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ARELLANO UNIVERSITY

COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
SURGICAL SCRUB (Major) in_______________

Pasig City General Hospital________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Case Number
November 13, 2013

J.S.L.
2013001128

E Pelvic Laparotomy with Left


Salpingectomy

Ana Cristina G. de Jesus, RN

Joycelyn Parazzo-Reyes RN, MAN

November 13,2013

J.S.A.
563970

E C/S

Marie Celeste A. Orbeta, RN

Joycelyn Parazzo-Reyes RN, MAN

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY

COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
SURGICAL SCRUB (Major) in_______________

Taguig-Pateros District Hospital________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Explore Laparotomy

John Niro D. Estandarde, RN

Gene P. Ravarra RN, MAN

Case Number
September 11, 2013

R.Q.B.
131367

Noted by: ELIZABETH G. MARCHA RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY

COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
ACTUAL DELIVERY in_______________

Parong Lying-in Clinic__________________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

PROCEDURE PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Normal Spontaneous Delivery

Delia Parong, RM

Joycelyn Parazzo-Reyes, RN, MAN

Normal Spontaneous Delivery

Delia Parong, RM

Joycelyn Parazzo-Reyes, RN, MAN

Case Number
July 5, 2012
6:00 AM
July 26, 2012
2:03 PM

M.S.F.
#0077-69

M.P.
#0078-27

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
ACTUAL DELIVERY in_______________

Quirino Memorial Medical Center________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

PROCEDURE PERFORMED

SUPERVISED BY
Clinical Instructor
(Name and Signature)

O.R. Nurse On Duty


(Name and Signature)

Case Number
July 4, 2012
5:42 PM

F.M.O.
#800815

Normal Spontaneous Delivery

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Bessie Ann Delos Reyes, RN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
ASSISTED DELIVERY in_______________

Quirino Memorial Medical Center________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

PROCEDURE PERFORMED

SUPERVISED BY
Clinical Instructor
(Name and Signature)

O.R. Nurse On Duty


(Name and Signature)

Case Number
July 4, 2012
3:20 PM

A.L.DH
#794961

Normal Spontaneous Delivery

Bessie Ann Delos Reyes, RN, MAN

July 4, 2012
7:36 PM

A.T.P.
#798301

Normal Spontaneous Delivery

Bessie Ann Delos Reyes, RN, MAN

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
ASSISTED DELIVERY in_______________

Parong Lying-in Clinic________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

PROCEDURE PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Case Number
July 12, 2012

A.A.M
007790

Normal Spontaneous Delivery

Delia M. Parong, RM

Joycelyn Parazzo-Reyes RN, MAN

July 26, 2012

M.P.A.
007827

Normal Spontaneous Delivery

Delia M. Parong, RM

Joycelyn Parazzo-Reyes RN, MAN

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
IMMEDIATE NEWBORN CORD CARE in_______________
Parong Lying-in Clinic________________________________
Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

Immediate Newborn Care


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

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Delivery Room

Delia M. Parong, RM

Joycelyn Parazzo-Reyes RN, MAN

Case Number
June 28, 2012

Baby Boy K.
007744

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
IMMEDIATE NEWBORN CORD CARE in_______________
Quirino Memorial Medical Center________________________________
Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

Immediate Newborn Care


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

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Case Number
November 20, 2013

Baby Boy C.
879793

Delivery Room

Lolita Francisco RN, MAN

November 25, 2013

Baby Boy R.
885437

Delivery Room

Lolita Francisco RN, MAN

November 25, 2013

Baby Boy S.
836371

Delivery Room

Lolita Francisco RN, MAN

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

ARELLANO UNIVERSITY
COLLEGE OF NURSING
Pag-asa St., Caniogan, Pasig City
642-1310 loc 103, 642-1310 Fax, www.arellano.edu.ph
March 20, 2007 number 030 Series of 2007
SURGICAL SCRUB (Major) in_______________

Pasig City General Hospital________________________________


Hospital/ Home/ Lying-in/ Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student:_RAMOS, KIMBERLY GO_________________________________________________________

Date Performed
and
Time Started

Patients INITIAL Only

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
(Name and Signature)

Case Number
November 13, 2013

J.S.L.
2013001128

E Pelvic Laparotomy with Left


Salpingectomy

Ana Cristina G. de Jesus, RN

Joycelyn Parazzo-Reyes RN, MAN

November 13,2013

J.S.A.
563970

E C/S

Marie Celeste A. Orbeta, RN

Joycelyn Parazzo-Reyes RN, MAN

Noted by: ELIZABETH G. MARCHA, RN, MAN


Clinical Coordinator: PRC I.D. No. 0107179 Valid Until September 2, 2014
Date Document is signed:_______________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN

Approved by: MARLENE R. PADUA, RN, MAN


Dean: PRC I.D. No. 0025831 Valid Until November 24, 2015
Date Document is signed:___________________ Time:_____________
Highest Nursing Degree Earned: BSN, MAN