Capitol University

College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City
(CHED 070: PACUCOA Level 3, June 14, 1982 Manila)


SURGICAL SCRUB in Capitol University Medical City, Cagayan de Oro City
Hospital, City


Prepared by: KWESI GEM LANTACA YASAY Year of Admission in the BSN Program: June 2009
Printed Name and Signature of Student: KWESI GEM LANTACA YASAY Year Graduated in BSN Program: March 2014


















No. Date Performed
Time
Started
Case
No.
Patients Name SURGICAL PROCEDURE PERFORMED
Supervised by
Name and Signature of C.I.
1

November 20, 2012

11:28 AM

023833

Marty N. Vicente
Removal of External Fixator and pin and application of
short leg posterior mold.


Jessele B. Janioso , R.N., M.N.
2
September 24,
2013

1:55 PM

001551

Leonila Maus

Cystoscopy, Ureteroscopy Right Basket Extraction of
Stone, Failed Double J Stenting


Jessele B. Janioso , R.N., M.N.
3

September 30,
2013

1:25 PM

030920

Janine Custodio

Incision Deep with Bearing of Bone Cortex Femur


Jessele B. Janioso , R.N., M.N.
4

October 1, 2013

1:20 PM

030945

Cristina Abanador

Lumpectomy


Jessele B. Janioso , R.N., M.N.
5

October 7, 2013

7:55 AM

022928

Evangeline Beja

Colonscopy

Jessele B. Janioso , R.N., M.N.
Approved by: Fidela B. Ansale, R.N., M.A.N.
(Print Name & Signature)

Dean, PRC I.D. No.: 0085045 Valid Until: February 7, 2016_______
Date Document is signed: ____________ Time: _______________
Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING__



Noted by: Honeylou A. Oponda, R.N., M.A, M.A.N.
(Print Name & Signature)

Clinical Coordinator, PRC I.D. No.: 0217896 Valid Until: January 6, 2016
Date Document is signed: __________________ Time: _________________
Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING__



Approved by: Fidela B. Ansale, R.N., M.A.N. ____
(Print Name & Signature)

Dean, PRC I.D. No.: 0085045 Valid Until: February 7, 2016_______
Date Document is signed: ____________ Time: _______________
Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING__



ODC Form 2B
O.R. CIRCULATING FORM
ODC Form 2A
O.R. SCRUB FORM
Minor