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    Sample PRC Requirements

    Uploaded by

    Rodney Beltran Subaran
    This document contains records from a student nurse's clinical rotations, including: - Three surgical procedures the student observed as a circulating nurse in the operating room of Divine Word Hospital. - Three surgical procedures the student assisted with as a scrub nurse in the same hospital. - Three newborn care procedures the student performed in the neonatal intensive care unit of Leyte Provincial Hospital. - Three deliveries the student assisted with in the maternity ward of Leyte Provincial Hospital. Each record includes details of the procedure, the supervising nurse and instructor, and their signatures.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Sample PRC Requirements

    Uploaded by

    Rodney Beltran Subaran
    134 views4 pages
    This document contains records from a student nurse's clinical rotations, including: - Three surgical procedures the student observed as a circulating nurse in the operating room of Divine Word Hospital. - Three surgical procedures the student assisted with as a scrub nurse in the same hospital. - Three newborn care procedures the student performed in the neonatal intensive care unit of Leyte Provincial Hospital. - Three deliveries the student assisted with in the maternity ward of Leyte Provincial Hospital. Each record includes details of the procedure, the supervising nurse and instructor, and their signatures.

    Original Description:

    Hospital Cases

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    © © All Rights Reserved

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    This document contains records from a student nurse's clinical rotations, including: - Three surgical procedures the student observed as a circulating nurse in the operating room of Divine Word Hospital. - Three surgical procedures the student assisted with as a scrub nurse in the same hospital. - Three newborn care procedures the student performed in the neonatal intensive care unit of Leyte Provincial Hospital. - Three deliveries the student assisted with in the maternity ward of Leyte Provincial Hospital. Each record includes details of the procedure, the supervising nurse and instructor, and their signatures.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    134 views4 pages

    Sample PRC Requirements

    Uploaded by

    Rodney Beltran Subaran
    This document contains records from a student nurse's clinical rotations, including: - Three surgical procedures the student observed as a circulating nurse in the operating room of Divine Word Hospital. - Three surgical procedures the student assisted with as a scrub nurse in the same hospital. - Three newborn care procedures the student performed in the neonatal intensive care unit of Leyte Provincial Hospital. - Three deliveries the student assisted with in the maternity ward of Leyte Provincial Hospital. Each record includes details of the procedure, the supervising nurse and instructor, and their signatures.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 4

    ST.

    SCHOLASTICAS COLLEGE TACLOBAN


    COLLEGE OF NURSING & MIDWIFERY
    Sta. Cruz Street, Tacloban City
    Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
    CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
    Hospital, Municipality / City / Province

    O.R. FORM 1A
    MAJOR SURGERY

    Prepared by:
    Printed Name with Signature of Student: SUBARAN, RODNEY B.
    Patients
    INITIALS
    Case Number

    PROCEDURE PERFORMED

    O.R. Nurse On Duty


    (Name and Signature) If Midwife on Duty,
    Signature not Required

    September 04, 2014


    11:23 AM- 12:50 PM

    M. R.
    226083

    1st Degree Low Transverse Cesearean Section


    (Pregnancy Uterine Weeks Age of Gestation Non-Reassuring Fetal
    Status, Persistent Fetal Bradycardia Delivere By 1 st Degree Low
    Transverse To A Live Baby Girl, Meconium Stain Amniotic fluid,
    Apgar Score 9, Body Weight 2.8 Kilogram, Body Lenght 49
    Centimeter)

    MS. MICHELLE ANN V. BACIERRA, RN

    July 02, 2014


    10:00 AM- 12:40PM

    T. P.
    233108

    Open Reduction And Internal Fixation Lock Plating Tibia Fibula


    Right
    (Fracture Closed Comminuted Distal Third Tibia Fibula Right)

    MR. FRANCIS JAMIL S. OCADO, RN

    July 07, 2015


    9:23 AM- 10:40 AM

    M. M.
    233188

    Laparatomy Cholecystectomy
    (Cholecystolithiasis, Liver Cirrhosis)

    MS. JENNY G. DEGORIO, RN

    Date Performed and


    Time Started

    MS. CHRISTINE MARIE N. TORRES, RN, MAN


    Over-all Clinical Coordinator
    PRC No.: 0170781
    Valid until: January 22, 2017
    PNA No.: 11704
    Valid until: Lifetime Membership

    SUPERVISED BY
    Clinical Instructor
    (Name and Signature)

