3+3+2 ACCOMPLISHED REQUIREMENTS of 3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Aaron

Paul A. Santos, RN Name of Hospital Offering IV Training: Dr. Yangas Hospital Date of IV Training Program Attended: October 1-3, 2011
I.

PRC Number: 0042292 Provider No.: 214 Venue: AVR (High School DYCI)

Initiating/Maintaining Peripheral IV Infusions

Patient No. 1 2

Name of Patient Razel De leon Bryan Fereza Ederyln Garcia

Age 19 25

Date 1001-11

Time 8:00am

Kind of Infusion D5LR D5W

Site L. metacarpal L. metacarpal R. metacarpal

Type of Cannula ga.22 ga.20

Dose

Rate

Signature Over Printed Name of Certified Trainer/Preceptor/M.D.,RN Leonicia T. German, RN, MAN

License No. 0373339 0373339

1000ml 16gtts/min. 1000ml 20gtts/min. Leonicia T. German, RN, MAN

1001-11 11:30am 1002-11

22

1:00pm

PNSS

ga.22

500ml

16gtts/min. Leonicia T. German, RN, MAN

0373339

Submitted by: Aaron Paul A. Santos, RN Date submitted: 10-10- 2011 (Signature over printed name)

Received by: Roger Carlo P. Pineda, RN

Approved by: Teodoro M. Reyes, RN, M.D. Director of Nursing Services (Signature over printed name)

3+3+2 ACCOMPLISHED REQUIREMENTS of 3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Aaron Paul A. Santos, RN Name of Hospital Offering IV Training: Dr. Yangas Hospital Date of IV Training Program Attended: October 1-3, 2011 II. Administering Intravenous Drugs Patient No. 1 Name of Patient Alfred Gutierrez Roberto Linag Miguel Manalaysay Age 45 Date Time Kind of Infusion Ranitidine Site R. metacarpal L. metacarpal L. metacarpal Type of Cannula ga.20 Dose 50mg Leonicia T. German, RN, MAN 2 50 0102-11 0103-11 8:00am Tramadol ga.20 50mg Leonicia T. German, RN, MAN 3 30 9:00am Metronidazole ga.20 500mg Leonicia T. German, RN, MAN 0373339 0373339 Rate Signature Over Printed Name of Certified Trainer/Preceptor/M.D.,RN License No. 0373339 PRC Number: 0042292 Provider No.: 214 Venue: AVR (High School DYCI)

0101-11 11:00am

Submitted by: Aaron Paul A. Santos, RN Date submitted: 10-10- 2011 (Signature over printed name)

Received by: Roger Carlo P. Pineda, RN

Approved by: Teodoro M. Reyes, RN, M.D. Director of Nursing Services (Signature over printed name)

3+3+2 ACCOMPLISHED REQUIREMENTS of 3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse: Aaron Paul A. Santos, RN Name of Hospital Offering IV Training: Dr. Yangas Hospital Date of IV Training Program Attended: October 1-3, 2011 III. Administering and Maintaining Blood and Blood Components PRC Number: 0042292 Provider No.: 214 Venue: AVR (High School DYCI)

Patient No. 1

Name of Patient Eisen Farrel Corsiga Maria La del Bario

Age 21

Date

Time

Kind of Infusion PRBC

Site L. metacarpal R. metacarpal

Type of Cannula ga.18

Dose

Rate

Signature Over Printed Name of Certified Trainer/Preceptor/M.D.,RN Leonicia T. German, RN, MAN

License No. 0373339

0102-11 2:30pm 0103-11 3:00pm

250ml 10gtts/min.

20

PRBC

ga.18

300ml 10gtts/min. Leonicia T. German, RN, MAN

0373339

Submitted by: Aaron Paul A. Santos, RN Date submitted: 10-10- 2011 (Signature over printed name)

Received by: Roger Carlo P. Pineda, RN

Approved by: Teodoro M. Reyes, RN, M.D. Director of Nursing Services (Signature over printed name)