Wesleyan University - Philippines

Mabini Extension, Cabanatuan City, Nueva Ecija, Philippines 3100 Tel Nos.: (044) 463-2162 / 2074 Loc. 122 Telefax: (044) 463-0596 www.wesleyan.edu.ph Accreditation: Level II, S.Y. 2007-2012

DELIVERY CASES (ACTUAL)

Prepared By: SURNAME , FIRST MIDDLE NAME (Printed Name and Signature of Student)
DATE PERFORMED AND TIME STARTED July 11, 2012 3:33 PM PATIENTS INITIALS CASE NUMBER RFL 126605 PROCEDURE PERFORMED D.R. NURSE ON DUTY Lalaine Joy V. Lumaban PJGMRMC ____signature____________ Julie P. Dela Cruz, RN, MAN Hospital SUPERVISED BY

Normal Spontaneous Delivery

Geraldine Cuaresma

October 17, 2012 6:20 AM

ELD 12100982

Normal Spontaneous Delivery

January 4 , 2012 9:45 PM

RAD 1301005

Normal Spontaneous Delivery

Noted by:

Concurred by:

Approved by:

ADAHLIA T. BASCO, RN, MAN

RLE Coordinator Wesleyan University Philippines Degree: Bachelor of Science in Nursing PRC No.: 0178398 Valid Until: July 28, 2014 PNA No.: 18000 Valid Until: Lifetime Date Signed: _____________________

PINKY MIRIAM D. CANLAS, RN, MAN

Chief Nurse Dr. PJGMRMC Degree: Bachelor of Science in Nursing PRC No.: 0075648 Valid Until: September 22, 2012 PNA No.: 0075648 Valid Until: Lifetime Date Signed: _____________________

REYNALDO M. SAMONTE, RN, Ph.D

Dean, College of Nursing Wesleyan University Philippines Degree: Doctor of Philosophy PRC No.: 0192386 Valid Until: May 16, 2014 PNA No.: 047845 Valid Until: December 2012 ADPCN No.: ________ Valid Until: _________

Date Signed: _____________________

Wesleyan University - Philippines

Mabini Extension, Cabanatuan City, Nueva Ecija, Philippines 3100 Tel Nos.: (044) 463-2162 / 2074 Loc. 122 Telefax: (044) 463-0596 www.wesleyan.edu.ph Accreditation: Level II, S.Y. 2007-2012

DELIVERY CASES (ASSIST)

Prepared By: SURNAME , FIRST MIDDLE NAME (Printed Name and Signature of Student)
DATE PERFORMED AND TIME STARTED July 4, 2012 6:00PM PATIENTS INITIALS CASE NUMBER JAB 108107 PROCEDURE PERFORMED D.R. NURSE ON DUTY SUPERVISED BY

Normal Spontaneous Delivery

G Quinto PJGMRMC ________________ Julie P. Dela Cruz, RN, MAN Hospital

____Geraldine Cuaresma,RN, MAN

October 3, 2012 1:38PM

JAV 12109925

Normal Spontaneous Delivery

_____________signature____ Juan P Dela Cruz, RN, MAN

January4, 2012 8:25AM

MRP 1301003

Normal Spontaneous Delivery

Noted by:

Concurred by:

Approved by:

ADAHLIA T. BASCO, RN, MAN

RLE Coordinator Wesleyan University Philippines Degree: Bachelor of Science in Nursing PRC No.: 0178398 Valid Until: July 28, 2014 PNA No.: 18000 Valid Until: Lifetime Date Signed: _____________________

PINKY MIRIAM D. CANLAS, RN, MAN

Chief Nurse Dr. PJGMRMC Degree: Bachelor of Science in Nursing PRC No.: 0075648 Valid Until: September 22, 2012 PNA No.: 0075648 Valid Until: Lifetime Date Signed: _____________________

REYNALDO M. SAMONTE, RN, Ph.D

Dean, College of Nursing Wesleyan University Philippines Degree: Doctor of Philosophy PRC No.: 0192386 Valid Until: May 16, 2014 PNA No.: 047845 Valid Until: December 2012 ADPCN No.: ________ Valid Until: _________

Date Signed: _____________________

Wesleyan University - Philippines

Mabini Extension, Cabanatuan City, Nueva Ecija, Philippines 3100 Tel Nos.: (044) 463-2162 / 2074 Loc. 122 Telefax: (044) 463-0596 www.wesleyan.edu.ph Accreditation: Level II, S.Y. 2007-2012

SURGICAL SCRUB CASES (MAJOR)

Prepared By: SURNAME , FIRST MIDDLE NAME (Printed Name and Signature of Student)
DATE PERFORMED AND TIME STARTED September 5, 2012 11:04AM PATIENTS INITIALS CASE NUMBER JRP 130057 MAJOR SURGICAL PROCEDURE PERFORMED Open Cholecystectomy O.R. NURSE ON DUTY ___ ____________ Ericson L. Coso, RN, MAN PJGMRMC __ ____________ Ericson L. Coso, RN, MAN PJGMRMC SUPERVISED BY ____ ____________ Jonathan M Ocampo, RN, MAN

September 6, 2012 10:30AM

JRM 136970

Open Reduction Internal Fixation Intra Medullary Nailing Femur Left

____ ____________ Mark Anthony A. Mendez, RN, MAN

November 15, 2012 2:00AM

MHL 151612

Lower Transverse Caesarean With Bilateral Tubal Ligation

__ ____________ Princess E. Domingo, RN, MAN PJGMRMC

____ ____________ Jonathan M Ocampo, RN, MAN

Noted by:

