MAJOR OPERATIONS

Date of Name of Operation Type of Name of Name of Name of O.R.

No. Case No. Diagnosis Name of C.I.
Operation Patient Performed Anesthesia Surgeon Hospital Scrub Nurse

Mindanao
Pelvic Laparotomy,
December 13, Ectopic Pregnancy Spinal Sanitarium Darilyn G. Literatus,
1 177724 Pamlian, Asnairah Salpingectomy, Right Dr. Abdusalam, Celso R. Borces, R.N
2009 Anesthesia and R.N., MAN
Adneosiolysis
Hospital

Mindanao
Debalucos, Ma. Cholecystectomy with Spinal Epidural Sanitarium Emmanuel C. Evalyn Lecciones, R.N.,
2 June 15, 2010 107357 Cholelithiasis Dr. Joseph Daroy
Victoria IOC (cholongioram) Anesthesia and Hechanova, R.N MAN
Hospital
Mindanao
Cystoscopy,
October 20, Lindongan, Spinal Dr. Omar Sanitarium Jandy Lou Tagolgol,
3 188748 Bladder Mass T/C TCCA Transurethral Resection On call
2010 Magandia Anesthesia Burungawan and R.N
of Bladder Tumor
Hospital
Debridement, Open
Mindanao
Reduction and
November 17, Sanitarium Sheilma Dreamy
4 189588 Radto, Azimah Fracture Open Type III-B Radius Application of External Axillary Block Dr. Abad Erwin jay Resabal, R.N
2010 and Manata, R.N., MAN
Fixation Right, Tendon
Hospital
Repair Right
Mindanao
Delivered Alive baby girl in
November 17, Cesarean Section with Spinal Epidural Sanitarium Jandy Lou Tagolgol, Sheilma Dreamy
5 154829 Baguio, Bessie Operative Delivery, G8P5P6 38- Dr. Yu
2010 Bilateral Tubal ligation Anesthesia and R.N Manata, R.N., MAN
39 weeks transverse in Labor
Hospital

Prepared by: Concurred by: Noted by: Approved by:

Muamir A. Alingan______ ____________________________________ _________________________________________ __________________________________

Signature over Printed Name
Signature over Printed Name of Chief Nurse
Date Signed: _________________________
Degree: _____________________________
a.) PRC No. ____________________
Valid Until: _________________
b.) PNA No. ____________________
Valid Until: _________________
c.) ANSAP No. _________________
Valid Until: _________________
Signature over Printed Name of Clinical Coordinator
Date Signed: _______________________________
Degree: ___________________________________
a.) PRC No. ____________________________
Valid Until: __________________________
b.) PNA No. ____________________________
Valid Until: __________________________
Signature over Printed Name of Dean
Date Signed: _______________________
Degree: ___________________________
a.) PRC No. ____________________
Valid Until: __________________
b.) PNA No. ____________________
Valid Until: __________________
c.) PRC No. ____________________
Valid Until: __________________
 MINOR OPERATIONS

Date of Type of Name of Name of O.R. Scrub

8 Case No. Name of Patient Diagnosis Operation Performed Name of Surgeon Name of C.I.
Operation Anesthesia Hospital Nurse
Lanao del
August 28, Suturing of Open Wound at Left Local Dr. Grace joy Norte Edgar Anthony Y.
1 007295 Fernandez, Glenn Suturing Wilma Oliveros, R.N
2009 upper lip Anesthesia Yańez Provincial Mascardo, R.N., MAN
Hospital
Mindanao
Mahilom, Jheane Local Sheilma Dreamy
2 April 26, 2010 000014 Cleft Lip Cheiloplasty Dr. Butch Mapayo Sanitarium Juliver Job Garcia, R.N
Claude Anesthesia Manata, R.N., MAN
and Hospital
Mindanao
Local Sheilma Dreamy
3 April 26, 2010 000086 Sarri, Rosalyn Bilateral Cleft Lip Bilateral Cheiloplasty Dr. Cembrano Sanitarium Juliver Job Garcia, R.N
Anesthesia Manata, R.N., MAN
and Hospital
Kolambuga
Panimdim, Re-suturing, Incision Local Tristan Jediah V. David Rillera, R.N.,
4 June 28, 2010 5110705 Hematoma formation at left Leg Dr. Glenn Fuentes n District
Warlito M. and Drainage Anesthesia Labitad, R.N MAN (CAR)
Hospital
Mindanao
Maito, Lacerated Wound Sole Left foot 3 Debridement of Left Local Dr. Abner Dela Emmanuel C. Carley Quidet, R.N.
5 July 13, 2010 169976 Sanitarium
Pundaodaya ½ inches foot Anesthesia cruz Hechanova, R.N MAN (CAR)
and Hospital

