BENGUET STATE UNIVERSITY MINOR College of Nursing La Trinidad, Benguet, 2601 Philippines Phone number: 309-3882; Fax number: 422-2281; E-mail:ents3@yahoo.com; Web site:www.bsu.edu.ph LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- November 3, 2011
SURGICAL SCRUB in BENGUET GENERAL HOSPITAL
Name of Student: Signature of student:
Date Performed Patient Name and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY: Case Number Time Started
Noted by: LAWRENCE C. CARANTO,RN Concurred by: VIRGINIA B. SAGUIDIC, RN
Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 003986 Valid until: January 15,2012 PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 02806 Valid until: Lifetime Date signed: Time signed : ANSAP No.: 01376 Valid until: December 31,2010 Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed: Highest Nursing degree earned: Master of arts in Nursing (MAN) OCD FORM 2B O.R. Scrub Form BENGUET STATE UNIVERSITY MINOR Approved by: VICENTE G.PANAGAN JR.,RN College of Nursing Dean, PRC I.D. No. 296633 Valid Until: April 11,2011 La Trinidad, Benguet, 2601 Philippines PNA No.: 063313 Valid Until:December 31,2010 Phone number: 309-3882; Fax number: 422-2281; E- mail:ents3@yahoo.com; Web site:www.bsu.edu.ph LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- ADPCN NO.: 0838 Valid Until: December 31,2010 November 3, 2011 Date signed: Time signed: SURGICAL SCRUB in BAGUIO GENERAL HOSPITAL AND MEDICAL Specify Highest Nursing Degree Earned: CENTER, Baguio City Name of Student: Signature of student:
Date Performed Patient Name
and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY: Case Number Time Started
Noted by: LAWRENCE C. CARANTO,RN Concurred by: ELENA B. TAMPICAN,RN
Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 004369 Valid until: January 27,2011 PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 04718 Valid until: Lifetime Date signed: Time signed : ANSAP No.: 01036 Valid until: December 31,2010 Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed: Highest Nursing degree earned: Master of arts in Nursing (MAN)
Approved by: VICENTE G.PANAGAN JR.,RN
Dean, PRC I.D. No. 296633 Valid Until: April 11,2011 PNA No.: 063313 Valid Until:December 31,2010 ADPCN NO.: 0838 Valid Until: December 31,2010 Date signed: Time signed: Specify Highest Nursing Degree Earned: