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ODC Form 2A
O.R. SCRUB FORM
Major
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
SURGICAL SCRUB in Ilocos Training and Regional Medical Center
Parian, San Fernando City, La Union
Prepared by:Ocaoi Maverick Taganap Signature of Student________________________________
Student
Date Performed and Time Started
Patient's INITIAL SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty SUPERVISED BYCase Number
November 17, 20119:18 am
M.A.G.2011-0027003
Extracapsular Cataract Extraction with Posterior
Chamber Insertion of Intraocular Lens Left Eye
___________________________Felix Leo B.Aragon, RN
______________________________Aurelio Manego, RN, MAN
(Thesis Writing II)
November 10, 20117:41 am
V.I.D.2011-0026299
Emergency Open cholecystectomy, IOC
with Tube Drain
___________________________Romel S. Lucina, RN
______________________________Aurelio Manego, RN, MAN
(Thesis Writing II)
August 22,20117:25 pm
Q.F.G.2011-0018868
Open Reduction internal Fixation Intrarepullary
Nailing Left Femur
___________________________Crisanti H. Alviar, RN
______________________________Aurelio Manego, RN, MAN
(Thesis Writing II)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012
Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2B
O.R. CIRCULATING FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
SURGICAL SCRUB in Lorma Medical Center, Carlatan, City of San Fernando, La Union
Prepared by: Ocaoi Maverick Taganap Signature of Student ________________________________
Student
Date Performed and Time Started
Patient's INITIAL SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty SUPERVISED BYCase Number
January 19,201110:05am
G.L.L.362368
PKE with PCIOL Implant Phacoemulsification
Post Chamber Intraocular Lens
___________________________Glorifina G. Dacumos, RN
______________________________Purificacion M. Soriano, RN, MAN
(Thesis Writing II)
February 10, 20119:50 am
A.M.L.350604
Cesarean Section___________________________
Glorifina G. Dacumos, RN______________________________
Jonalyn Padilla, RN, MAN(Thesis Writing I)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1A
ACTUAL DELIVERY FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
ACTUAL DELIVERY in Ilocos Training and Regional Medical Center .
Parian , San Fernando City , La Union
Prepared by: Ocaoi Maverick Taganap Signature of Student________________________________
Student
Date Performed and Time Started
Patient's INITIAL PROCEDURE PERFORMED
Assisted Delivery
D.R. Nurse on Duty SUPERVISED BYCase Number
June 21,20118:25am
N.L.D.2011-0012594
Normal Spontaneous Delivery ( with Right
Mediolateral Episiotomy )
___________________________Genelyn F.Layno, RN
_______________________________Consuelo Enano, RN,MAN
June 14, 201110:26 am
C.T.G2011-0012962
Normal Spontaneous Delivery ( with Right
Mediolateral Episiotomy )
___________________________Genelyn F. Layno, RN
_______________________________Consuelo Enano, RN,MAN
__________________________________________________________
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1B
ASSISTED DELIVERY FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
ACTUAL DELIVERY in Ilocos Training and Regional Medical Center
Parian, San Fernando City, La Union
Prepared by:Ocaoi Maverick Taganap Signature of Student_________________________________
Student
Date Performed and Time Started
Patient's INITIAL PROCEDURE PERFORMED
Assisted Delivery
D.R. Nurse on Duty SUPERVISED BYCase Number
June 15,2011 7:50 am
W.B.M2011-0012722
Normal Spontaneous Delivery ( with Right
Mediolateral Episiotomy )
___________________________GenelynF. Layno, RN
_______________________________Consuelo Enano, RN,MAN
June 22,20118:25 am
L.D.B2011-0018923
Normal Spontaneous Delivery ( with Right
Mediolateral Episiotomy )
___________________________Ligaya F. Valdez, RN
_______________________________Consuelo Enano, RN,MAN
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1B
ASSISTED DELIVERY FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
ACTUAL DELIVERY in Lorma Medical Center, Carlatan, City of San Fernando, La Union
Prepared by: Janry Clement Del Moral Mostoles Signature of Student_________________________________
Student
Date Performed and Time Started
Patient's INITIAL PROCEDURE PERFORMED
Assisted Delivery
D.R. Nurse on Duty SUPERVISED BYCase Number
April 20,20118:12 pm
A.R.L0322588
Normal Spontaneous Delivery ( with Right
Mediolateral Episiotomy )
___________________________Yolanda K. Gayyed, RN
_______________________________Jonalyn Padilla, RN, MAN
(Thesis Writing I)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1C
CORD CARE FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
IMMEDIATE NEWBORN CORD CARE in Lorma Medical Center, Carlatan, City of San Fernando, La Union
Prepared by:Ocaoi Maverick Taganap Signature of Student __________________________________
Student
Date Performed and Time Started
Patient's INITIAL Immediate Newborn
Cord Care PERFORMED
(Where Performed)
Nurse on Duty SUPERVISED BY
Case Number
February 10,20128:25 am
O.G.D.364206
Delivery Room___________________________
Mark G. Sison, RN____________________________
Jonalyn Padilla, RN,MAN(Thesis Writing I)
February 03,201210:50 am
A.S.B.363608
Delivery Room___________________________
Rodel T. Novales, RN____________________________
Jonalyn Padilla, RN,MAN(Thesis Writing I)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1C
CORD CARE FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
IMMEDIATE NEWBORN CORD CARE in Lorma Medical Center, Carlatan, City of San Fernando La Union
Prepared by:Ocaoi Maverick Taganap Signature of Student __________________________________
Student
Date Performed and Time Started
Patient's INITIAL Immediate Newborn
Cord Care PERFORMED
(Where Performed)
Nurse on Duty SUPERVISED BY
Case Number
December 15,20118:10 pm R.G.M.
560536Delivery Room
___________________________Ma. Cecilia H. Galon , RN
____________________________Fe M. Nisperos, RN, MAN
(Thesis Writing II)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2B
O.R. CIRCULATING FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 700-2500, Fax Number 242-3628, Lorma.org
(ACSCU-AAI Level III RE-ACCREDITED STATUS valid until April 2012)
SURGICAL SCRUB in Ilocos Training and Regional Medical Center
Parian, San Fernando City, La Union
Prepared by: Ocaoi Maverick Taganap Signature of Student ________________________________
Student
Date Performed and Time Started
Patient's INITIAL SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty SUPERVISED BYCase Number
August 23, 201110:05am
G.L.L.2011- 0101804
Mesh Herniorraphy, Right Hyroceolectomy
Right Inguinal
___________________________Crisanti H. Alviar, RN
______________________________Aurelio Manego, RN, MAN
(Thesis Writing II)
Noted by: Honesto G. Alnas Approved by: Ludivina D. Magpali Clinical Coordinator Dean
PRC I.D No. 0248316 Valid Until: April 24,2015 PRC I.D No. 0186484 Valid Until: August 5, 2012Date document is signed:___________ Time:____________ Date document is signed:___________ Time:____________Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