Prepared by : Concurred by : Noted by : Approved by :

Muamir A. Alingan ______ ____________________________________ __________________________________________ __________________________________

Signature over Printed Name
Signature over Printed Name of Chief Nurse
Date Signed: ________________________
Degree: ____________________________
a.) PRC No. ____________________
Valid Until: _________________
b.) PNA No. ____________________
Valid Until: _________________
c.) ANSAP No. _________________
Valid Until: _________________
Signature over Printed Name of Clinical Coordinator
Date Signed: _______________________________
Degree: ___________________________________
a.) PRC No. ____________________________
Valid Until: __________________________
b.) PNA No. ____________________________
Valid Until: __________________________
Signature over Printed Name of Dean
Date Signed: _______________________
Degree: ___________________________
a.) PRC No. ____________________
Valid Until: __________________
b.) PNA No. ____________________
Valid Until: __________________
c.) PRC No. ____________________
Valid Until: __________________
 ACTUAL DELIVERIES

Supervised by :
Case Name of Date of Time of Gender of Name of Type of
No. Diagnosis Age Name & Signature of
No. Mother Delivery Delivery Baby Hospital Delivery
Qualified C.I.
PUFT Delivery Spontaneous an
Lanao del Norte Normal Spontaneous
1 003724 alive Bb. Girl Cephalic weight Serenio, Marivic 30 June 23, 2010 12:00 NN Female Christopher jem Botanas, R.N
Provincial Hospital Vaginal Delivery
2.4 kg G5P5
Delivered Live Birth Bb. Boy
Mindanao
birth weight 7.5 lbs. APGAR Nejarda, Lynneh Normal Spontaneous
2 189453 24 November 17, 2010 12:54 AM Male Sanitarium and Primitive Santias, R.N., MAN
Score 8,10 by Normal Michelle Delivery
Hospital
Spontaneous Delivery
PUFT Spontaneous Delivery an Normal Spontaneous
Magbanwa, Jean Lanao del Norte
3 004200 Alive Bb. Girl, Cephalic weight 20 December 17, 2010 2:01 PM Female Vaginal Delivery On call
Rose F. Provincial Hospital
2.65 kg G1P1 with Episiotomy
PUFT Spontaneous Delivery an
Lanao del Norte Normal Spontaneous
4 002408 Alive Bb. Boy, Cephalic weight Ebcay, Faith U. 25 December 21, 2010 1:15 AM Male On call
Provincial Hospital Delivery
3.8 kg G3P3
PUFT Normal Spontaneous Normal Spontaneous
Francisco, Genalyn Lanao del Norte
5 004209 Delivery an Alive Bb. Boy, 35 December 21, 2010 3:03 AM Male Delivery with On call
A. Provincial Hospital
Cephalic weight 2.5 kg G1P1 Episiotomy

Prepared by: Concurred by: Noted by: Approved by:

_______________________ ____________________________________ __________________________________________ __________________________________

Signature over Printed Name
Signature over Printed Name of Chief Nurse
Date Signed: ________________________
Degree: ____________________________
a.) PRC No. ____________________
Valid Until: _________________
b.) PNA No. ____________________
Valid Until: _________________
c.) ANSAP No. _________________
Signature over Printed Name of Clinical Coordinator
Date Signed: _______________________________
Degree: ___________________________________
a.) PRC No. ____________________________
Valid Until: __________________________
b.) PNA No. ____________________________
Valid Until: __________________________
Signature over Printed Name of Dean
Date Signed: _______________________
Degree: ___________________________
a.) PRC No. ____________________
Valid Until: __________________
b.) PNA No. ____________________
Valid Until: __________________
c.) PRC No. ____________________
 Valid Until: _________________ Valid Until: __________________

DELIVERIES ASSISTED

Date of Time of Gender Name of Type of Supervised by :

