CANOSSA COLLEGE College of Nursing San Pablo City, Laguna 1ST Street Lakeside Park Subd., San Pablo City (049) 562- 3891 SURGICAL SCRUB in Community General Hospital of San Pablo City, Laguna O.R. Form 1A O.R. SCRUB FORM Major Date Performed And Time Started November 21, 2022 1:00 PM May 19, 2023 3:45 AM June 3, 2023 8:30 PM Patient’s INITIALS (only) Case Number L.T.N 3118 H.M. 2066 R.J.D.V 2319 SURGICAL PROCEDURE PERFORMED Nurse On Duty (Name and Signature) Clinical Instructor Name and Signature Cesarean Section Beverly Kathleen Brucal, RN Kathleen B. Corcolon, RN, MAN Hysterectomy Jemirae Mica Quijano, RN Kathleen B. Corcolon, RN, MAN Open Reduction Nailing Tibia Left Loida C. Capistrano, RN Kathleen B. Corcolon, RN, MAN O.R. Form 1A O.R. CIRCULATING FORM Major Prepared by: PATRICIA ANNE R. GATCHALIAN Patient’s INITIALS (only) Date Performed And Time Started October 14, 2022 10:44 AM June 1, 2023 1:45 PM June 3, 2023 6:02 PM Case Number M.V.P.D. 3366 K.J.C.C. 2302 N.V.S.R. 2338 Prepared by: PATRICIA ANNE R. GATCHALIAN SUPERVISED BY SUPERVISED BY SURGICAL PROCEDURE PERFORMED Nurse On Duty (Name and Signature) Clinical Instructor Name and Signature Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy Jan Michael Alinios, RN Kathleen B. Corcolon, RN, MAN Cesarean Section John Rossvelt Espinosa, RN Kathleen B. Corcolon, RN, MAN Cesarean Section John Rossvelt Espinosa, RN Kathleen B. Corcolon, RN, MAN CANOSSA COLLEGE College of Nursing San Pablo City, Laguna 1ST Street Lakeside Park Subd., San Pablo City (049) 562- 3891 ACTUAL DELIVERY and ESSENTIAL INTRAPARTUM NEWBORN CARE in Laguna Provincial Hospital – San Pablo City District Hospital D.R. Form ACTUAL DELIVERY FORM Patient’s INITIALS (only) Date Performed And Time Started Case Number November 16, 2023 2:48 PM G.L.M. 370773 SURGICAL PROCEDURE PERFORMED Normal Spontaneous Delivery Nurse On Duty (Name and Signature) Ma. Janelle E. Briones, RN Patient’s INITIALS (only) Case Number October 26, 2023 3:32 PM K.F.R. 302081 Prepared by: PATRICIA ANNE R. GATCHALIAN Vivian P. Lajara, RN, MAN Normal Spontaneous Delivery Vivian P. Lajara, RN, MAN Normal Spontaneous Delivery Vivian P. Lajara, RN, MAN EINC Form ESSENTIAL INTRAPARTUM NEWBORN CARE FORM Prepared by: PATRICIA ANNE R. GATCHALIAN Date Performed And Time Started SUPERVISED BY Clinical Instructor Name and Signature SURGICAL PROCEDURE PERFORMED Nurse On Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature Essential Intrapartum Newborn Care Girlie Mannphy A. Lacambra, RN, RM, MAN Essential Intrapartum Newborn Care Girlie Mannphy A. Lacambra, RN, RM, MAN Essential Intrapartum Newborn Care Girlie Mannphy A. Lacambra, RN, RM, MAN
