PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St.

, Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph SURGICAL SCRUB in UNIVERSITY OF THE PHILIPPINES PHILIPPINE GENERAL HOSPITAL, MANILA Hospital, Municipality/City/ Province

ODC Form 2A O.R. SCRUB FORM MAJOR

Prepared by: Printed Name with Signature of Student Date Performed and Time Started February 4, 2013 3:00 PM February 4, 2013 7:00PM February 5, 2013 9:00 AM June 3, 2013 11:00 AM June 26, 2013 10:00 AM TAN, CHRISTIAN SAN JOSE SUPERVISED BY Clinical Instructor (Name and Signature)

Patient's INITIALS (only) Case Number TL 3893574 KAP 2964985

SURGICAL PROCEDURE PERFORMED

O.R Nurse On Duty (Name and Signature)

Cranio Excision of Trauma

Mark Bryan Carolino, R.N. Michael Vincent V. Mercado, RN

Bilateral Tonsillectomy

Maria Josefa Alfiler, R.N. Michael Vincent V. Mercado, RN

Tracheostomy Direct Laryngoscopy and Biopsy 3893605 Modified Radical Mastectomy Right

Mary Grace Santos, R.N. Michael Vincent V. Mercado, RN Aiza Lyra Magsino, R.N. Michael Vincent V. Mercado, RN

3870398

3784384

Tymphanomastoidectomy Arnedo, Romler, R.N.

Michael Vincent V. Mercado, RN

Noted by:
(Print Name and Signature)

JENNIFER P. REYES Valid Until June 12, 2015 Time Master of Arts in Nursing

Approved by:
(Print Name and Signature)

DR. GILMORE G. SOLIDUM Valid Until July 27, 2014 Time Master of Arts in Nursing

Clinical Coordinator, PRC I.D. No. 0301312 Date document is signed: Please specify Highest Nursing Degree Earned:

Dean, PRC I.D. No. 0172020 Date document is signed: Please specify Highest Nursing Degree Earned:

PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St., Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph SURGICAL SCRUB in UNIVERSITY OF THE PHILIPPINES PHILIPPINE GENERAL HOSPITAL, MANILA Hospital, Municipality/City/ Province

ODC Form 2B 2A O.R. SCRUB FORM MINOR FORM MAJOR

Prepared by: Printed Name with Signature of Student TAN, CHRISTIAN SAN JOSE

Date Performed and Time Started

Patient's INITIALS (only) Case Number

SURGICAL PROCEDURE PERFORMED

O.R. Nurse On Duty (Name and Signature)

SUPERVISED BY Clinical Instructor (Name and Signature)

June 03, 2013 6:00 AM

YC 3924620

Open Cholecystectomy

Joena De Castro, R.N.

Michael Vincent V. Mercado, RN

July 27, 2013 4:55 PM

RL 3815950

Cystoscopy; biopsy of bladder mass

Gershandee Jesse B. Pataueg RN

Michael Vincent V. Mercado, RN

July 27, 2013 10:00 PM

LR 3930473

Michael Vincent V. Mercado, RN Excision of Cyst, Bilateral Tonsilectomy Reginald Jbeili, RN

Noted by:
(Print Name and Signature)

JENNIFER P. REYES Valid Until June 12, 2015 Time Master of Arts in Nursing

Approved by:
(Print Name and Signature)

DR. GILMORE G. SOLIDUM Valid Until July 27, 2014 Time Master of Arts in Nursing

Clinical Coordinator, PRC I.D. No. 0301312 Date document is signed: Please specify Highest Nursing Degree Earned:

Dean, PRC I.D. No. 0172020 Date document is signed: Please specify Highest Nursing Degree Earned:

PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St., Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph ACTUAL DELIVERY in GAT ANDRES BONIFACIO MEMORIAL MEDICAL CENTER, MANILA Hospital, Municipality/City/ Province

ODC Form 1A ACTUAL DELIVERY FORM

Prepared by: Printed Name with Signature of Student PULANCO, KEN BAUTISTA

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) JAR 81761 PROCEDURE PERFORMED ACTUAL DELIVERY

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

June 30, 2013 1:37 AM

Gravity 1 Parity 0 Pregnancy Uterine 38 4/7 weeks Age of gestationNormal Spontaneous Vaginal Delivery Gravida 2 Parity 1 Pregnancy Uterine 40 weeks Age of gestationNormal Spontaneous Vaginal Delivery Gravida 2 Parity 1 Pregnancy Uterine 39 2/7 weeks Age of gestation Normal Spontaneous Vaginal Delivery Gravida 3, parity 2 Pregnancy Uterine 39 weeks Age of gestation Normal Spontaneous Vaginal Delivery Gravida 1, parity 0 Pregnancy Uterine 35 weeks Age of gestation Normal Spontaneous Vaginal Delivery

Marycarbelle Manaois

Dennie Grace M. Ng, R.N., MAN

October 6, 2011 10:38 PM

CEL 2371468

Dennie Grace M. Ng, R.N., MAN

August 11, 2013 11:10 PM August 8, 2013 12:50 AM August 8, 2013 12:44 AM

MMN 2617963

Dennie Grace M. Ng, R.N., MAN Dennie Grace M. Ng, R.N., MAN

MLA 2619042 CC 2617914

Dennie Grace M. Ng, R.N., MAN

Approved by:
(Print Name and Signature)

GILMORE G. SOLIDUM 0172020 Valid Until July 27, 2014

Dean, PRC I.D. No.

