Professional Documents
Culture Documents
Caseload Caseslip For DR and OR Updated
Caseload Caseslip For DR and OR Updated
Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)
SURGERY IN____________________________________________________________________________________
Hospital/Home/Lying-in Clinic/Municipality/City/Province
O.R Form 1A
O.R SCRUB FORM
Prepared by: Major
Printed Name with Signature of Student:________________________________________________________________________
PRC I.D No. ______0769820____________ Valid Until: September 16, 2024__ PRC I.D No. 0160104_____________ Valid Until: September 09, 2025______________
Date document is signed: _______________ Time:_________________________ Date document is signed: Time: ___________________________________
Please Specify Degree Earned: RN, MSN ________________________________ Please Specify Degree Earned: RN, MAN, Ed.D _____________________________________________
UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK University Seal
COLLEGE OF NURSING
Arellano St. Dagupan City
Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)
SURGERY IN____________________________________________________________________________________
Hospital/Home/Lying-in Clinic/Municipality/City/Province
O.R Form 1B
O.R CIRCULATING FORM
Prepared by: Major
Printed Name with Signature of Student:________________________________________________________________________
Noted by: REBENSON F. SISON _____ Approved by: MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean
PRC I.D No. ______0769820____________ Valid Until: September 16, 2024__ PRC I.D No. 0160104_____________ Valid Until: September 09, 2025_____
Date document is signed: _______________ Time:_________________________ Date document is signed: Time: __________________________________
Please Specify Degree Earned: RN, MSN________________________________ Please Specify Degree Earned: RN, MAN, Ed.D ____________________________________
UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK University Seal
COLLEGE OF NURSING
Arellano St. Dagupan City
Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)
PRC I.D No. _____0769820_________ Valid Until: September 16, 2024_ PRC I.D No. 0160104_____________ Valid Until: September 09, 2025______________
Date document is signed: ________________ Time:__________________ Date document is signed: Time: ___________________________________
Please Specify Degree Earned: RN, MSN__________________________ Please Specify Degree Earned: RN, MAN, Ed.D _____________________________________________
UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK University Seal
COLLEGE OF NURSING
Arellano St. Dagupan City
Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)
PRC I.D No. 0769820___________ Valid Until: September 16, 2024 PRC I.D No. 0160104_____________ Valid Until: September 09, 2025______________
Date document is signed: ___________ Time: ______________________ Date document is signed: Time: __________________________________
Please Specify Degree Earned: RN, MSN__________________________ Please Specify Degree Earned: RN, MAN, Ed.D _____________________________________________
UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK University Seal
COLLEGE OF NURSING
Arellano St. Dagupan City
Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)
Date Performed Patient’s INITIAL only Essential Newborn Cord Care Supervised by:
And PERFORMED D.R NURSE/MIDWIFE ON CLINICAL INSTRUCTOR
Time Started Case Number Indicate where performed e.g. D.R., Nursery, DUTY (Name and Signature)
(Not Applicable for N.I.C.U., or Home
Birthing/Lying-in Clinics/Homes
PRC I.D No. 0769820 Valid Until: September 16, 2024__ PRC I.D No. 0160104_____________ Valid Until: September 09, 2025________________
Date document is signed: ____________ Time: ______________________ Date document is signed: Time: _____________________________________
Please Specify Degree Earned: RN, MSN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D ________________________________________________
FOR CASE SLIP/CASELOAD PURPOSES