LICEO DE CAGAYAN UNIVERSITY

College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in NORTHERN MINDANAO MEDICAL CENTER, CAPITOLCOMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

PROCEDURE
PERFORMED

D.R. Nurse On duty


SUPERVISED BY

Case Number

October 20, 2012
9:41 PM


R.M.V
01001461


Normal Spontaneous Vaginal Delivery

Karen Jimelle C. Bernadas RN

Remedios S. Role, RN, MAN

October 19, 2012
6:05 PM

Y.M.M
458207


Normal Spontaneous Vaginal Delivery

Karen Jimelle C. Bernadas RN

Remedios S. Role, RN, MAN

October 20, 2012
3:35 PM


C.G.E
01001453

Normal Spontaneous Vaginal Delivery

Karen Jimelle C. Bernadas RN

Remedios S. Role, RN, MAN

Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
D.R. Form
ACTUAL HANDLING DELIVERY
FORM
LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009

IMMEDIATE NEWBORN CORD CARE in NORTHERN MINDANAO MEDICAL CENTER, CAPITOLCOMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG

Date Performed
and
Time Started
Patients INITIAL Only
Immediate Newborn Cord Care
PERFORMED


D.R. Nurse On duty


SUPERVISED BY


Case Number

October 24, 2011
1:40 AM

V.M
884112

Newborn Intensive Care Unit

Nieseoul Ebajay RN

Remedios S. Role, RN, MAN

October 24, 2011
5:53 AM

A.A
883432

Newborn Intensive Care Unit

Nieseoul Ebajay RN

Remedios S. Role, RN, MAN

October 19, 2012
2:55 PM

S.J
100091
Newborn Intensive Care Unit

Nieseoul Ebajay RN

Remedios S. Role, RN, MAN

Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
ICNB Form
IMMEDIATE CARE OF THE NEWBORN FORM
LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in NORTHERN MINDANAO MEDICAL CENTER, CAPITOLCOMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

PROCEDURE
PERFORMED

D.R. Nurse On duty


SUPERVISED BY

Case Number

March 30, 2912
6:54 PM


M.J
574779


Normal Spontaneous Vaginal Delivery

Concepcion Pagara RN,MN

Remedios S. Role, RN, MAN

October 19, 2012
5:13 PM

L.C.J
01000624


Normal Spontaneous Vaginal Delivery

Karen Jimelle C. Bernadas RN

Remedios S. Role, RN, MAN

October 19, 2012
6:50 PM


A.C.S
590211

Normal Spontaneous Vaginal Delivery

Karen Jimelle C. Bernadas RN

Remedios S. Role, RN, MAN

Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
D.R. Form
ACTUAL HANDLING DELIVERY
FORM
O.R. Form 1A
O.R. SCRUB FORM
Major

LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in NORTHERN MINDANAO MEDICAL CENTER, CAPITOLCOMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On duty


SUPERVISED BY

Case Number


January 16, 2012
1:30 PM

Q.R
906117

Open Reduction Internal Fixation using
reconstructive plates (Titanium)
Interosseous wiring and interdental wiring

Fidelo Rey Mandawe RN

Emmie G. Basas, RN, MN







Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
O.R. Form 1A
O.R. SCRUB FORM
Major

LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in Cagayan de Oro Polymedic General Hospital ApolinarioSreet Velez Cagayan de Oro City, Misamis Oriental

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On duty


SUPERVISED BY

Case Number


January 17, 2012
1:03 PM

M. J.P
0508

Bilateral Cheiloplasty

April Ray Macapagal RN

Emmie G. Basas, RN, MN

January 17, 2012
8:38 AM


O. C
0302

Arteriovenous Fistula Left Radiocephalic

Escanilla Love Joy RN

Emmie G. Basas, RN, MN




Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in NORTHERN MINDANAO MEDICAL CENTER, CAPITOLCOMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On duty


SUPERVISED BY

Case Number


February 27, 2012
12:00 NN

P.L
52235

Cystoscopy Transuretral Resection of
Bladder Tumor

Lydia L. Labitad RN, MN

Emmie G. Basas, RN, MN

March 5, 2012
9:55 AM


L.S
923686

Open Reduction cross pinning distal
humerus left and application of long arm
posterior molding left


Mark Czar Anton Barba RN

Emmie G. Basas, RN, MN




Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
O.R. Form 1A
O.R. CIRCULATING FORM
Major

LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City, Philippines
858- 4093 to 95 local 115, 858- 3123, www.liceo.edu.ph
PACU COA LEVEL III AUTONOMOUS LEVEL
October 2008 November 2009
ACTUAL DELIVERY in Cagayan de Oro Polymedic General Hospital ApolinarioSreet Velez Cagayan de Oro City, Misamis Oriental

Prepared by:
Printed Name and Signature of Student: MARTINEZ, LARESSA FE CAHILOG


Date Performed
and
Time Started
Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On duty


SUPERVISED BY

Case Number


January 24, 2012
10:12 AM

B.T
0488

Close Reduction by Manipulation and
Application of Armsling

Norlene A. Kiamco RN

Emmie G. Basas RN, MN









Noted By: Approved By:
MA. DOLORES D. MERCADO, RN, MAN JUDITH T. DALMAN, RN, MAN
RLE In-charge Dean
PRC ID no.: 0173120 PRC ID no.: 0193192
Valid Until: February 27, 2015 Valid Until: October 28, 2016
Date Signed: ______________ Date Signed: _____________
O.R. Form 1A
O.R. CIRCULATING FORM
Major