Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
I.
Patient
No.
Name of Patient
Age
Date
Time
Kind of Infusion
Site
Datoon, Riyesa A.
16 years old
08/22/16
4:30 PM
Satana, Leonita G.
81 years old
08/22/16
5:45 PM
Jasa, Pablo P.
84 years old
08/22/16
7:05 PM
II.
Name of Patient
Age
Chiepe, Devine C.
24 years old
Siosan, Reme J.
70 years old
Bebar, Emelita E.
68 years old
Patient
No.
1
Gauge 20
(Venflon)
Gauge 20
(Venflon)
Gauge 18
(Supercath 5)
Dose
Rate
125 cc/hr
41 gtts/min
80 cc/hr
80 mgtts/min
40 cc/hr
40 mgtts/min
Signature over
Printed Name of
Certified
Trainer/Preceptor
Anabelle L. Turga
Anabelle L. Turga
Anabelle L. Turga
License
No./Expiry
Date
AN-002231/
03-02-19
AN-002231/
03-02-19
AN-002231/
03-02-19
Patient
No.
III.
Type of
Cannula
Date
08/22/1
6
08/22/1
6
08/22/1
6
Time
Drugs Incorporated
10.00 A.M.
12:00 P.M.
2:00 P.M.
Dose
Diagnosis
License
No./Expiry
Date
AN-002231/
03-02-19
AN-002231/
03-02-19
AN-002231/
03-02-19
Age
Date
Time
I.V. Insertion
69 years old
08/23/16
4:15 PM
Type of
Cannula
Gauge 22
(Venflon)
Diagnosis
Myelodisplastic Syndrome,
Diabetes Mellitus
This is to certify that I had successfully performed the above requirements as countersigned by my witnesses.
Received by: _______________________________________________
Submitted by: CRISTEL DOANNE C. PALABRICA, R.N.
ANSAP
Signature over Printed Name
I.V. Therapy Certification Card No. ____________________________
Approved by:
License
No./Expiry
Date
AN-002231/
03-02-19