PILAR COLLEGE

P.O BOX 283 Zamboanga City 7000 PHILIPPINES SURGICAL SCUB in Cuidad Medical Zamboanga, Zamboanga City, Philippines Prepared by: Name & Signature of Student Aprillyn B. Hadjail Date Performed and Time Started Patient¶s Name Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)

ODC Form 2B O.R. CIRCULATING Form

Supervised By Clinical Instructor Name and Signature

August 14, 2010 8:55 pm

Nalzaro, Ellen 43231

Total Abdominal Hysterectomy with Bilateral Salphingo- Oophorectomy

Edelyn Sison Uy, RN

Jofrey A. Wong, RN, MN

Noted by: JOFREY A. WONG, RN, MN Valid until: May 09, 2012 Clinical Coordinator, PRC I.D. No. 0352086 Date document signed ________________________Time ________________ Highest Nursing Degree Earned: Master of Nursing

Approved by: JOCELYN C. LOQUIAS, RN, MAN Dean, PRC I.D. No. 0080831 Valid until: December 19, 2012 Date document signed ________________Time____________________ Highest Nursing Degree Earned: Master of Arts in Nursing