Scribd
Upload
263 views2 pages

Nursing Student Clinical Log

This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

Uploaded by

Bon Jovie Araño Reyes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
263 views2 pages

Nursing Student Clinical Log

This document appears to be a record of clinical procedures performed by a nursing student. It contains: 1) Header information identifying the nursing school, student (Sayana Kaye-Anne F.), and form purpose. 2) A table listing 3 medical procedures performed by the student over 3 dates in July-August 2009. For each, it includes the patient name and ID, date, time, procedure performed, supervising nurse, and hospital. 3) Signatures and credentials of supervising nurses and school administrators concurring with and approving the student's performance of the procedures.

Uploaded by

Bon Jovie Araño Reyes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

LA CONSOLACION COLLEGE MANILA ODC Form 1

#8 Mendiola St., Mendiola Manila O.R. MAJOR FORM


(02) 736-02035 / (02) 313-0513 / [Link]
Government Recognition Level IV, No. 17 on January 23, 2006

Prepared By (Name of Student): SAYANA, KAYE-ANNE F. Signature of Student: ______________________

DATE TIME CASE PROCEDURE OR NURSE ON


No. NAME OF PATIENT SUPERVISED BY HOSPITAL
PERFORMED STARTED NUMBER PERFORMED DUTY

Total Abdominal Amisola Maternity Hospital


1. 07/22/09 9:45AM Ofelia Calbayar 20015141 Hysterectomy Bilateral Darlene Presa, RN _______________________ Hermosa St., Manugid
Salpingo Oophorectomy Agnes Anne B. Comendador, RN Tondo, Manila

Total Abdominal Amisola Maternity Hospital


_______________________
2. 08/10/09 7:35AM Sheryl Lazaro 20016481 Hysterectomy Bilateral Jo Erespe, RN Hermosa St., Manugid
Agnes Anne B. Comendador, RN
Salpingo Oophorectomy Tondo, Manila

Amisola Maternity Hospital


_______________________
3. 08/11/09 9:28AM Amor Garcia Exploratory Laparatomy Darlene Inasoriam, RN Hermosa St., Manugid
20017538 Agnes Anne B. Comendador, RN
Tondo, Manila

Concurred By:
Chief Nurse

Rosana R. Del fonso, RN, MATNE,


MAN,MST __________________________________ __________________________________ __________________________________
(Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name) (Signature Over Printed Name)
PRC No: 0138625 Valid Until: Nov. 2010 PRC No: _________ Valid Until: ________ PRC No: _________ Valid Until: ________ PRC No: _________ Valid Until: ________
PNA No: 21125 Valid Until:Dec. 31,2010 PNA No: _________ Valid Until: ________ PNA No: _________ Valid Until: ________ PNA No: _________ Valid Until: ________
Date signed: _________ Time: _________ Date signed: _________ Time: _________ Date signed: _________ Time: _________ Date signed: _________ Time: _________
Highest Nursing Degree Earned: Highest Nursing Degree Earned: ________ Highest Nursing Degree Earned: ________ Highest Nursing Degree Earned: ________

Noted By: Approved By:


Notes:
CoordinatorClinical

Joann P. Bumanglag RN,MAN Alejandro F. Sorita RN, MAN


(Signature Over Printed Name) (Signature Over Printed Name)
PRC No:0239004 Valid Until: July 2011 PRC No:0305011 Valid Until:Dec. 26, 2012
Dean

PNA No: 007252 Valid Until: Dec. 2010 PNA No:007255 Valid Until: Oct. 31, 2010
Date signed: _________ Time: _________ ADPCN No:0860 Valid Until: 2012
Highest Nursing Degree Earned: Master of Date signed: _________ Time: _________
Arts in Nursing Highest Nursing Degree Earned: Master of
Arts in Nursing
F-SCNU-005 Page 1 of 5
(Rev1-January 01, 2010)

You might also like