3 + 3 + 2 A660HPL|8hE0 RE0U|REHENT8 0F

3-0AY A8|6 |NTRAVEN0U8 ThERAPY TRA|N|NC F0R NUR8E8

Nare ol Red|sle(ed Nu(se: CAJlTA. ALFRE0 8ENJAVlN L. PRC No.: 0N PR0CE33
Nare ol losp|la| 0lle(|rd l\ T(a|r|rd: \lCENTE 30TT0 VEV0RlAL VE0lCAL CENTER P(ov|de( No.: 151
0ale ol l\ T(a|r|rd P(od(ar Allerded: APRlL 28 - 30. 2011 \erue: 8. R00Rl0uEZ 3T.. CE8u ClTY

|. |n|t|at|ng | Ha|nta|n|ng Per|phera| |V |nfus|on
Pat|ent
No.
Name of Pat|ent Age 0ate T|me K|nd of |nfus|on 8|te Type of 6annu|a 0ose Rate
8|gnature over Pr|nted Name of
6ert|f|ed Tra|ner|Preceptor| H.0., R.N.
L|cense
No.
1 P|ao. Cra(|sse l. 18 5/3/2011 2:20 PV 05 LR Cepra||c \e|r 018 1 L 30

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912
2 \e(da(a. R|c|v A. 19 5/3/2011 8:59 AV 05 0.9 NaC| 0o(sa| lard \e|r 020 1 L 25

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912
3 Avaca|de. Vade|vr N. 31 5/3/2011 11:11 AV 05 0.9 NaC| 0o(sa| lard \e|r 022 1 L 20

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912

||. Adm|n|ster|ng |ntravenous 0rug
Pat|ent
No.
Name of Pat|ent Age 0ate T|me 0rug |ncorporated 0ose 0|agnos|s
8|gnature over Pr|nted Name of
6ert|f|ed Tra|ner|Preceptor| H.0., R.N.
L|cense
No.
1 Vara|ao. Ve(|vr 3. 32 5/3/2011 3:22 PV Rar|l|d|re 50 V0 2 rL Tvpro|d Feve(

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912
2 Vara|ao. Ve(|vr 3. 32 5/3/2011 3:25 PV lvosc|re 1 rL Tvpro|d Feve(

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912
3 Aoavor. Jade|vr P. 3 5/1/2011 10:12 AV lvosc|re 1 rL 0asl(oerle(|l|s

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912

|||. Adm|n|ster|ng and Ha|nta|n|ng |ood and |ood 6omponents
Pat|ent
No.
Name of Pat|ent Age 0ate T|me
Vo|ume | |ood Type | 6omponents |
Rate
|V
|nsert|on
Type of
6annu|a
0|agnos|s
8|gnature over Pr|nted Name of
6ert|f|ed Tra|ner|Preceptor| H.0., R.N
L|cense
No.

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912

ARNuLF0 L. JARANAY. R.N.. Ed. 0.
010912



8ubm|tted by: 6AJ|TA, ALFRE0 ENJAH|N L. 0ate 8ubm|tted: HAY 28, 2011 Rece|ved by: __________________________ Approved by: ALHA . UNCA, R.N., H.N., 0.P.A
0|rector of Nurs|ng 8erv|ces
[8|gnature over Pr|nted Name}
l\T F0RV 09 s 09