minor case eamc.docx
TRANSCRIPT
UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNASTO.NIÑO, CITY OF BIÑAN, LAGUNA
COLLEGE OF NURSINGWeb-Site = www.uphsl.edu.ph
ACCREDITATION LEVEL: PACUCOA – LEVEL II – First ReaccreditedYear Granted: February 2008
SURGICAL SCRUB IN EAST AVENUE MEDICAL CENTER DILIMAN, QUEZON CITY (Minor) Hospital, Municipality / City / Province
Prepared by:Name of Student PONCE, KATRINA P. Signature of Student _________________________
Concurred by:(Print Name and Signature)
Nora Diaz RN, MANChief NursePRC ID No. 045102Valid Until November 2014PNA No. 14597Valid Until Life MemberDate document is signed _____________Time ______________Nursing Degree Earned BS Nursing, RN, MAN
Concurred by:(Print Name and Signature)
_________________________Chief NursePRC ID No. ______________Valid Until ______________PNA No. ______________Valid Until ______________Date document is signed _____________Time ______________Nursing Degree Earned __________________________
Noted by:(Print Name and Signature)
Teresita A. Alcantara RN, MANClinical CoordinatorPRC ID No. 126077Valid Until January 29, 2015PNA No. 15336Valid Until Life MemberDate document is signed _____________Time ______________Nursing Degree Earned BS Nursing, RN, MAN
Approved by:(Print Name and Signature)
Estrella A. San Juan RN, MANDeanPRC ID No. 0157881Valid Until November 25, 2014PNA No. 002721Valid Until October 2014Date document is signed _____________Time ______________Nursing Degree Earned BS Nursing, RN, MAN
Date Performed
Time Started
Patient’s Name Case Number
PROCEDURE PERFORMED O.R. Nurse on Duty(Name Only)
SUPERVISED BY CLINICAL INSTRUCTOR NAME AND SIGNATURE
June 1,2012
7:45 AM TANAJI, MICHAEL #881294EXCISION OF SEBACEOUS CYST AT RIGHT WRIST J. MATES RN
June 1,2012
9:45 AM CARANDANG, MARCO #867359EXCISION OF LIPOMA, AT RIGHT LEG J. REYES RN
Marites M. Lavadia RN, MANPRC ID No. 0150316
June 2,2012
8:05 AM DE LEON, LUISA #889240 TONSILLECTOMYF. RAMOS RN
Valid Until: March 11, 2014PNA No. 17915
June 2, 2012
11:10 AM LUMPAS, ERICKA #898151 TONSILLECTOMYJ. REYES RN
Valid Until: Lifetime Member
