University of the Philippines Manila

The Health Sciences Center

COLLEGE OF NURSING
WHO Collaborating Center for Leadership in Nursing Development
CHED Center for Excellence
Sotejo Hall, Pedro Gil St., Ermita, Manila

NAME OF STUDENT:__________________ DATE OF ASSIGNMENT: _ __________________ ____
NAME OF PATIENT: ____________ ____________ __ ____ CIVIL STATUS:____________________________
MEDICAL DIAGNOSIS: _______________________________________________ WARD: __ BED: _ AGE: ______ SEX: ______
LAB STUDY

NAME OF TEST/
PROCEDURE
NORMAL VALUE
ACTUAL FINDINGS
date SIGNIFICANCE OF THE FINDINGS


NAME OF TEST/
PROCEDURE
NORMAL VALUE ACTUAL FINDINGS SIGNIFICANCE OF THE FINDINGS