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    ODC Form: Valdez, Sheena Love P. - Signature of Student

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    Sheena Love Valdez
    The document appears to be a record of surgical procedures and immediate newborn care performed by a nursing student at Urdaneta District Hospital. It lists 5 procedures performed between August 1-9, 2010 including an emergency C-section, wound exploration, and episiorrhapy/perineorrhapy. It also documents immediate newborn cord care performed on 5 babies between August 1-9, 2010 in the delivery room. The document is signed by the student, supervising nurses, clinical coordinator, chief nurse, and dean to verify the records.

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    ODC Form: Valdez, Sheena Love P. - Signature of Student

    Uploaded by

    Sheena Love Valdez
    45 views6 pages
    The document appears to be a record of surgical procedures and immediate newborn care performed by a nursing student at Urdaneta District Hospital. It lists 5 procedures performed between August 1-9, 2010 including an emergency C-section, wound exploration, and episiorrhapy/perineorrhapy. It also documents immediate newborn cord care performed on 5 babies between August 1-9, 2010 in the delivery room. The document is signed by the student, supervising nurses, clinical coordinator, chief nurse, and dean to verify the records.

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    The document appears to be a record of surgical procedures and immediate newborn care performed by a nursing student at Urdaneta District Hospital. It lists 5 procedures performed between August 1-9, 2010 including an emergency C-section, wound exploration, and episiorrhapy/perineorrhapy. It also documents immediate newborn cord care performed on 5 babies between August 1-9, 2010 in the delivery room. The document is signed by the student, supervising nurses, clinical coordinator, chief nurse, and dean to verify the records.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    45 views6 pages

    ODC Form: Valdez, Sheena Love P. - Signature of Student

    Uploaded by

    Sheena Love Valdez
    The document appears to be a record of surgical procedures and immediate newborn care performed by a nursing student at Urdaneta District Hospital. It lists 5 procedures performed between August 1-9, 2010 including an emergency C-section, wound exploration, and episiorrhapy/perineorrhapy. It also documents immediate newborn cord care performed on 5 babies between August 1-9, 2010 in the delivery room. The document is signed by the student, supervising nurses, clinical coordinator, chief nurse, and dean to verify the records.

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    LYCEUM NORTHERN LUZON

    Mc McArthur Highway, Urdaneta City, Pangasinan ODC Form


    Tel No. (075) 568-7963 and 66 O.R SCRUB FORM (MINOR)
    SURGICAL SCRUB in Urdaneta District Hospital Urdaneta City, Pangasinan
    Hospital/Home/Lying-In Clinic, Municipality/City/Province
    Prepared by:
    Name of Student:__ Valdez, Sheena Love P. ______ Signature of Student:

    Date Performed Patient’s Name SUPERVISED BY


    and PROCEDURE PERFORMED Clinical instructor
    Time Started Case Number O.R Nurse On Duty Name and Signature

    August 8, 2010 Jeramy Ibatan


    Episiorrhapy Ms. Laila Dumalao RN Marc Darwin L. Ragojos RN, RM, MAN
    10:25 PM 8176
    August 9, 2010 Jenalyn Ignasio
    Perineorrhapy Mrs. Ma. Theresa Dy RN Marc Darwin L. Ragojos RN, RM, MAN
    11:05 PM 8217
    August 3, 2010 Alejandro Barbado
    Marc Darwin L. Ragojos RN, RM, MAN
    1:05 AM 7924 Incision and Drainage Mrs. Joanne Estanilla RN

    Noted by: MRS. BELINDA M. ANGELES BSN- RN, MAN Concurred by: Mrs. Mary Eleanor B. Mayo, BSN, RN, MAN
    Clinical Coordinator, PRC I.D No. 00125308 Valid Until Sept. 14, 2011 Chief Nurse, PRC I.D No. 0154083 Valid Until March 04, 2011
    PNA No. 0013221 Valid Until Lifetime Member PNA No. 17011 Valid Until Lifetime Member
    Date document is signed: Time Date document is signed Time
    Highest Nursing Degree Earned: BSN, RN, MAN Highest Nursing Degree Earned BSN, RN, MAN

    Approved by: MRS. MYRA P. LOCQUIAO RM, RN, MAN


    Dean, PRC I.D No. 0346601 Valid Until NOVEMBER 25, 2011 PNA No. 18301 Valid Until Lifetime Member
    ADPCN No. 16558 Valid Until NOVEMBER 25, 2011 Date document signed: Time
    Highest Nursing Degree Earned: RM, RN, MAN
    LYCEUM NORTHERN LUZON
    MacArthur Highway, Urdaneta City, Pangasinan ODC Form
    Tel No. (075) 568-7963 and 66 O.R. SCRUB FORM (MAJOR)
    SURGICAL SCRUB in Urdaneta District Hospital Urdaneta City, Pangasinan
    Hospital/Home/Lying-In Clinic, Municipality/City/Province

