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Zamboanga City Medical Center, Zamboanga City: Surgical Procedure Performed

A student named Eirees Joy Atilano Mendoza performed a surgical scrub and observed a completion curettage procedure at the Zamboanga City Medical Center on December 15, 2014 from 5:10 pm. The procedure was supervised by clinical instructor Angeline R. Cuizon, RM, RN, MN. The form documents the student's participation and is signed by the clinical coordinator, operating nurse, clinical instructor, and dean of the college of nursing.

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Edmund Rufino
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58 views

Zamboanga City Medical Center, Zamboanga City: Surgical Procedure Performed

A student named Eirees Joy Atilano Mendoza performed a surgical scrub and observed a completion curettage procedure at the Zamboanga City Medical Center on December 15, 2014 from 5:10 pm. The procedure was supervised by clinical instructor Angeline R. Cuizon, RM, RN, MN. The form documents the student's participation and is signed by the clinical coordinator, operating nurse, clinical instructor, and dean of the college of nursing.

Uploaded by

Edmund Rufino
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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O.R.

Form 1B
O.R. CIRCULATING FORM
Minor

ATENEO DE ZAMBOANGA UNIVERSITY


La Purisima Street, Zamboanga City, Philippines
Tel. No.(63)(62)991-0871 to 76/Fax No. (63)(62) 0010870/E-mail: http://mail.adzu.edu.ph/Website: www.adzu.edu.ph
Accreditation by: PAASCU and CHED Accredited Level III/ Year Granted: May 05, 2008-2013
SURGICAL SCRUB in ZAMBOANGA CITY MEDICAL CENTER, ZAMBOANGA CITY
Hospital, Municipality/ City/ Province

Prepared by:
Name of Student: MENDOZA, EIREES JOY ATILANO
Date Performed
and
Time Started

Patients Initials

December 15, 2014

B.B.

5:10 pm

Case Number

789148

Noted by:
JOSEPHINE JUDITH PERANO-ALFORTE, RN, MN
Clinical Coordinator
PRC I.D. No. 0112157
Valid Until: 2016
PNA I.D. No. 2014-029901
Valid Until: 2014

Signature of Student__________________________

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


Name and Signature

SUPERVISED BY:
Clinical Instructor
Name and Signature

Completion Curettage

Maria Victoria T. Reyes


RM, RN

Angeline R. Cuizon
RM, RN, MN

Approved by:
MARIA LORNA BELLO-PABER, RN, MAN
Dean
PRC I.D. No. 0059150
Valid Until: 2016
PNA I.D. No. 6141
Valid Until: Lifetime Member
ADPCN No. 11-056

Valid Until: 2014

Date document is signed: _______________________ Time: ______________


Highest Degree Earned: MASTER IN NURSING

Date document is signed: ________________________ Time: __________


Highest Degree Earned: MASTER OF ARTS IN NURSING

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