Eirees.minor
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ATENEO DE ZAMBOANGA UNIVERSITY La Purisima Street, Zamboanga City, Philippines Tel. No.(63)(62)991-0871 to 76/Fax No. (63)(62) 0010870/E-mail: http://mail.adzu.edu.ph/Website: www.adzu.edu.ph Accreditation by: PAASCU and CHED Accredited Level III/ Year Granted: May 05, 2008-2013 SURGICAL SCRUB in ZAMBOANGA CITY MEDICAL CENTER, ZAMBOANGA CITY Hospital, Municipality/ City/ Province Prepared by: Name of Student: MENDOZA, EIREES JOY ATILANO Signature of Student__________________________ Date Performed and Time Started Patient’s Initials SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty Name and Signature SUPERVISED BY: Clinical Instructor Name and Signature Case Number December 15, 2014 5:10 pm B.B. 789148 Completion Curettage Maria Victoria T. Reyes RM, RN Angeline R. Cuizon RM, RN, MN Noted by: Approved by: JOSEPHINE JUDITH PERANO-ALFORTE, RN, MN MARIA LORNA BELLO-PABER, RN, MAN Clinical Coordinator Dean O.R. Form 1B O.R. CIRCULATING FORM
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Transcript of Eirees.minor
ATENEO DE ZAMBOANGA UNIVERSITYLa Purisima Street, Zamboanga City, Philippines
Tel. No.(63)(62)991-0871 to 76/Fax No. (63)(62) 0010870/E-mail: http://mail.adzu.edu.ph/Website: www.adzu.edu.phAccreditation by: PAASCU and CHED Accredited Level III/ Year Granted: May 05, 2008-2013
SURGICAL SCRUB in ZAMBOANGA CITY MEDICAL CENTER, ZAMBOANGA CITY Hospital, Municipality/ City/ Province
Prepared by:Name of Student: MENDOZA, EIREES JOY ATILANO Signature of Student__________________________
Date Performed and
Time Started
Patient’s Initials SURGICAL PROCEDURE PERFORMED
O.R. Nurse On DutyName and Signature
SUPERVISED BY:Clinical Instructor
Name and SignatureCase Number
December 15, 2014
5:10 pm
B.B.
789148Completion Curettage Maria Victoria T. Reyes
RM, RNAngeline R. Cuizon
RM, RN, MN
Noted by: Approved by:JOSEPHINE JUDITH PERANO-ALFORTE, RN, MN MARIA LORNA BELLO-PABER, RN, MANClinical Coordinator DeanPRC I.D. No. 0112157 Valid Until: 2016 PRC I.D. No. 0059150 Valid Until: 2016PNA I.D. No. 2014-029901 Valid Until: 2014 PNA I.D. No. 6141 Valid Until: Lifetime Member
ADPCN No. 11-056 Valid Until: 2014
Date document is signed: _______________________ Time: ______________ Date document is signed: ________________________ Time: __________ Highest Degree Earned: MASTER IN NURSING Highest Degree Earned: MASTER OF ARTS IN NURSING
O.R. Form 1BO.R. CIRCULATING FORM
Minor
