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Transcript of PRC Cases Blank
Prepared by:
STUDENT
LEGEND:
Concurred by:
JULITA M. LATOSQUINSignature Over printed name of CHIEF NURSEDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Approved By:
Signature Over printed name of DEANDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:c). ADPCN No.: Valid Until:
Noted by:
Signature Over printed name of RLE COORDINATORDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Name of Student: SURNAME, GIVEN NAME MIDDLE NAMEName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2007Year Graduated (BSN Program): 2011
MAJOR OPERATIONS
No.Date of
OperationCase No.
Name of Patient
DiagnosisOperation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Supervised by:Name of Qualified Clinical Instructor
PRCID #
Date of Validity
PNA ID #
Date of Validity
Signature of Qualified Clinical
Instructor
1.
2.
3.
4.
5.
Prepared by:
STUDENT
LEGEND: Hospital
Concurred by:
JULITA M. LATOSQUINSignature Over printed name of CHIEF NURSEDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Approved By:
Signature Over printed name of DEANDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:c). ADPCN No.: Valid Until:
Noted by:
Signature Over printed name of RLE COORDINATORDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Name of Student: SURNAME, GIVEN NAME MIDDLE NAMEName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2007Year Graduated (BSN Program): 2011
MINOR OPERATIONS
No.Date of
OperationCase No.
Name of Patient
DiagnosisOperation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Supervised by:Name of Qualified Clinical Instructor
PRCID #
Date of Validity
PNA ID #
Date of Validity
Signature of Qualified Clinical
Instructor
1.
2.
3.
4.
5.
Prepared by:
STUDENT
LEGEND:
Concurred by:
JULITA M. LATOSQUINSignature Over printed name of CHIEF NURSEDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Approved By:
Signature Over printed name of DEANDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:c). ADPCN No.: Valid Until:
Noted by:
Signature Over printed name of RLE COORDINATORDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Name of Student: SURNAME, GIVEN NAME MIDDLE NAMEName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2007Year Graduated (BSN Program): 2011
ACTUAL DELIVERIES
No. Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of HospitalType of Delivery
Supervised by:Name of Qualified Clinical Instructor
PRC ID #
Date of Validity
PNA ID #
Date of Validity
Signature of Qualified Clinical
Instructor
1.
2.
3.
4.
5.
Prepared by:
STUDENT
LEGEND:
Concurred by:
Signature Over printed name of CHIEF NURSEDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Approved By:
Signature Over printed name of DEANDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:c). ADPCN No.: Valid Until:
Noted by:
Signature Over printed name of CLINICAL COORDINATORDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Name of Student: SURNAME, GIVEN NAME MIDDLE NAMEName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2007Year Graduated (BSN Program): 2011
DELIVERY ASSISTED
No. Case No. Diagnosis Name of Mother AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of Hospital
Type of Delivery
Supervised by:Name of Qualified Clinical Instructor
PRC ID #
Date of Validity
PNA ID #
Date of Validity
Signature of Qualified Clinical
Instructor
1.
2.
3.
4.
5.
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors CollegeDate Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009
Prepared by:
STUDENT
LEGEND:
Concurred by:
Signature Over printed name of CHIEF NURSEDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Approved By:
Signature Over printed name of DEANDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:c). ADPCN No.: Valid Until:
Noted by:
Signature Over printed name of CLINICAL COORDINATORDate Signed:Degree:a). PRC No.: Valid Until:b). PNA No.: Valid Until:
Name of Student: SURNAME, GIVEN NAME MIDDLE NAMEName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2007Year Graduated (BSN Program): 2011
CORD CARE
No.Case No.
Date Performed
Name of BabyGender of
BabyName of Mother Age
Name of Hospital
Supervised by:Name of Qualified Clinical Instructor
PRC ID #
Date of Validity
PNA ID #
Date of Validity
Signature of Qualified Clinical
Instructor
1.
2.
3.
4.
5.