GOLDEN GATE COLLEGES

P. Prieto St., Batangas City

Tel Nos. 723-2663/723-2471/723-7712/300-7642/Fax # (043) 723-2077/ggc_batangas_city@yahoo.com, www.goldengatecolleges.com

SURGICAL SCRUB in GOLDEN GATE GENERAL HOSPITAL

Hospital/Home/Lying-in Clinic, Municipality/City /Province

Prepared by:

Printed Name and Signature of Student: ROMAR RICO H. ARCEGA

Date Performed Patient’s INITIAL Only

and SURGICAL PROCEDURE O.R Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
Name and Signature
May 23, 2022 E.A.C. Extracapsular Cataract Extraction with
11:15 AM 0374 Intraoccular Lens in Left Eye Evelyn C. Cruzat ,RN Lyka D. Chavez, RN. MAN
May 24, 2022 J.M.B.S.
12:40 PM 0382 Thoracostomy with Drainage Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
May 26, 2022 S.M.M.
01:05 PM 0397 Open Cholecystectomy Evelyn Cruzat ,RN Lyka D. Chavez, RN. MAN

SEMIRA ANN A. PANGANIBAN ,RN.MAN, PhD MARY JANE B. EBORA ,RN.MAN ALLAN O. DIMAANO ,RN.RM,MAN, PhD
Clinical Coordinator Chief Nurse Clinical Coordinator
Degree: BSPT, BSN MAN Degree: BSN MAN Degree: BSN, MAN, Ed.D
PRC No.: 0375643 PRC No.: 0370859 PRC No.: 0371413
Valid Until: November 07, 2024 Valid Until: September 19, 2024 Valid Until: February 03, 2024
PNA No.: M-37693 PNA No.: M-38546 PNA No.: M-37679
 Tel Nos. 723-2663/723-2471/723-7712/300-7642/Fax # (043) 723-2077/ggc_batangas_city@yahoo.com, www.goldengatecolleges.com

SURGICAL SCRUB in GOLDEN GATE GENERAL HOSPITAL

Hospital/Home/Lying-in Clinic, Municipality/City /Province

Prepared by:

Printed Name and Signature of Student: ROMAR RICO H. ARCEGA

Date Performed Patient’s INITIAL Only

and SURGICAL PROCEDURE O.R Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
Name and Signature
May 23, 2022 Z.B.C.
08:01 AM 0378 Appendectomy Evelyn C. Cruzat ,RN Lyka D. Chavez, RN. MAN
June 02, 2022 A.R.
10:05 AM 0449 Debridement, Burns Emilyn G. Milan ,RN Lyka D. Chavez, RN. MAN
June 03, 2022 R.D.L.
01:15 PM 0453 Excision, Breast mass Left Evelyn C. Cruzat ,RN Lyka D. Chavez, RN. MAN
 Tel Nos. 723-2663/723-2471/723-7712/300-7642/Fax # (043) 723-2077/ggc_batangas_city@yahoo.com, www.goldengatecolleges.com

IMMEDIATE NEWBORN CORD CARE in GOLDEN GATE GENERAL HOSPITAL

Hospital/Home/Lying-in Clinic, Municipality/City /Province

Prepared by:

Printed Name and Signature of Student: ROMAR RICO H. ARCEGA

Date Performed Patient’s INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number Indicate where performed e.g. (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying-in D.R., Nursery, NICU or Home Signature Not Required)
Clinics/Homes)
December 04, 2019 B.D.C.
07:06 AM 2019-936 Cord Dressing Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
December 04, 2019 R.G.
10:15 AM 2019-937 Cord Dressing Evelyn C. Cruzat ,RN Lyka D. Chavez, RN. MAN
December 04, 2019 A.T.
01:45 PM 2019-938 Cord Dressing Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
 ACTUAL DELIVERY in GOLDEN GATE GENERAL HOSPITAL
Hospital/Home/Lying-in Clinic, Municipality/City /Province

Prepared by:

Printed Name and Signature of Student : ROMAR RICO H. ARCEGA

Date Performed Patient’s INITIAL Only D. R. Nurse on Duty SUPERVISED BY

and (Name and Signature) Clinical Instructor
Time Started Case Number PROCEDURE PERFORMED (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying-in Signature Not Required)
Clinics/Homes)
December 05, 2019 G.S.A.
06:31 AM 939 Normal Spontaneous Delivery Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
December 06, 2019 J.M.J.
09:58 AM 941 Normal Spontaneous Delivery Evelyn C. Cruzat ,RN Lyka D. Chavez, RN. MAN.
December 09, 2019 K.C.R.
01:30 PM 947 Normal Spontaneous Delivery Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
 SURGICAL SCRUB in GOLDEN GATE GENERAL HOSPITAL
Hospital/Home/Lying-in Clinic, Municipality/City /Province

Prepared by:

Printed Name and Signature of Student: ROMAR RICO H. ARCEGA

Date Performed Patient’s INITIAL Only

and SURGICAL PROCEDURE O.R Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
Name and Signature
May 30, 2022 P.C.P.
08:15 AM 0436 Colonoscopy Evelyn Cruzat ,RN Lyka D. Chavez, RN. MAN
May 30, 2022 I.C.
09:10 AM 0440 Excision, Breast mass Right Analisa V. Bagon ,RN Lyka D. Chavez, RN. MAN
May 31, 2022 R.C.M.
10:05 AM 0445 Excision Evelyn Cruzat ,RN Lyka D. Chavez, RN. MAN