CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No.

(049) 545 9921

SURGICAL SCRUB in Calamba Doctors Hospital Hospital, Municipality/City/ Province

ODC Form 2A O.R. SCRUB FORM MAJOR

Prepared by: Printed Name with Signature of Student Date Performed and Time Started Marry Joy D. Pardico SUPERVISED BY Clinical Instructor (Name and Signature)

Patient's INITIALS (only) Case Number

SURGICAL PROCEDURE PERFORMED

O.R Nurse On Duty (Name and Signature)

November 17, 2012 8:36 pm December 8, 2012 10:20 am

CSN CN: 370941 FFS CN:380022

Excision Biopsy Open Appendectomy

Layoso Perez

Mr. Alvin Doctora Mrs. Felicidad Daquis

Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
SURGICAL SCRUB in Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico JPRMH Hospital, Municipality/City/ Province

ODC Form 2A O.R. SCRUB FORM MAJOR

Date Performed and Time Started

Patient's INITIALS (only) Case Number

SURGICAL PROCEDURE PERFORMED

O.R. Nurse On Duty (Name and Signature)

SUPERVISED BY Clinical Instructor (Name and Signature)

July 12, 2013 8:05pm

JLG CN: 232992

D&C

Ricarte, L

Mr. Diosdado Manaloto

Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921

ODC Form 2A O.R. SCRUB FORM MAJOR

ASSISTED DELIVERY in

JPRMH Hospital, Municipality/City/ Province

Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) PROCEDURE PERFORMED ASSISTED DELIVERY

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

August 02, 2013 5:45pm

DE CN: 1155618

Normal Spontaneous Delivery

Samoza, Jayson

Mr. Diosdado Manaloto

Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
IMMEDIATE NEWBORN CORD CARE in JPRMH Hospital, Municipality/City/ Province

ODC Form 2A O.R. SCRUB FORM MAJOR

Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes)

IMMEDIATE NEWBORN CORD CARE PERFORMED Indicate where performed e.g. D.R., Nursery, NICU, or Home

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

July 18, 2013 2:25pm

Bb. Boy R CN: 226519

Cord dressing DR

Ricarte, L

Mr. Diosdado Manaloto

Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
IMMEDIATE NEWBORN CORD CARE in Calamba Doctors Hospital Hospital, Municipality/City/ Province

ODC Form 2A O.R. SCRUB FORM MAJOR

Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) PROCEDURE PERFORMED ASSISTED DELIVERY

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

December 8, 2012 9:30am

Bb. Girl L CN: 12183023

Cord dressing NICU

Villanueva, J

Mrs. Felicidad Daquis

Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time

Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time