Office Acronym PED

FM-QMS-007
VALENZUELA MEDICAL CENTER Page/s
Rev 2 – 03/01/17
1 of 2
DEPARTMENT OF PEDIATRICS
Revision Number 3
MASTERLIST OF FORMS
Effectivity Date As of March 1, 2017

Forms No. Forms Title Person Responsible Effectivity Date

FM-PED-002 Performance Evaluation Form for Pediatric Residents Pediatric Consultants 03/17/2014

FM-PED-003 Evaluation Form for Case Presentation of Residents Pediatric Consultants 03/17/2014

FM-PED-004 Schedule of Residents Pediatric Residents 08/04/2014

FM-PED-005 Newborn Deliveries Pediatric Residents 08/04/2014

FM-PED-006 Patient Data Collection Form Pediatric Residents 08/04/2014

FM-PED-007 Endorsement Form (Obsolete) Pediatric Residents 02/15/2016

FM-PED-008 Case Presentation Form(Junior Interns) Pediatric Consultants/Residents 02/15/2016

FM-PED-009 Focused/Small Group Discussion(Junior Interns) Pediatric Consultants/Residents 02/15/2016

FM-PED-010 OSCE Evaluation Form Pediatric Consultants/Residents 02/15/2016

FM-PED-011 Case Presentation or Management/ Grand Rounds Form Pediatric Consultants 02/15/2016
(Resident Performance Assessment Scale)
FM-PED-012 Technical Evaluation Tool Residents Applicant Pediatric Consultants 02/15/2016

FM-PED-013 Mini-Clinical Evaluation Exercise (mini-CEx) form Pediatric Consultants 02/15/2016

FM-PED-014 Case-Based Discussion(CBD) Form Pediatric Consultants 02/15/2016

Prepared by: Approved by:

HIYASMIN M. LIM, MD, FPPS, FPSAAI MARY GRACE H. REYES, MD, MPH, MMHA, FPSMS, FPDS
Chair, Pediatrics Department Chief of Medical Professional Staff II
 Office Acronym PED
FM-QMS-007
VALENZUELA MEDICAL CENTER Page/s
Rev 2 – 03/01/17
2 of 2
DEPARTMENT OF PEDIATRICS
Revision Number 3
MASTERLIST OF FORMS
Effectivity Date As of March 1, 2017

FM-PED-015 Focused Small Group Discussion Pediatric Consultants 02/15/2016

FM-PED-017 OPD Summary Weekly Report Pediatric Residents 02/15/2016

FM-PED-018 Maternal and Newborn Record Pediatric Residents 02/15/2016

FM-PED-019 Pediatric Data Base Pediatric Residents/Junior Interns 06/10/2016

FM-PED-020 Pediatric Emergency Medical Record Chart Pediatric Residents/Junior Interns 06/10/2016

FM-PED-021 Pediatric Out Patient Form(Old Patient) Pediatric Residents/Junior Interns 06/10/2016

FM-PED-022 Pediatric Out Patient Form(New Patient) Pediatric Residents/Junior Interns 06/10/2016

FM-PED-023 Monthly Census Report Pediatric Residents 05/01/2017

FM-PED-024 Annual Research Output Pediatric Residents 05/01/2017

FM-PED-025 Pediatric Pre-Operative Evaluation Form Pediatric Residents/Junior Interns 05/01/2017

FM-PED-026 Adolescent History & Physical Exam for 10-18 years/364 days of Age Pediatric Residents/Junior Interns 05/01/2017

FM-PED-027 Blood Cultures and Sensitivity Report Pediatric Residents 05/01/2017

Prepared by: Approved by:

HIYASMIN M. LIM, MD, FPPS, FPSAAI MARY GRACE H. REYES, MD, MPH, MMHA, FPSMS, FPDS
Chair, Pediatrics Department Chief of Medical Professional Staff II