Wesleyan University Philippines

COLLEGE OF NURSING Mabini Extension, Cabanatuan City

Name of Student: Year and Block: Name of Hospital:

Eduardo L. Joson Memorial Hospital I. MAJOR OPERATIONS Operation Performed Types of Anesthesia Name of Surgeon / Anesthesiologist Staff Nurse

No.

Date of Operation

Case no.

Name of Patient

Diagnosis

Prepared by:

Supervised by: PRECIOUS F. MACAPAGAL RN, RM Clinical Instructor

Noted by: CANDIDA P. DELA CRUZ, RM, RN Head Nurse

Concurred by: MARLYN P. JACINTO, RN Nurse Supervisor

Name of Student

Wesleyan University Philippines

COLLEGE OF NURSING Mabini Extension, Cabanatuan City
Name of Student: Year and Block: Name of Hospital: Eduardo L. Joson Memorial Hospital

II. No. 1 Date Case no. Name of Patient Diagnosis

MINOR OPERATIONS Operation Performed Type of Anesthesia Name of Surgeon / Anesthesiologist Staff Nurse

Prepared by:

Supervised by: PRECIOUS F. MACAPAGAL RN, RM Clinical Instructor

Noted by: CANDIDA P. DELA CRUZ, RM, RN Head Nurse

Concurred by: MARLYN P. JACINTO, RN Nurse Supervisor

Name of Student

Wesleyan University Philippines

COLLEGE OF NURSING Mabini Extension, Cabanatuan City
Name of Student: Year and Block: Name of Hospital: Eduardo L. Joson Memorial Hospital

IV. DELIVERIES ASSISTED No. Case no. Diagnosis Name of Mother Age Date of Delivery Time of Delivery Type of Delivery Gender Of Baby Staff Nurse

3 4 5

Prepared by:

Supervised by: PRECIOUS F. MACAPAGAL RN, RM Clinical Instructor

Noted by: CANDIDA P. DELA CRUZ, RM, RN Head Nurse

Concurred by: MARLYN P. JACINTO, RN Nurse Supervisor

Name of Student

Wesleyan University Philippines

COLLEGE OF NURSING Mabini Extension, Cabanatuan City

Name of Student: Year and Block: Name of Hospital: Eduardo L. Joson Memorial Hospital

III.

ACTUAL DELIVERIES

No.

Case no.

Diagnosis

Name of Mother

Age

Date of Delivery

Time of Delivery

Type of Delivery

Gender Of Baby

Staff Nurse

4 5

Prepared by:

Supervised by: PRECIOUS F. MACAPAGAL RN, RM Clinical Instructor

Noted by: CANDIDA P. DELA CRUZ, RM, RN Head Nurse

Concurred by: MARLYN P. JACINTO, RN Nurse Supervisor

Name of Student

Wesleyan University Philippines

COLLEGE OF NURSING Mabini Extension, Cabanatuan City

Name of Student: Year and Block: Name of Hospital: Eduardo L. Joson Memorial Hospital

IV.

CORD CARE

No.

Case no.

Date Performed

Name of Baby

Gender of Baby

Name of Mother

Age

Staff Nurse

Prepared by:

Supervised by: PRECIOUS F. MACAPAGAL RN, RM Clinical Instructor

Noted by: JAYNE P. FABIAN, RN Head Nurse

Concurred by: MARLYN P. JACINTO, RN Nurse Supervisor

Name of Student

ORIGINAL COPY