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  • Final Caseload Forms Blank

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    kimmieey
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    This document contains a student's clinical record from the University of Pangasinan College of Nursing. It includes sections for major operations and minor operations performed by the student, listing the date, time, patient initials, diagnosis, operation performed, type of anesthesia, surgeon, hospital, and signature of the clinical instructor supervising the student. The record is signed by the student, clinical instructor, clinical coordinator, dean and chief nurse, with their professional information and credentials provided.

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    This is the latest format for our caseloads which you may download..

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    This document contains a student's clinical record from the University of Pangasinan College of Nursing. It includes sections for major operations and minor operations performed by the student, listing the date, time, patient initials, diagnosis, operation performed, type of anesthesia, surgeon, hospital, and signature of the clinical instructor supervising the student. The record is signed by the student, clinical instructor, clinical coordinator, dean and chief nurse, with their professional information and credentials provided.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    567 tayangan5 halaman

    Final Caseload Forms Blank

    Diunggah oleh

    kimmieey
    This document contains a student's clinical record from the University of Pangasinan College of Nursing. It includes sections for major operations and minor operations performed by the student, listing the date, time, patient initials, diagnosis, operation performed, type of anesthesia, surgeon, hospital, and signature of the clinical instructor supervising the student. The record is signed by the student, clinical instructor, clinical coordinator, dean and chief nurse, with their professional information and credentials provided.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai DOCX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 5

    UNIVERSITY OF PANGASINAN

    COLLEGE OF NURSING
    Arellano St., Dagupan City University Seal
    Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
    (Level I PACUCOA; Year Granted: March 05, 2007)
    (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

    NAME OF STUDENT: First course (if any):


    School graduated from:
    Year:
    Year of admission in the BSN Program:
    Year graduated from BSN Program:

    I. MAJOR OPERATIONS
    TIME of
    DATE of OPERATION PATIENT’S INITIALS OPERATION TYPE of NAME of NAME of Name & Signature of
    No. DIAGNOSIS
    OPERATION STARTED- PERFORMED ANESTHESIA SURGEON HOSPITAL Qualified Clinical Instructor
    ENDED CASE NO.

    5
    LEGEND:

    Concurred by:
    Prepared by: Chief Nurse
    PRC I.D. No.: Valid Until:
    PNA No.: Valid Until:
    Date document is signed: Time:
    Student Please specify Highest Nursing Degree Earned:

    Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
    Clinical Instructor Clinical Coordinator Dean
    Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
    Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
    PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
    PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:
    UNIVERSITY OF PANGASINAN
    COLLEGE OF NURSING
    Arellano St., Dagupan City University Seal
    Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
    (Level I PACUCOA; Year Granted: March 05, 2007)
    (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

    NAME OF STUDENT: First course (if any):


    School graduated from:
    Year:
    Year of admission in the BSN Program:
    Year graduated from BSN Program:

    II. MINOR OPERATIONS


    TIME of
    DATE of OPERATION PATIENT’S INITIALS OPERATION TYPE of NAME of NAME of Name & Signature of
    No. DIAGNOSIS
    OPERATION STARTED- PERFORMED ANESTHESIA SURGEON HOSPITAL Qualified Clinical Instructor
    ENDED CASE NO.

    5
    LEGEND:

    Concurred by:
    Prepared by: Chief Nurse
    PRC I.D. No.: Valid Until:
    PNA No.: Valid Until:
    Date document is signed: Time:
    Student Please specify Highest Nursing Degree Earned:

    Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
    Clinical Instructor Clinical Coordinator Dean
    Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
    Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
    PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
    PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:
    UNIVERSITY OF PANGASINAN
    COLLEGE OF NURSING
    Arellano St., Dagupan City University Seal
    Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
    (Level I PACUCOA; Year Granted: March 05, 2007)
    (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

    NAME OF STUDENT: First course (if any):


    School graduated from:
    Year:
    Year of admission in the BSN Program:
    Year graduated from BSN Program:

    III. ACTUAL DELIVERIES


    MOTHER’S INITIALS DATE of TIME of TYPE NAME of Name & Signature of
    No. DIAGNOSIS AGE GENDER of BABY
    CASE NO. DELIVERY DELIVERY of DELIVERY HOSPITAL Qualified Clinical Instructor

    5
    LEGEND:

    Concurred by:
    Prepared by: Chief Nurse
    PRC I.D. No.: Valid Until:
    PNA No.: Valid Until:
    Student Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:

    Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
    Clinical Instructor Clinical Coordinator Dean
    Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
    Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
    PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
    PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:
    UNIVERSITY OF PANGASINAN
    COLLEGE OF NURSING
    Arellano St., Dagupan City University Seal
    Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
    (Level I PACUCOA; Year Granted: March 05, 2007)
    (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

    NAME OF STUDENT: First course (if any):


    School graduated from:
    Year:
    Year of admission in the BSN Program:
    Year graduated from BSN Program:

    IV. ASSISTED DELIVERIES


    MOTHER’S INITIALS DATE of TIME of TYPE NAME of Name & Signature of
    No. DIAGNOSIS AGE GENDER of BABY
    CASE NO. DELIVERY DELIVERY of DELIVERY HOSPITAL Qualified Clinical Instructor

    5
    LEGEND:

    Concurred by:
    Prepared by: Chief Nurse
    PRC I.D. No.: Valid Until:
    PNA No.: Valid Until:
    Date document is signed: Time:
    Student Please specify Highest Nursing Degree Earned:

    Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
    Clinical Instructor Clinical Coordinator Dean
    Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
    Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
    PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
    PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:
    UNIVERSITY OF PANGASINAN
    COLLEGE OF NURSING
    Arellano St., Dagupan City University Seal
    Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
    (Level I PACUCOA; Year Granted: March 05, 2007)
    (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

    NAME OF STUDENT: First course (if any):


    School graduated from:
    Year:
    Year of admission in the BSN Program:
    Year graduated from BSN Program:

    V. IMMEDIATE NEWBORN CORD CARE


    TIME OF BABY’S INITIALS Name & Signature of
    No. DATE PERFORMED GENDER of BABY MOTHER’S INITIALS AGE NAME of HOSPITAL
    DELIVERY CASE NO. Qualified Clinical Instructor

    5
    LEGEND:

    Concurred by:
    Prepared by: Chief Nurse
    PRC I.D. No.: Valid Until:
    PNA No.: Valid Until:
    Student Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:

    Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
    Clinical Instructor Clinical Coordinator Dean
    Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
    Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
    PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
    PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
    Please specify Highest Nursing Degree Earned:

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