Professional Documents
Culture Documents
Institute of Nursing
Old National Road, City of Bian, Laguna (049) 511-9359 loc 312 Tele fax (02) 520-6749 www.smcl.edu.ph
SURGICAL SCRUB in Hospital, Municipality/City/Province Prepared by: Name of Student Date Performed and Time Started Patients Name Case Number Signature of Student
PROCEDURE PERFORMED
Major Operation
Noted by: Administrator, PRC ID No. PNA No. 2012-033209 Date document is signed: Highest Nursing Degree Earned:
Smyrnah D.M Roque Valid Until 0187365 Valid Until October 31, 2012 Time MAN
8-9-14
Concurred by: Chief Nurse, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
SURGICAL SCRUB in Hospital, Municipality/City/Province Prepared by: Name of Student Date Performed and Time Started Patients Name Case Number Signature of Student
PROCEDURE PERFORMED
Minor Operation
Noted by: Administrator, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
Concurred by: Chief Nurse, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
IMMEDIATE NEWBORN CARE in Hospital, Municipality/City/Province Prepared by: Name of Student Date Performed and Time Started Patients Name Case Number Signature of Student
PROCEDURE PERFORMED
Noted by: Administrator, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
Concurred by: Chief Nurse, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
ACTUAL DELIVERY in Hospital, Municipality/City/Province Prepared by: Name of Student Date Performed and Time Started Patients Name Case Number Signature of Student
PROCEDURE PERFORMED
Noted by: Administrator, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
Concurred by: Chief Nurse, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
ASSISTED DELIVERY in Hospital, Municipality/City/Province Prepared by: Name of Student Date Performed and Time Started Patients Name Case Number Signature of Student
PROCEDURE PERFORMED
Noted by: Administrator, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned:
Concurred by: Chief Nurse, PRC ID No. PNA No. Date document is signed: Highest Nursing Degree Earned: