PRC FORM for March 2011 Graduates

8/8/2019 PRC FORM for March 2011 Graduates

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Republic of the Philippines

Professional Regulation Commission

Board of Nursing

SOUTHWESTERN UNIVERSITY

College of NursingVilla Aznar Urgello Street Cebu City

Phone no: 415-55-55 local 183, Telefax: 418-72-78, Email Address: [email protected]

ACTUAL DELIVERY in Sacred Heart Hospital

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

Prepared by:Printed Name and Signature of Student Juan Santos dela Cruz

Date Performed and

Time Started

Patients INITIAL (only)

PROCEDURE

PERFORMED

D.R. Nurse/Midwife On Duty

(Name and Signature)

SUPERVISED BY

Clinical InstructorName and Signature

Case Number

April 23. 20106:19 PM

G.J.M089264

Normal SpontaneousVaginal Delivery Mrs. Teresita M. Nacua Mrs. Corazon B. Dumadag, RN MA

Noted by: RAMON PERLEY M. PANDAAN Approved by: LUCRIS A. TAN JR.

OR/DR Clinical Coordinator, PRC I.D. No. 0243199 Valid Until July 8, 2010 Dean, PRC I.D. No.0285376 Valid Until April 9, 2012Date document is signed:________Time____________ Date document is signed:________Time________Please specify Highest Nursing Degree Earned: RN, MAN Specify Highest Nursing Degree Earned: RN, MD, MAN

(STRICTLY NO DESIGNATES)

ODC Form 1AACTUAL DELIVERY FOR
mailto:[email protected]:[email protected]


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Republic of the PhilippinesProfessional Regulation Commission

Board of Nursing




SURGICAL SCRUB in _______________________________________________________________________Hospital, Municipality / City / Province

Prepared by:

Printed Name and Signature of Student ______________________________________

Date Performedand

Time Started

Patients INITIAL only SURGICAL PROCEDUREPERFORMED

O.R. Nurse on Duty(Name AND Signature)

SUPERVISED BYClinical Instructor

Name and SignatureCase Number

Noted by: RAMON PERLEY M. PANDAAN Approved by: LUCRIS A. TAN JR.

OR/DR Clinical Coordinator, PRC I.D. No. 0243199 Valid Until July 8, 2010 Dean, PRC I.D. No.0285376 Valid Until April 9, 2012Date document is signed:________Time____________ Date document is signed:________Time________Please specify Highest Nursing Degree Earned: RN, MAN Specify Highest Nursing Degree Earned: RN, MD, MAN


ODC Form 2AO.R. SCRUB FORM

Major


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Board of Nursing




ACTUAL DELIVERY in _______________________________________________________________________

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

Prepared by:Printed Name and Signature of Student ______________________________________

Date Performedand

Time Started

Patients INITIAL only PROCEDURE

PERFORMED

ASSISTED DELIVERY

D.R. Nurse/Midwife On Duty(Name and Signature)

SUPERVISED BYClinical Instructor

Name and SignatureCase Number

Noted by: RAMON PERLEY M. PANDAAN Approved by: LUCRIS A. TAN JR.OR/DR Clinical Coordinator, PRC I.D. No. 0243199 Valid Until July 8, 2010 Dean, PRC I.D. No.0285376 Valid Until April 9, 2012Date document is signed:________Time____________ Date document is signed:________Time________Please specify Highest Nursing Degree Earned: RN, MAN Specify Highest Nursing Degree Earned: RN, MD, MAN


ODC Form 1BASSISTED DELIVERY FO


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Board of Nursing




SURGICAL SCRUB in _______________________________________________________________________Hospital, Municipality / City / Province

Prepared by:Printed Name and Signature of Student ______________________________________

Date Performed

andTime Started

Patients INITIAL only

SURGICAL PROCEDURE

PERFORMED

O.R. Nurse On Duty


SUPERVISED BY


Case Number



ODC Form 2BO.R. SCRUB MINOR


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Board of Nursing




IMMEDIATE NEWBORN CORD CARE in _______________________________________________________________________Hospital / Home / Lying-In Clinic, Municipality / City / Province

Prepared by:

Printed Name and Signature of Student ______________________________________

Date Performed

andTime Started

Patients INITIAL only Immediate Newborn Cord Care

PERFORMEDIndicate where performed e.g. D.R.,

Nursery, NICU, or Home

D.R. Nurse/Midwife On Duty


SUPERVISED BY


Case Number


ODC Form 1CIMMEDIATE NEWBORN CORD

CARE


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PRC FORM for March 2011 Graduates

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