    Prepared by:
    Name of Student: Valdez, Sheena Love P. Signature of Student:

    Date Performed Patient’s Name SUPERVISED BY


    and PROCEDURE PERFORMED O.R Nurse On Duty Clinical instructor
    Time Started Case Number Name and Signature
    August 1, 2010 Gidette Garcia Emergency Lower Segment Cesarean
    Mrs. Beatriz Mercado RN Marc Darwin L. Ragojos RN, RM, MAN
    12:18 AM 7941 Section
    August 30, 2010 Lito Acosta Emergency Wound Exploration of Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM, MAN
    11:42 PM 8908 Bleeders

    Noted by: MRS. BELINDA M. ANGELES BSN- RN, MAN Concurred by: Mrs. Mary Eleanor B. Mayo, BSN, RN, MAN
    Clinical Coordinator, PRC I.D No. 00125308 Valid Until Sept. 14, 2011 Chief Nurse, PRC I.D No. 0154083 Valid Until March 04, 2011
    PNA No. 0013221 Valid Until Lifetime Member PNA No. 17011 Valid Until Lifetime Member
    Date document is signed: Time Date document is signed Time
    Highest Nursing Degree Earned: BSN-RN, MAN Highest Nursing Degree Earned BSN,RN, MAN

    Approved by: MRS. MYRA P. LOQUIAO


    Dean, PRC I.D No. 0346601 Valid Until NOVEMBER 25, 2011 PNA No. 18301 Valid Until: Lifetime Member
    ADPCN No. 16558 Valid Until NOVEMBER 25, 2011 Date document signed: Time
    Highest Nursing Degree Earned: RM, RN, MAN
    LYCEUM NORTHERN LUZON ODC Form
    MacArthur Highway, Urdaneta City, Pangasinan D.R. IMMEDIATE NEWBORN
    Tel No. (075) 568-7963 and 66 CORD CARE FORM
    IMMEDIATE NEWBORN CORD CARE in Urdaneta District Hospital Urdaneta City, Pangasinan
    Hospital/Home/Lying-In Clinic, Municipality/City/Province

    Prepared by:
    Name of Student: Valdez, Sheena Love P. Signature of Student:

    Date Performed Patient’s Name SUPERVISED BY


    and
    Immediate Newborn Cord Care Clinical instructor
    ________________________________________________________________
    O.R Nurse On Duty
    Time Started Case Number PERFORMED Name and Signature
    August 9, 2010 Baby Girl Agdan
    Delivery Room Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM,MAN
    10:21 PM 8143
    August 3, 2010 Baby Girl Nepalis
    Delivery Room Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM,MAN
    2:17 AM 8016
    0000

    August 1, 2010 Baby Girl Tira


    Delivery Room Mrs. Beatriz Mercado RN Marc Darwin L. Ragojos RN, RM,MAN
    2:45 AM 7946
    August 9, 2010 Baby Boy Saripada
    Delivery Room Ms. Laila Dumlao RN Marc Darwin L. Ragojos RN, RM,MAN
    4:34 AM 8180
    August 9, 2010 Baby Girl Lorenzo
    Delivery Room Ms. Laila Dumlao RN Marc Darwin L. Ragojos RN, RM,MAN
    7:05 AM 8184

    Noted by: MRS. BELINDA M. ANGELES BSN- RN, MAN Concurred by: Mrs. Mary Eleanor B. Mayo, BSN,. RN, MAN
    Clinical Coordinator, PRC I.D No. 00125308 Valid Until Sept. 14, 2011 Chief Nurse, PRC I.D No. 0154083 Valid Until March 04, 2011
    PNA No. 0013221 Valid Until Lifetime Member PNA No. 17011 Valid Until Lifetime Member
    Date document is signed: Time Date document is signed Time
    Highest Nursing Degree Earned: BSN-RN, MAN Highest Nursing Degree Earned BSN, RN, MAN

    Approved by: MRS. MYRA P. LOQUIAO RM, RN, MAN


    Dean, PRC I.D No. 0346601 Valid Until NOVEMBER 25, 2011 PNA No. 18301 Valid Until Lifetime Member
    ADPCN No. 16558 Valid Until NOVEMBER 25, 2011 Date document signed: Time
    Highest Nursing Degree Earned: RM, RN, MAN
    LYCEUM NORTHERN LUZON ODC Form
    MacArthur Highway, Urdaneta City, Pangasinan D.R. ASSIST FORM
    Tel No. (075) 568-7963 and 66
    ASSISTED DELIVERY in Urdaneta District Hospital Urdaneta City, Pangasinan
    Hospital/Home/Lying-In Clinic, Municipality/City/Province

    Prepared by:
    Name of Student Valdez, Sheena Love P. Signature of Student: ___