Date document is signed: Please specify Highest Nursing Degree Earned: Noted by:
(Print Name and Signature)

Time DOCTOR OF PHILISOPHY

JENNIFER P. REYES Valid Until June 12, 2015 Time MASTER OF ARTS IN NURSING

Clinical Coordinator, PRC I.D. No. 0301312 Date document is signed: Please specify Highest Nursing Degree Earned:

PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St., Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph ASSISTED DELIVERY in UNIVERSITY OF THE PHILIPPINES-PHILIPPINE GENERAL HOSPITAL, MANILA Hospital, Municipality/City/ Province

ODC Form 1B 2A ODC Form ASSISTED DELIVERY O.R. SCRUB FORM FORM MAJOR

Prepared by: Printed Name with Signature of Student PULANCO, KEN BAUTISTA

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) IR 3923191 PROCEDURE PERFORMED ASSISTED DELIVERY

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

June 5, 2013 2:00 PM

Pregnancy Uterine 36 4/7 weeks age of gestation by ultrasound, cephalic in labor, young primagravida Normal Spontaneous Vaginal Delivery

VilmaCacho RN

Cynthia Dancel RN

PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St., Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph ASSISTED DELIVERY in GAT ANDRES BONIFACIO MEMORIAL MEDICAL CENTER, MANILA Hospital, Municipality/City/ Province

ODC Form 1B 2A ODC Form ASSISTED DELIVERY O.R. SCRUB FORM FORM MAJOR

Prepared by: Printed Name with Signature of Student PULANCO, KEN BAUTISTA

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) SR 87559 BT 126417 RT 126181 DJ 101336 PROCEDURE PERFORMED ASSISTED DELIVERY

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

June 29, 2013 7:00 PM July 5, 2013 2:20 PM July 5, 2013 4:00 PM July 5, 2013 8:00 PM

Gravity 5 Parity 5 Pregnancy Uterine 39 weeks Age of Gestation Normal Spontaneous Vaginal Delivery Gravity 5 Parity 5 Pregnancy Uterine 38 2/7 weeks Age of Gestation Normal Spontaneous Vaginal Delivery Gravity 5 Parity 4 Pregnancy Uterine 36 weeks Age of Gestation Normal Spontaneous Vaginal Delivery Gravida 5 Parity 5 Pregnancy Uterine 36 weeks age of gestation cephalic in labor, Normal Spontaneous Vaginal Delivery

Cherry L. Prado, R.N. MSN

Cherry L. Prado, R.N. MSN

Cherry L. Prado, R.N. MSN

Cherry L. Prado, R.N. MSN

Noted by:
(Print Name and Signature)

JENNIFER P. REYES Valid Until June 12, 2015 Time MASTER OF ARTS IN NURSING

Approved by:
(Print Name and Signature)

GILMORE G. SOLIDUM Valid Until July 27, 2014 Time DOCTOR OF PHILISOPHY

Clinical Coordinator, PRC I.D. No. 0301312 Date document is signed: Please specify Highest Nursing Degree Earned:

Dean, PRC I.D. No. 0172020 Date document is signed: Please specify Highest Nursing Degree Earned:

PAMANTASAN NG LUNGSOD NG MAYNILA (UNIVERSITY OF THE CITY OF MANILA) General Luna St. corner Muralla St., Manila, Philippines, 1002 Telephone No. (+632) 527 7941 Web Address: www.plm.edu.ph

ODC Form ODC Form 1C 2A O.R. SCRUB FORM CORD CARE FORM MAJOR

IMMEDIATE NEWBORN CORD CARE in

GAT ANDRES BONIFACIO MEMORIAL MEDICAL CENTER, MANILA Hospital, Municipality/City/ Province

Prepared by: Printed Name with Signature of Student PULANCO, KEN BAUTISTA

Date Performed and Time Started

Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) Baby Boy A 681339 Baby Girl B 681353 Baby Boy G 681374 Baby Girl D 681397 Baby Boy H 681402

IMMEDIATE NEWBORN CORD CARE PERFORMED

Indicate where performed e.g. D.R., Nursery, NICU, or Home

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor (Name and Signature)

February 4, 2013 10:19 PM February 5, 2013 12:56 AM February 6, 2013 11:20 PM February 7, 2013 3:24 AM February 7, 2013 2:40 AM

Nursery Nursery Nursery Nursery Nursery

Manuela P. Tirazona RN, MAN Manuela P. Tirazona RN, MAN Manuela P. Tirazona RN, MAN Manuela P. Tirazona RN, MAN Manuela P. Tirazona RN, MAN

Noted by:
(Print Name and Signature)

JENNIFER P. REYES Valid Until June 12, 2015 Time MASTER OF ARTS IN NURSING

Approved by:
(Print Name and Signature)

GILMORE G. SOLIDUM Valid Until July 27, 2014 Time DOCTOR OF PHILISOPHY

Clinical Coordinator, PRC I.D. No. 0301312 Date document is signed: Please specify Highest Nursing Degree Earned:

Dean, PRC I.D. No. 0172020 Date document is signed: Please specify Highest Nursing Degree Earned: