XAVIER UNIVERSITY – DR. JOSE P.

RIZAL SCHOOL OF MEDICINE

DEPARTMENT OF OB-GYN REQUIREMENTS
SY 2022-2023
Date of Rotation: _____________________________________
MAJOR GYNECOLOGIC OPERATIONS (ASSIST)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

2.

3.

CESAREAN SECTIONS (ASSIST)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

3.

4.

5.

NORMAL SPONTANEOUS DELIVERY OF EPISIOTOMY (HANDLE)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

3.

4.

5.
 6.

7.

8.

9.

10.

LEOPOLD’S MANEUVER (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

3.

4.

5.

SPECULUM EXAM (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

3.

4.

5.

PAP’S SMEAR (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature
 1.

2.

3.

4.

5.

BIMANUAL PELVIC EXAM (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

3.

4.

5.

OPEN GLOVING (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

PROPER GOWNING & DONNING GLOVES CLOSED TECHNIQUE (PERFORM)

No. Name of Patient Date Hospital Case No. Age Parity Resident on Duty Signature

1.

2.

Clinical Preceptors:
____________________________________________ ____________________________________________
DR. CORAZON B. MATA DR. MARY ANN E. RATAG
NMMC MRXUH
 Date Signed: _________________________ Date Signed: ___________________________

DEPARTMENT OF PEDIA REQUIREMENTS

SY 2022-2023
Date of Rotation: ______________________________________________________

PERFORM COMPLETE HISTORY AND PHYSICAL EXAM

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

ATTEND NEONATAL DELIVERY AND CARE

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

VENIPUNCTURE
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

ARTERIAL BLOOD GAS ANALYSIS

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

VACCINATION
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

URETHRAL CATHETERIZATION
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

PPD TESTING AND INTERPRETATION

Date Name of Patient Age/Sex Hospital No. DIAGNOSIS INTERPRETATION REMARKS Name and Signature of Resident

CBG MONITORING
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

PEFR
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

NGT/OGT INSERTION
Date Name of Patient Age Hospital No. DIAGNOSIS REMARKS Name and Signature of
 Resident

GASTRIC LAVAGE
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

COLLECTION OF BLOOD SPECIMEN

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

INJECTION
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

URINE COLLECTION
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

RUMPLE-LEEDE (TOURNIQUET) TEST

Name and Signature of

Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

ANTHROPOMETRIC MEASURES (Length, Height, HG, OC, AC)

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

BALLARD’S SCORING

Name and Signature of

Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

BP MEASUREMENT
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

PROPER POSITIONING AND RESTRAINT FOR SPECIFIC PROCEDURE

Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

NEBULIZATION
Name and Signature of
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS
Resident

APGAR SCORING
Date Name of Patient Age/Sex Hospital No. DIAGNOSIS REMARKS Name and Signature of
 Resident

Clinical Preceptors:
____________________________________________ ____________________________________________
DR. JANNIE LYNE N. PALISBO DR. FELIX BERNARD R. CEPEDA
NMMC MRXUH
Date Signed: _________________________ Date Signed: ___________________________