    Date Performed Patient’s Name SUPERVISED BY


    and PROCEDURE PERFORMED O.R Nurse On Duty Clinical instructor
    Time Started Case Number Name and Signature
    August 11, 2010 Amylyn de Guzman
    Normal Spontaneous Delivery Marc Darwin L. Ragojos RN, RM,MAN
    4:14 AM 8252 Ms. Laila Dumlao RN
    August 10, 2010 Mylen Patacsil
    Normal Spontaneous Delivery
    11:25 PM 8241 Ms. Laila Dumlao RN Marc Darwin L. Ragojos RN, RM,MAN
    August 10, 2010 Rosalyn Ortiz Normal Spontaneous Delivery
    6:35 AM 8217 Ms. Laila Dumlao RN Marc Darwin L. Ragojos RN, RM,MAN
    August 10, 2010 Jennylyn Lagua Normal Spontaneous Delivery Marc Darwin L. Ragojos RN, RM,MAN
    4:15 PM 8218 Ms. Laila Dumlao RN
    August 16, 2010 Joanne Chung Normal Spontaneous Delivery Marc Darwin L. Ragojos RN, RM,MAN
    1:20 AM 8388 Ms. Laila Dumlao RN

    Noted by: MRS. BELINDA M. ANGELES BSN- RN, MAN Concurred by: MRS. MARY ELEANOR B. MAYO, BSN,. RN, MAN
    Clinical Coordinator, PRC I.D No. 00125308 Valid Until Sept. 14, 2011 Chief Nurse, PRC I.D No. 0154083 Valid Until March 04, 2011
    PNA No. 0013221 Valid Until Lifetime Member PNA No. 17011 Valid Until Lifetime Member
    Date document is signed: Time Date document is signed Time
    Highest Nursing Degree Earned: BSN-RN, MAN Highest Nursing Degree Earned BSN,RN, MAN

    Approved by: MRS. MYRA P. LOQUIAO


    Dean, PRC I.D No. 0346601 Valid Until NOVEMBER 25, 2011 PNA No. 18301 Valid Until Lifetime Member
    ADPCN No. 16558 Valid Until NOVEMBER 25, 2011 Date document signed: Time
    Highest Nursing Degree Earned: RM, RN, MAN
    LYCEUM NORTHERN LUZON ODC Form
    MacArthur Highway, Urdaneta City, Pangasinan D.R. ACTUAL FORM
    Tel No. (075) 568-7963 and 66
    ACTUAL DELIVERY in Urdaneta District Hospital Urdaneta City, Pangasinan
    Hospital/Home/Lying-In Clinic, Municipality/City/Province

    Prepared by:
    Name of Student: Valdez, Sheena Love P. Signature of Student:

    Date Performed Patient’s Name SUPERVISED BY


    and PROCEDURE PERFORMED O.R Nurse On Duty Clinical instructor
    Time Started Case Number Name and Signature
    August 24, 2010 Teresa Codilla G2P1 Normal Spontaneous Delivery Mrs. Beatriz Mercado RN Marc Darwin L. Ragojos RN, RM
    4:13 AM 8632
    August 18, 2010 Elizabeth de Leon G2P1 Normal Spontaneous Delivery Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM
    1:17 AM 8458
    August 18, 2010 Elsa Trinidad
    G2P1 Normal Spontaneous Delivery Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM
    2:34 AM 8465
    August 25, 2010 Virna Metillo
    G1P0 Normal Spontaneous Delivery Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM
    12:48 AM 8654

    August 18, 2010 Regina Valenzuela


    G1P0 Normal Spontaneous Delivery Mrs. Joanne Estanilla RN Marc Darwin L. Ragojos RN, RM
    7:14 AM 8414

    Noted by: MRS. BELINDA M. ANGELES BSN- RN, MAN Concurred by: MRS. MARY ELEANOR B. MAYO, BSN,. RN, MAN
    Clinical Coordinator, PRC I.D No. 00125308 Valid Until Sept. 14, 2011 Chief Nurse, PRC I.D No. 0256791 Valid Until December 03, 2010
    PNA No. 0013221 Valid Until Lifetime Member PNA No. 04794 Valid Until Lifetime Member
    Date document is signed: Time Date document is signed
    Highest Nursing Degree Earned: RN, MAN Highest Nursing Degree Earned BSN, RN, MAN

    Approved by: MRS. MYRA P, LOQUIAO RM, RN, MAN


    Dean, PRC I.D No. 0346601 Valid Until NOVEMBER 25, 2011 PNA No. 18301 Valid Until Lifetime Member
    ADPCN No. 16558 Valid Until NOVEMBER 25, 2011 Date document signed: Time
    Highest Nursing Degree Earned: RM, RN, MAN
    LYCEUM NORTHERN LUZON
    McArthur Highway, Urdaneta City, Pangasinan
    Tel No. (075) 568-7963 and 66

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