Concurred by:

Approved by:

ADAHLIA T. BASCO, RN, MAN

RLE Coordinator Wesleyan University Philippines Degree: Bachelor of Science in Nursing PRC No.: 0178398 Valid Until: July 28, 2014 PNA No.: 18000 Valid Until: Lifetime Date Signed: _____________________

PINKY MIRIAM D. CANLAS, RN, MAN

Chief Nurse Dr. PJGMRMC Degree: Bachelor of Science in Nursing PRC No.: 0075648 Valid Until: September 22, 2012 PNA No.: 0075648 Valid Until: Lifetime Date Signed: _____________________

REYNALDO M. SAMONTE, RN, Ph.D

Dean, College of Nursing Wesleyan University Philippines Degree: Doctor of Philosophy PRC No.: 0192386 Valid Until: May 16, 2014 PNA No.: 047845 Valid Until: December 2012 ADPCN No.: ________ Valid Until: _________

Date Signed: _____________________

Wesleyan University - Philippines

Mabini Extension, Cabanatuan City, Nueva Ecija, Philippines 3100 Tel Nos.: (044) 463-2162 / 2074 Loc. 122 Telefax: (044) 463-0596 www.wesleyan.edu.ph Accreditation: Level II, S.Y. 2007-2012

SURGICAL SCRUB CASES (MINOR)

Prepared By: SURNAME , FIRST MIDDLE NAME (Printed Name and Signature of Student)
DATE PERFORMED AND TIME STARTED August 29, 2012 11:15PM PATIENTS INITIALS CASE NUMBER REP 136440 MINOR SURGICAL PROCEDURE PERFORMED O.R. NURSE ON DUTY ____ ___________ Jemillo M. Alegada, RN, MAN PJGMRMC SUPERVISED BY ____ ____________ Mark Anthony A. Mendez, RN, MAN

Appendectomy

August 30, 2012 1:55PM

GSP 136638

Wound Debridement Myoraphy Left Shoulder

____ ___________ Leylani S. Pablo, RN PJGMRMC __ ____________ Princess E. Domingo, RN, MAN PJGMRMC

____ ____________ Jonathan M Ocampo, RN, MAN

September 6, 2012 12:30PM

MRF 138626

Incision And drainage With Drain

____ ____________ Jonathan M Ocampo, RN, MAN

Noted by:

Concurred by:

Approved by:

ADAHLIA T. BASCO, RN, MAN

RLE Coordinator Wesleyan University Philippines

PINKY MIRIAM D. CANLAS, RN, MAN

Chief Nurse Dr. PJGMRMC

REYNALDO M. SAMONTE, RN, Ph.D

Dean, College of Nursing Wesleyan University Philippines

Degree: Bachelor of Science in Nursing PRC No.: 0178398 Valid Until: July 28, 2014 PNA No.: 18000 Valid Until: Lifetime Date Signed: _____________________

Degree: Bachelor of Science in Nursing PRC No.: 0075648 Valid Until: September 22, 2012 PNA No.: 0075648 Valid Until: Lifetime Date Signed: _____________________

Degree: Doctor of Philosophy PRC No.: 0192386 Valid Until: May 16, 2014 PNA No.: 047845 Valid Until: December 2012 ADPCN No.: ________ Valid Until: _________

Date Signed: _____________________

Wesleyan University - Philippines

Mabini Extension, Cabanatuan City, Nueva Ecija, Philippines 3100 Tel Nos.: (044) 463-2162 / 2074 Loc. 122 Telefax: (044) 463-0596 www.wesleyan.edu.ph Accreditation: Level II, S.Y. 2007-2012

IMMEDIATE NEWBORN CORD CARE CASES

Prepared By: SURNAME , FIRST MIDDLE NAME (Printed Name and Signature of Student)
DATE PERFORMED AND TIME STARTED PATIENTS INITIALS CASE NUMBER IMMEDIATE NEWBORN CORD CARE PERFORMED IN NURSE ON DUTY SUPERVISED BY

October 4, 2012 2:17PM

Baby LID 12109930

Delivery Room

____signature____________ Julie P. Dela Cruz, RN, MAN Hospital ____signature____________ Julie P. Dela Cruz, RN, MAN Hospital ____signature____________ Julie P. Dela Cruz, RN, MAN Hospital

____signature____________ Juan P. Dela Cruz, RN, MAN

January 10, 2012 2:59PM

Baby ROR 1301017 Baby RMD 334844

Delivery Room

____signature_____________ Juan P. Dela Cruz, RN, MAN

June 28, 2012 8:30AM

Delivery Room

____signature_____________ Juan P. Dela Cruz, RN, MAN

Noted by:

Concurred by:

Approved by:

ADAHLIA T. BASCO, RN, MAN

PINKY MIRIAM D. CANLAS, RN, MAN

REYNALDO M. SAMONTE, RN, Ph.D

RLE Coordinator Wesleyan University Philippines Degree: Bachelor of Science in Nursing PRC No.: 0178398 Valid Until: July 28, 2014 PNA No.: 18000 Valid Until: Lifetime Date Signed: _____________________

Chief Nurse Dr. PJGMRMC Degree: Bachelor of Science in Nursing PRC No.: 0075648 Valid Until: September 22, 2012 PNA No.: 0075648 Valid Until: Lifetime Date Signed: _____________________

Dean, College of Nursing Wesleyan University Philippines Degree: Doctor of Philosophy PRC No.: 0192386 Valid Until: May 16, 2014 PNA No.: 047845 Valid Until: December 2012 ADPCN No.: ________ Valid Until: _________

Date Signed: _____________________