RN, MAN0163411

III. Administering and Maintaining Blood and Blood Components (2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION)

Patient No.Name of PatientAgeDateTimeVolume/Blood Type/Components/RateIV InsertionType of CannulaDiagnosisSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

19-11-69Harry Pollojan15December 14, 201211:10am450ml/B+/PRBC/10-15gtts/minSide Dripg. 18AnemiaArlene C. Navarro, RN, MAN0163411

Submitted By:John Henry O. Valencia, RNDate Submitted:Received By:Arlene C. Navarro, RN, MANApproved By:Evelyn R. Rubia, RN, Ph.DSignature over Printed NameDirector of Nursing Service(Signature over Printed Name)

3 + 3 + 1 ACCOMPLISHED REQUIREMENTS OF3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM FOR NURSES

Name of Registered Nurse:MYRA C. BEBITPRC Number:0700622Name of Hospital Offering IV Training:BATAAN GENERAL HOSPITALProvider No.:106Date of IV Training Program Attended:November 30, 2012 December 02, 2012Venue:Louis Restaurant, City of Balanga, Bataan

I. Initializing / Maintaining Peripheral IV Infusions

Patient No.Name of PatientAgeDateTimeKind of InfusionSiteType of CannulaDoseRateSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

19-11-99Lydia Belen66December 14, 201211:10amD5LRL Metacarpal Veing. 221L31-32gtts/minArlene C. Navarro, RN, MAN0163411

19-12-00Ricardo Dela Cruz41December 14, 201212:00nnPLRR Metacarpal Veing. 241L31-32gtts/minArlene C. Navarro, RN, MAN0163411

19-12-01Eyhanna Gigante3/12December 14, 201212:15pmD5IMBR Metatarsal Veing. 26250ml20-21gtts/minArlene C. Navarro, RN, MAN0163411

II. Administering Intravenous Drugs

Patient No.Name of PatientAgeDateTimeDrug IncorporatedDoseDiagnosisSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

09-56-71Ruben Opina Jr.36December 14, 201208:00amMetochlopromide2ccHPN; CRDArlene C. Navarro, RN, MAN0163411

19-11-69Harry Pollojan15December 14, 201210:40amParacetamol300mgAnemiaArlene C. Navarro, RN, MAN0163411

08-35-68Perlita Sebastian57December 14, 201211:50amCeftriaxone1ampDM Type 1Arlene C. Navarro, RN, MAN0163411

III. Administering and Maintaining Blood and Blood Components (2 NURSES IN ONE BLOOD TRANSFUSION ADMINISTRATION)

Patient No.Name of PatientAgeDateTimeVolume/Blood Type/Components/RateIV InsertionType of CannulaDiagnosisSignature Over Printed Name of Certified Trainer/Preceptor/MD, RNLicense No.

08-37-70Reynaldo Dela Cruz54December 14, 201210:30am450ml/O+/PRBC/10-15gtts/minSide Dripg. 18SepsisArlene C. Navarro, RN, MAN0163411

Submitted By:Myra C. Bebit, RNDate Submitted:Received By:Arlene C. Navarro, RN, MANApproved By:Evelyn R. Rubia, RN, Ph.DSignature over Printed NameDirector of Nursing Service(Signature over Printed Name)