MAJOR AND MINOR OPERATIONS SAMPLE DATA

Supervised by
Date of Name of Name and Signature of O.R Scrub
No. Case No. Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital (Name & Signature of Qualified
Operation Patient Nurse
Clinical Instructor)
Hospital Maycel PU 40 6/7 Weeks AOG
Data 4/4/09 LTCS SAB Dr. Santos OMMC Elena Esguerra Mr. Richard Loresco
Busadne Single Footling G1 P0
Maycel Pregnancy Uterine 40 6/7 Low Transverse Cesarean
PRC April 04, Dr. Maria Christina Ospital Ng Maynila
Busadne Weeks Of Gestation Single Section Subarachnoid Block Elena M. Esguerra, RN Richard D. Loresco, RN, RM, MAN
Entry 2009 Estella Santos Medical Center
Footling Gravida 1 Para 0
Hospital Josephine Mass; (L) Nasal Cavity Excision Biopsy, (L)
Data 4/4/09 GA-ET Dr. De Jesus OMMC Ms. Anna Limen Mr. Richard Loresco
Maylas
PRC April 04, Josephine Mass; Left Nasal Cavity Biopsy Under General General Endotracheal Ospital Ng Maynila
1378536 Dr. Noel De Jesus Anna F. Limen, RN Richard D. Loresco, RN, RM, MAN
Entry 2009 Maylas Anesthesia Anesthesia Medical Center
Hospital Eliseo CSM (L & R Eye) ECCE w/ PCIOL
Data 4/4/09 GA-IV Dr. Dayacap OMMC Mr. Jose Christopher E. Sison Mr. Richard Loresco
Aglibot
Eliseo Cataract Senile Mature Extra Capsular Cataract
PRC April 05, 1384758 General Anesthesia Ospital Ng Maynila
Aglibot (Left > Right Eye) Extraction With Posterior Dr. Eduardo Dayacap Jose Christopher E. Sison, RN Richard D. Loresco, RN, RM, MAN
Entry 2006 Intravenous Medical Center
Chamber Intraocular Lens

ACTUAL AND ASSISTED DELIVERIES SAMPLE DATA

Time of Supervised by
No. Case No. Diagnosis Name of Mother Age Date of Delivery Gender of Baby Name of Hospital Type of Delivery
Delivery (Name & Signature of Qualified Clinical Instructor)
Hospital
Data G1 P0 PU 39 4/7Wks AOG CIL Jacquelene Felix 19 12/ 25/08 8:05 PM F OMMC NSD Mr. Richard Loresco
Gravida 1 Para 0 Pregnancy Uterine
PRC 19 Years Ospital Ng Maynila Medical Normal Spontaneous
39 – 40 Weeks Age Of Gestation Jacquelene Felix Old December 25, 2008 8:05 PM Female Richard D. Loresco, RN, RM, MAN
Entry Center Delivery
Gestation Cephalic In Labor
Hospital
Data G4 P3 PU 39 5/7 Wks AOG CIL Marivic Enriquez 24 y/o 12/ 26/08 7:10 PM F OMMC NSD Mr. Richard Loresco
Gravida 4 Para 3 Pregnancy Uterine 24
PRC Ospital Ng Maynila Medical Normal Spontaneous
39 - 40 Weeks Of Gestation Marivic Enriquez Years December 26, 2006 7:10 PM Female Richard D. Loresco, RN, RM, MAN
Entry Center Delivery
Cephalic In Labor Old

> do not abbreviate!