    MRS.ZUSIE B.ABUDA, RN,MAN


    PRC No.:
    Valid until:
    PNA No.:
    Valid until:

    MR. RODERICK R. LABICANE, RN, MAN


    PRC No.: 0364547
    Valid until: December 3, 2016
    PNA No.:
    Valid until:

    MR. RODERICK R. LABICANE, RN, MAN


    PRC No.: 0364547
    Valid until: December 3, 2016
    PNA No.:
    Valid until:

    MRS. CAROLINA D. BARROT, RN, MAN, PhD


    DEAN OF COLLEGE OF NURSING
    PRC No.: 0133674
    Valid until: September 21, 2017
    PNA No.: ____________
    Valid until: _________________
    ADPCN:_____________
    Valid until: _________________

    I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
    pertinent laws, rules and regulations of the Republic of the Philippines.
    Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
    Doc No. ___________
    Page No. __________
    Book No. __________
    Series of 2015

    ST. SCHOLASTICAS COLLEGE TACLOBAN


    COLLEGE OF NURSING & MIDWIFERY
    Sta. Cruz Street, Tacloban City
    Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
    SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
    Hospital, Municipality / City / Province

    O.R. FORM 1A
    MAJOR SURGERY

    Prepared by:
    Printed Name with Signature of Student: SUBARAN, RODNEY B.

    Date Performed and


    Time Started

    Patients
    INITIALS
    Case Number

    February 28, 2014


    1:45 PM- 3:25 PM

    C. R.
    220079

    Abdominal Myomectomy
    (Multiple Myoma Uteri Intramural And Subserous)

    MS. FRANCIS ARIANE V. ALBESA, RN

    September 14, 2014


    2:00 PM- 3:15 PM

    P. L.
    225342

    Debridement, Repair of Scalp Avulsion Parieto Occipital Left And


    Lateral Cantus Left
    (Scalp Avulsion, Parieto Occipital Left And Lateral Cantus)

    MR. VALERIANO S. PRINCILLO III, RN

    July 04, 2014


    9:35 AM-

    D. R.
    226702

    Removal Of Implant
    (Status Post open Reduction Plating Left Clavicle)

    MR. VALERIANO S. PRINCILLO III, RN

    SURGICAL PROCEDURE PERFORMED

    MS. CHRISTINE MARIE N. TORRES, RN, MAN


    Over-all Clinical Coordinator
    PRC No.: 0170781
    Valid until: January 22, 2017
    PNA No.: 11704
    Valid until: Lifetime Membership

    O.R. Nurse On Duty


    (Name and Signature) If Midwife on Duty,
    Signature not Required

    SUPERVISED BY
    Clinical Instructor
    (Name and Signature)

    MRS.ZUSIE B.ABUDA, RN,MAN


    PRC No.:
    Valid until:
    PNA No.:
    Valid until:
    :

    MRS.ZUSIE B.ABUDA, RN,MAN


    PRC No.:
    Valid until:
    PNA No.:
    Valid until:

    MR. RODERICK R. LABICANE, RN, MAN


    PRC No.: 0364547
    Valid until: December 3, 2016
    PNA No.:
    Valid until:

    MRS. CAROLINA D. BARROT, RN, MAN, PhD


    DEAN OF COLLEGE OF NURSING
    PRC No.: 0133674
    Valid until: September 21, 2017
    PNA No.: _____________
    Valid until: _________________
    ADPCN:_______________
    Valid until: _________________

    I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
    pertinent laws, rules and regulations of the Republic of the Philippines.
    Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
    Doc No. ___________
    Page No. __________
    Book No. __________
    Series of 2015

    ST. SCHOLASTICAS COLLEGE TACLOBAN


    COLLEGE OF NURSING & MIDWIFERY
    Sta. Cruz Street, Tacloban City
    Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
    CORD CARE in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
    Hospital, Municipality / City / Province
    Prepared by:
    Printed Name with Signature of Student: SUBARAN, RODNEY B.

