ST.

SCHOLASTICAS COLLEGE TACLOBAN

COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
Hospital, Municipality / City / Province

O.R. FORM 1A
MAJOR SURGERY

Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.
Patients
INITIALS
Case Number

PROCEDURE PERFORMED

O.R. Nurse On Duty

(Name and Signature) If Midwife on Duty,
Signature not Required

September 04, 2014

11:23 AM- 12:50 PM

M. R.
226083

1st Degree Low Transverse Cesearean Section

(Pregnancy Uterine Weeks Age of Gestation Non-Reassuring Fetal
Status, Persistent Fetal Bradycardia Delivere By 1 st Degree Low
Transverse To A Live Baby Girl, Meconium Stain Amniotic fluid,
Apgar Score 9, Body Weight 2.8 Kilogram, Body Lenght 49
Centimeter)

MS. MICHELLE ANN V. BACIERRA, RN

July 02, 2014

10:00 AM- 12:40PM

T. P.
233108

Open Reduction And Internal Fixation Lock Plating Tibia Fibula

Right
(Fracture Closed Comminuted Distal Third Tibia Fibula Right)

MR. FRANCIS JAMIL S. OCADO, RN

July 07, 2015

9:23 AM- 10:40 AM

M. M.
233188

Laparatomy Cholecystectomy
(Cholecystolithiasis, Liver Cirrhosis)

MS. JENNY G. DEGORIO, RN

Date Performed and

Time Started

MS. CHRISTINE MARIE N. TORRES, RN, MAN

Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership

SUPERVISED BY
Clinical Instructor
(Name and Signature)

MRS.ZUSIE B.ABUDA, RN,MAN

PRC No.:
Valid until:
PNA No.:
Valid until:

MR. RODERICK R. LABICANE, RN, MAN

PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:

MR. RODERICK R. LABICANE, RN, MAN

PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:

MRS. CAROLINA D. BARROT, RN, MAN, PhD

DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN:_____________
Valid until: _________________

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015

ST. SCHOLASTICAS COLLEGE TACLOBAN

COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY
Hospital, Municipality / City / Province

O.R. FORM 1A
MAJOR SURGERY

Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.

Date Performed and

Time Started

Patients
INITIALS
Case Number

February 28, 2014

1:45 PM- 3:25 PM

C. R.
220079

Abdominal Myomectomy
(Multiple Myoma Uteri Intramural And Subserous)

MS. FRANCIS ARIANE V. ALBESA, RN

September 14, 2014

2:00 PM- 3:15 PM

P. L.
225342

Debridement, Repair of Scalp Avulsion Parieto Occipital Left And

Lateral Cantus Left
(Scalp Avulsion, Parieto Occipital Left And Lateral Cantus)

MR. VALERIANO S. PRINCILLO III, RN

July 04, 2014

9:35 AM-

D. R.
226702

Removal Of Implant
(Status Post open Reduction Plating Left Clavicle)

MR. VALERIANO S. PRINCILLO III, RN

SURGICAL PROCEDURE PERFORMED

MS. CHRISTINE MARIE N. TORRES, RN, MAN

Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership

O.R. Nurse On Duty

(Name and Signature) If Midwife on Duty,
Signature not Required

SUPERVISED BY
Clinical Instructor
(Name and Signature)

MRS.ZUSIE B.ABUDA, RN,MAN

PRC No.:
Valid until:
PNA No.:
Valid until:
:

MRS.ZUSIE B.ABUDA, RN,MAN

PRC No.:
Valid until:
PNA No.:
Valid until:

MR. RODERICK R. LABICANE, RN, MAN

PRC No.: 0364547
Valid until: December 3, 2016
PNA No.:
Valid until:

MRS. CAROLINA D. BARROT, RN, MAN, PhD

DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: _____________
Valid until: _________________
ADPCN:_______________
Valid until: _________________

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015

ST. SCHOLASTICAS COLLEGE TACLOBAN

COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
CORD CARE in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality / City / Province
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.