No. Case No. Diagnosis Name of Mother Age
Delivery Delivery of Baby Hospital Delivery Name & Signature of Qualified C.I.
Normal
G1P1 PUFT Delivery Lanao del Norte
Spontaneous
1 000934 Spontaneous Alive Abne, Marilyn 35 December 13, 2009 12:40 AM Female Provincial Jofelle Cayaco, RN
Vaginal
Baby Girl Cephalic Hospital
Delivery
Normal
PUFT Delivery Lanao del Norte
Spontaneous
2 010770 Spontaneous Alive Ladlad, Joy 26 January 4, 2010 12:47 PM Female Provincial Jofelle Cayaco, RN
Vaginal
Baby Girl Cephalic Hospital
Delivery
Normal
Gregorio T.
Spontaneous
3 070426 PUFT in Labor Mocado, Rodelyn 19 April 1, 2010 11:25 AM Male Lluch Medical Primitive Santias,RN, MN
Vaginal
Hospital
Delivery
Normal
PUFT Delivery
Spontaneous
Spontaneous to an Kolambugan
4 0013557 Dandoy, Marichu B. 23 April 12, 2010 8:45 AM Male Delivery Phillip Caesar B. Baguio, RN
Alive Baby Boy, weight District Hospital
with
6 lbs., Cephalic, G1P0
Episiotomy
Normal
Mindanao Spontaneous
5 188494 Caparoso, Glendie 23 October 12, 2010 1:06 PM Male Sanitarium and Delivery On call
Hospital with
Episiotomy

Prepared by : Concurred by : Noted by : Approved by :

_______________________ ____________________________________ __________________________________________ __________________________________

Signature over Printed Name
Signature over Printed Name of Chief Nurse
Date Signed : ________________________ _
Degree : ____________________________ _
a.) PRC No. ____________________
Valid Until: _________________
b.) PNA No. ____________________
Valid Until: _________________
c.) ANSAP No. _________________
Valid Until: _________________
Signature over Printed Name of Clinical Coordinator
Date Signed : _______________________________
Degree : ___________________________________
a.) PRC No. ____________________________
Valid Until: __________________________
b.) PNA No. ____________________________
Valid Until: __________________________
Signature over Printed Name of Dean
Date Signed : _______________________
Degree : ___________________________
a.) PRC No. _______________________
Valid Until: _____________________
b.) PRC No. _______________________
Valid Until: _____________________
c.) PRC No. _______________________
Valid Until: _____________________
 CORD CARE

Supervised by :
No. Case No. Name of Mother Age Date of Delivery Gender of Baby Name of Hospital
Name & Signature of Qualified C.I.
1 0012918 Tomimbang, Janice 23 Feruary 16, 2010 Male Kolambugan District Hospital Daverly Caneda, RN

2 0159968 Ventures, Romelyn 39 June 22, 2010 Female Lanao del Norte Provincial Hospital Christopher Jem Botanas, RN
December 17,
3 021309 Palma, Janna Grace R. 18 Male Lanao del Norte Provincial Hospital On call
2010
December 17,
4 021326 Pikitpikit, Elenita A. 42 Male Lanao del Norte Provincial Hospital On call
2010
December 25,
5 021572 Burlado, Jocelyn M. 33 Male Lanao del Norte Provincial Hospital On call
2010

Prepared by : Concurred by : Noted by : Approved by :

_______________________ ____________________________________ __________________________________________ ___________________________________

Signature over Printed Name
Signature over Printed Name of Chief Nurse
Date Signed : ________________________
Degree : ____________________________
a.) PRC No. ____________________
Valid Until: _________________
b.) PNA No. ____________________
Valid Until: _________________
c.) ANSAP No. _________________
Valid Until: _________________
Signature over Printed Name of Clinical Coordinator
Date Signed : _______________________________
Degree : ___________________________________
a.) PRC No. ____________________________
Valid Until: __________________________
b.) PNA No. ____________________________
Valid Until: __________________________
Signature over Printed Name of Dean
Date Signed : _______________________
Degree : ___________________________
a.) PRC No. ____________________
Valid Until: __________________
b.) PRC No. ____________________
Valid Until: __________________
c.) PRC No. ____________________
Valid Until: __________________