    Date Performed and Time


    Started

    Patients
    INITIALS
    Case Number

    August 25, 2014


    11:31 AM

    Bb. Girl M.
    008244

    Neonatal Intensive Care Unit Essential Intrapartum


    Newborn Care Anthropometrics, Vaccines

    MS. ROSALIE R. UY, RN

    October 14, 2014


    7:10 PM

    Bb. Boy E.
    002854

    Neonatal Intensive Care Unit Essential Intrapartum


    Newborn Care Anthropometrics, Vaccines

    MRS. SARAH MEL B. ABAD, RN

    October 14, 2014


    10:59 PM

    Bb. Girl B.
    009336

    Neonatal Intensive Care Unit Essential Intrapartum


    Newborn Care Anthropometrics, Vaccines

    MRS. SARAH MEL B. ABAD, RN

    PROCEDURE PERFORMED

    MS. CHRISTINE MARIE N. TORRES, RN, MAN


    Over-all Clinical Coordinator
    PRC No.: 0170781
    Valid until: January 22, 2017
    PNA No.: 11704
    Valid until: Lifetime Membership

    Nurse On Duty
    (Name and Signature) If Midwife on Duty,
    Signature not Required

    IMMEDIATE NEW BORN


    CORD CARE FORM

    SUPERVISED BY
    Clinical Instructor
    (Name and Signature)
    MRS. VIRGINIA A. EDEP, RN,MAN
    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    MRS. VIRGINIA A. EDEP, RN,MAN


    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    MRS. VIRGINIA A. EDEP, RN,MAN


    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    MRS. CAROLINA D. BARROT, RN, MAN, PhD


    DEAN OF COLLEGE OF NURSING
    PRC No.: 0133674
    Valid until: September 21, 2017
    PNA No.: ____________
    Valid until: _________________
    ADPCN.:_____________
    Valid until: _________________
    I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
    pertinent laws, rules and regulations of the Republic of the Philippines.
    Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
    Doc No. ___________
    Page No. __________
    Book No. __________
    Series of 2015

    ST. SCHOLASTICAS COLLEGE TACLOBAN


    COLLEGE OF NURSING & MIDWIFERY
    Sta. Cruz Street, Tacloban City
    Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
    ASSISSTED DELIVERY in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
    Hospital, Municipality / City / Province
    Prepared by:
    Printed Name with Signature of Student: SUBARAN, RODNEY B.

    Date Performed and Time


    Started

    Patients
    INITIALS
    (only)
    Case Number

    PROCEDURE PERFORMED

    Nurse On Duty
    (Name and Signature) If Midwife on Duty, Signature
    not Required

    SUPERVISED BY
    Clinical Instructor
    (Name and Signature)

    MRS. VIRGINIA A. EDEP, RN,MAN


    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    August 25. 2014


    8:10 AM

    C. J.
    008163

    Actual Delivery Assisted


    Gravida 9 Para 8 (9009) Pregnancy Uterine Full Term Cephalic
    Delivered Normal Spotaneous Vaginal Delivery To A Term Alive
    Bb. Boy Apgar Score of 8-9 Meconium Stain

    MS. ROSALIE R. UY, RN

    October 14, 2014


    10:30 AM

    V. L.
    009141

    Actual Delivery Assisted


    Gravida 1 Para 1 (1001) Pregnancy Uterine Full Term
    Spotaneous Vaginal Delivery Apgar Score 9 Clear Amniotic
    Fluid Body Weight 2.98 Kilograms

    MRS. ANA RETHCIE M. LUSICO-LAGADAY, RN

    October 25, 2015


    1:11 PM

    S. K.
    030170

    Actual Delivery Assisted


    Gravida 1 Para 1 (1001) Pregnancy Uterine Transverse Cephalic
    Bb. Girl Apgar Score 9 Clear Amniotic Fluid Delivered By
    Spontaneous Vaginal Delivery

    MS. MARIAN B. NADERA, RN

    MS. CHRISTINE MARIE N. TORRES, RN, MAN


    Over-all Clinical Coordinator
    PRC No.: 0170781
    Valid until: January 22, 2017
    PNA No.: 11704
    Valid until: Lifetime Membership

    ASSISSTED
    DELIVERY FORM

    MRS. VIRGINIA A. EDEP, RN,MAN


    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    MRS. VIRGINIA A. EDEP, RN,MAN


    PRC No.: 0126416
    Valid until: July 30, 2016
    PNA No.:
    Valid until:

    MRS. CAROLINA D. BARROT, RN, MAN, PhD


    DEAN OF COLLEGE OF NURSING
    PRC No.: 0133674
    Valid until: September 21, 2017
    PNA No.: ____________
    Valid until: _________________
    ADPCN:_____________
    Valid until: _________________
    I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
    pertinent laws, rules and regulations of the Republic of the Philippines.
    Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
    Doc No. ___________
    Page No. __________
    Book No. __________
    Series of 2015

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