Date Performed and Time

Started

Patients
INITIALS
Case Number

August 25, 2014

11:31 AM

Bb. Girl M.
008244

Neonatal Intensive Care Unit Essential Intrapartum

Newborn Care Anthropometrics, Vaccines

MS. ROSALIE R. UY, RN

October 14, 2014

7:10 PM

Bb. Boy E.
002854

Neonatal Intensive Care Unit Essential Intrapartum

Newborn Care Anthropometrics, Vaccines

MRS. SARAH MEL B. ABAD, RN

October 14, 2014

10:59 PM

Bb. Girl B.
009336

Neonatal Intensive Care Unit Essential Intrapartum

Newborn Care Anthropometrics, Vaccines

MRS. SARAH MEL B. ABAD, RN

PROCEDURE PERFORMED

MS. CHRISTINE MARIE N. TORRES, RN, MAN

Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership

Nurse On Duty
(Name and Signature) If Midwife on Duty,
Signature not Required

IMMEDIATE NEW BORN

CORD CARE FORM

SUPERVISED BY
Clinical Instructor
(Name and Signature)
MRS. VIRGINIA A. EDEP, RN,MAN
PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

MRS. VIRGINIA A. EDEP, RN,MAN

PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

MRS. VIRGINIA A. EDEP, RN,MAN

PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

MRS. CAROLINA D. BARROT, RN, MAN, PhD

DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN.:_____________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015

ST. SCHOLASTICAS COLLEGE TACLOBAN

COLLEGE OF NURSING & MIDWIFERY
Sta. Cruz Street, Tacloban City
Tel. No. 325-2188 loc. 203 / Fax No. (053) 325-4089 / web.evis.ph/sschs
ASSISSTED DELIVERY in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality / City / Province
Prepared by:
Printed Name with Signature of Student: SUBARAN, RODNEY B.

Date Performed and Time

Started

Patients
INITIALS
(only)
Case Number

PROCEDURE PERFORMED

Nurse On Duty
(Name and Signature) If Midwife on Duty, Signature
not Required

SUPERVISED BY
Clinical Instructor
(Name and Signature)

MRS. VIRGINIA A. EDEP, RN,MAN

PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

August 25. 2014

8:10 AM

C. J.
008163

Actual Delivery Assisted

Gravida 9 Para 8 (9009) Pregnancy Uterine Full Term Cephalic
Delivered Normal Spotaneous Vaginal Delivery To A Term Alive
Bb. Boy Apgar Score of 8-9 Meconium Stain

MS. ROSALIE R. UY, RN

October 14, 2014

10:30 AM

V. L.
009141

Actual Delivery Assisted

Gravida 1 Para 1 (1001) Pregnancy Uterine Full Term
Spotaneous Vaginal Delivery Apgar Score 9 Clear Amniotic
Fluid Body Weight 2.98 Kilograms

MRS. ANA RETHCIE M. LUSICO-LAGADAY, RN

October 25, 2015

1:11 PM

S. K.
030170

Actual Delivery Assisted

Gravida 1 Para 1 (1001) Pregnancy Uterine Transverse Cephalic
Bb. Girl Apgar Score 9 Clear Amniotic Fluid Delivered By
Spontaneous Vaginal Delivery

MS. MARIAN B. NADERA, RN

MS. CHRISTINE MARIE N. TORRES, RN, MAN

Over-all Clinical Coordinator
PRC No.: 0170781
Valid until: January 22, 2017
PNA No.: 11704
Valid until: Lifetime Membership

ASSISSTED
DELIVERY FORM

MRS. VIRGINIA A. EDEP, RN,MAN

PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

MRS. VIRGINIA A. EDEP, RN,MAN

PRC No.: 0126416
Valid until: July 30, 2016
PNA No.:
Valid until:

MRS. CAROLINA D. BARROT, RN, MAN, PhD

DEAN OF COLLEGE OF NURSING
PRC No.: 0133674
Valid until: September 21, 2017
PNA No.: ____________
Valid until: _________________
ADPCN:_____________
Valid until: _________________
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and complete statement pursuant to the provisions of
pertinent laws, rules and regulations of the Republic of the Philippines.
Subscribed and sworn before me this ____________day of _______________________2015, Tacloban City, Philippines.
Doc No. ___________
Page No. __________
Book No. __________
Series of 2015