San Pablo Colleges Medical Center, San Pablo City, LAGUNA May 23-25, 2009
Name of Patient
Kinds of fusions
Type of Cannula
License No:
1. 2. 3. Pedia case
12y/o
II.
Patient No:
License No:
AN: 07-7116 AN: 07-7116 AN: 07-7116
1. 2. 3.
Name of Patient
Age y/o
Date 3-06-10
Time 8:00am
IV Insertion
1.
Submitted by
LMetacarpal Vein
Diagnosis UGIB
License No:
AN: 07-7116
Date Submitted:
Received by:
Approved by:
PROF. CLEOFE A. CABRERA Director, Nursing Service (Signature over printed Name)
3+3+1 ACCOMPLISHED REQUIREMENT of DAYS BASIC IV THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Name of Hospital Offering IV Training: Date of I V Training Program Attended:
San Pablo Colleges Medical Center, San Pablo City, LAGUNA February 21 23, 2013
Name of Patient
Age
Date
Time
Kinds of Infusions
Site
Type of Cannula
Dose
Rate
License No:
AN: 003993 AN: 003993 AN: 003993
1. 2. 3.
II.
Patient No:
Diagnosis
License No:
AN: 077116 AN: 077116 AN: 077116
1. 2. 3.
III. Administering & Maintaining Blood and Blood Components
Patient No:
Name of Patient
Age
Date
Time
IV Insertion
Type of Cannula
Diagnosis
License No:
AN: 077116
1.
Submitted by
(Signature over printed Name)
Date Submitted:
Received by:
Approved by:
PROF. CLEOFE A. CABRERA Director, Nursing Service (Signature over printed Name)
PRECEPTORS ANSAP NUMBER: 1. 2. BERNARDO ALIMAGNO JR. ROWENA P. BATI AN: 077116 AN: 003993