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SURGICAL SCRUB in Ricardo P. Rodriquez Memorial Hospital, City of San Fernando; Angeles University Foundation Medical Center, Angeles City
Hospital, Municipality/City/Province
Prepared by:
Cayanan, Faith Muñoz
Date Performed Patient's INITIAL (only) SURGICAL PROCEDURE
PERFORMED O.R. Nurse on Duty
(Name and Signature) SUPERVISED BY
Clinical Instructor
Name and Signature
Case Number
12-10-10
91307
A.C.V. Cesarean Section Rosario Padiernos, R.N.
Hydee A. Medina, R.N., M.N.
4-12-11 3619
B.C. Partial Hip Arthroplasty
Venancio Flores, R.N.
Karen David Sembrano, R.N., M.N.
4-14-11
21800
L.C.L. Diverting Colostomy Aries Tiongson, R.N.
Karen David Sembrano, R.N., M.N.
Noted by: Carmelita E. Siroy, R.N., M.A.N.
(Print Name and Signature) Approved by: Zenaida S. Fernandez, R.N., Ph.D.
(Print Name and Signature)
Clinical Coordinator, PRC I.D. No. 0111086 Valid Until: November 06, 2012 Dean, PRC I.D. No. 0070634 Valid Until: August 07, 2012
Date document is signed: ________________ Time: __________________
Please specify Highest Nursing Degree Earned: M.A.N. Date document is signed: _______________ Time: _______
Please specify Highest Nursing Degree Earned: Ph.D.
ANGELES UNIVERSITY FOUNDATION
Mac Arthur Hiway 2009 Angeles City
Tel Nos. +63 (045) 625-2888 local 711/+63 (045) 625-2811, Telefax +63 (045) 625-2809
Website: www.auf.edu.ph Email: [email protected]
SURGICAL CIRCULATING in Angeles University Foundation Medical Center, Angeles City
Hospital, Municipality/City/Province
Hospital, Municipality/City/Province
Prepared by:
Cayanan, Faith Muñoz
Date Performed Patient's INITIAL (only) SURGICAL PROCEDURE
PERFORMED O.R. Nurse on Duty
(Name and Signature) SUPERVISED BY
Clinical Instructor
Name and Signature
Case Number
12-10-10
91307
A.C.V. Cesarean Section Rosario Padiernos, R.N.
Hydee A. Medina, R.N., M.N.
4-12-11 3619
B.C. Partial Hip Arthroplasty
Venancio Flores, R.N.
Karen David Sembrano, R.N., M.N.
4-14-11
21800
L.C.L. Diverting Colostomy Aries Tiongson, R.N.
Karen David Sembrano, R.N., M.N.
Noted by: Carmelita E. Siroy, R.N., M.A.N.
(Print Name and Signature) Approved by: Zenaida S. Fernandez, R.N., Ph.D.
(Print Name and Signature)
Clinical Coordinator, PRC I.D. No. 0111086 Valid Until: November 06, 2012 Dean, PRC I.D. No. 0070634 Valid Until: August 07, 2012
Date document is signed: ________________ Time: __________________
Please specify Highest Nursing Degree Earned: M.A.N. Date document is signed: _______________ Time: _______
Please specify Highest Nursing Degree Earned: Ph.D.
ANGELES UNIVERSITY FOUNDATION
Mac Arthur Hiway 2009 Angeles City
Tel Nos. +63 (045) 625-2888 local 711/+63 (045) 625-2811, Telefax +63 (045) 625-2809
Website: www.auf.edu.ph Email: [email protected]
SURGICAL CIRCULATING in Angeles University Foundation Medical Center, Angeles City
Hospital, Municipality/City/Province