3+3+1 ACCOMPLISHED REQUIREMENTS of 3- DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES Name of Registered Nurse : Shayne

Marie C. Apon___ Name of Hospital Offering IV Training : St. Dominic Medical Center Date of IV Training Program Attended : May 29-31, 2013_________ I. Patient No. 189877 Initiating Maintaining Peripheral IV Infusions Age 74 Date June 14, 2013 June 14, 2013 June 14, 2013 Time 1655H Kind of Infusion D5LR Site Right Metacarpal Vein Left Metacarpal Vein Left Metacarpal Vein Type of Cannula Gauge 18 Gauge 18 Gauge 18 Dose 1 Liter Rate 31-32 gtts/min KVO Rashid R. Delos Reyes, R.N 1 Liter KVO Rashid R. Delos Reyes, R.N 09-012081 Signature over Printed Name of Certified Trainer/ Preceptor License No. PRC No. Provider No. Venue : 0757187______________ : 080__________________ : St. Dominic College of Asia

Name of Patient Almontero, Manuel Rivera Lim, Miriam Mallari Miranda, Violeta Frani II.

09-012081 Rashid R. Delos Reyes, R.N 09-012081

89014

48

1945H

PNSS

1 Liter

89012

75

1750H

PNSS

Administering IV Drugs Age 48 Date June 14, 2013 June 14, 2013 June 14, 2013 Time 1950H Drug Incorporated Tramadol Dose 50 mg Diagnosis T/C Left Femoral Hernia Rashid R. Delos Reyes, R.N 1955H Diphenhydramine 50 mg T/C Left Femoral Hernia Rashid R. Delos Reyes, R.N 1755H D5050 50 mL Hypoglycemic Crisis; Diabetes Mellitus, Hypertension 09-012081 Rashid R. Delos Reyes, R.N 09-012081 Signature over Printed Name of Certified Trainer/ Preceptor License No. 09-012081

Patient No. 89014

Name of Patient Lim, Miriam Mallari

89014

Lim, Miriam Mallari Miranda, Violeta Frani III.

48

89012

75

Administering & Maintaining Blood & Blood Components Components/ Blood Type/ Volume Rate Platelet Concentration/ Type A, RH +, 1 Unit, Fast Drip Type of Cannula Gauge 22 Signature over Printed Name of Certified Trainer/ Preceptor License No.

Patient No. 88595 6

Name of Patient

Age

Date June 10, 2013

Time

Site Left Foot Dorsal Vein

Diagnosis Dengue Hemmorrhagic Fever

Blanca, Flor Liona

1700H

09-012081 Rashid R. Delos Reyes, R.N

Submitted by: Shayne Marie C. Apon, R.N_ Signature over Printed Name

Approved by: Hazel N. Villagracia, RN MAN EdD / Chlc245/01-11-14 Trainers Signature / IV Card No./ Expiry Date