Embed Size (px)
Citation preview
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 1/7
UNIVERSITY OF PANGASINANCOLLEGE OF NURSING
Arellano St., Dagupan CityPhone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
I. MAJOR OPERATION
No.DATE of
OPERATION
TIME of OPERATION
STARTED-ENDED
PATIENT¶SINITIALS DIAGNOSIS OPERATION
PERFORMED
TYPE of ANESTHESI
ANAME of SURGEON NAME of
HOSPITALName & Sign
ClinicCASE NO.
1 May 5, 2010 12:25 pm-12:50 pmM.J.C
Status Post Partum, Normal SpontaneousDelivery, With VaginalLaceration, Gravid 2Para 2 (1-0-0-1)
Perineorrhaphy Local Dr. Frederick G. Lalas MapCHMaria Leah G. B00894
LEGEND: MapCH ± Mapandan Community Hospital
Noted by: ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011PNA No.: 029069 Valid Until: October 31, 2010_______ Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by: GRACE Z. JOVELIANOSChief Nurse
PRC I.D. No.: 0064042 Valid Until: SepPNA No.: 029073 Valid Until: OcDate document is signed:
Please specify Highest Nursing Degree Earned: BSN
Approved by: MARIA TERESA R. FAJARDean
PRC I.D. No.: 0160104 Valid Until: SepPNA No.: 013739 ________ Valid Until: OctADPCN No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Supervised by: MARIA LEAH G. BARANGAN Clinical Instructor
Date signed:Degree: BSN-RNPRC I.D. No.: 0392061 Valid Until: September 27, 2012PNA No.: 031851 Valid Until: October 31, 2010
NAME OF STUDENT: OVIEDO, Joan Ticsay
First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 2/7
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 3/7
UNIVERSITY OF PANGASINAN
COLLEGE OF NURSINGArellano St., Dagupan CityPhone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
II. MINOR OPERATION
No. DATE of OPERATION
TIME of OPERATION
STARTED-ENDED
PATIENT¶SINITIALS DIAGNOSIS OPERATION
PERFORMEDTYPE of
ANESTHESIA NAME of SURGEON NAME of HOSPITAL Qua
CASE NO.
1 June 8, 201012:25 pm-12:35 pm
K.C.DLacerated Wound
Right ArmSuturing Local Dr. Virginia C. Petrola LDH
Flor12419
LEGEND: LDH - Lingayen District Hospital (Primary)
Noted by: PROF. ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011PNA No.: 029069 ________ Valid Until: October 31, 2010Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by: Chief NursePRC I.D. No.: Valid Until:PNA No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Approved by: PROF. MARIA TERESA R. FAJARDean
PRC I.D. No.: 0160104 Valid Until: SeptemPNA No.: 013739 Valid Until: October ADPCN No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Supervised by: FLORENCE LOMIBAO Clinical Instructor
Date signed:Degree: ________ PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: OVIEDO, Joan Ticsay
First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 4/7
UNIVERSITY OF PANGASINANCOLLEGE OF NURSINGArellano St., Dagupan City
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph (Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
II. MINOR OPERATIONS
No. DATE of OPERATION
TIME of OPERATION
STARTED-ENDED
PATIENT¶SINITIALS DIAGNOSIS OPERATION
PERFORMEDTYPE of
ANESTHESIA NAME of SURGEON NAME of HOSPITAL
Name & SCli
CASE NO.
1 April 26, 20109:00 am-9:30 am N.D.T Redundant
PrepuceCircumcision Local Dr. Frederick G. Lalas MapCH
Maria Leah03944
2 April 29, 20102:00 pm-2:02 pm D.T.S Abscess Right
ThumbIncision And
Drainage None Dr. Erl danielsson P. Javier MapCH
Maria Leah03956LEGEND: MapCH - Mapandan Community Hospital (Primary)
Noted by: PROF. ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011
PNA No.: 029069 ________ Valid Until: October 31, 2010Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by: GRACE Z. JOVELIANOS
Chief NursePRC I.D. No.: 0064042 Valid Until: SePNA No.: 029073 Valid Until: OcDate document is signed: Please specify Highest Nursing Degree Earned: BSN
Approved by: MARIA TERESA R. FAJARDean
PRC I.D. No.: 0160104 Valid Until: Se
PNA No.: 013739 ________ Valid Until: OctADPCN No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Supervised by: MARIA LEAH G. BARANGAN Clinical Instructor
Date signed:
Degree: BSN-RNPRC I.D. No.: 0392061 Valid Until: September 27, 2012PNA No.: 031851 Valid Until: October 31, 2010
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 5/7
UNIVERSITY OF PANGASINAN
COLLEGE OF NURSINGArellano St., Dagupan CityPhone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
III. ACTUAL DELIVERIESNo. DIAGNOSIS
MOTHER¶S INITIALSAGE DATE of DELIVERY TIME of
DELIVERY GENDER of BABY TYPEof DELIVERY
NAME of HOSPITAL
Name CASE NO.
1Pregnancy Uterine
Full Term, 37 weeksAnd 1/7 days
V.B.M35 June 15, 2010 12:20 pm Baby Girl Normal Spontaneous
DeliveryManCH Florenc
2586
LEGEND: ManCH ± Manaoag Community Hospital
Noted by: PROF. ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011PNA No.: 029069 Valid Until: October 31, 2010Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by:Chief Nurse
PRC I.D. No.: Valid Until:PNA No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Approved by: PROF. MARIA TERESA R. FAJARDDean
PRC I.D. No.: 0160104 Valid Until: SeptPNA No.: 013739 Valid Until: OctADPCN No.: Valid Until:Date document is signed:
Please specify Highest Nursing Degree Earned:
Supervised by: FLORENCE LOMIBAO Clinical Instructor
Date signed:Degree: ________ PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 6/7
UNIVERSITY OF PANGASINAN
COLLEGE OF NURSINGArellano St., Dagupan CityPhone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
IV. ASSISTED DELIVERIESNo. DIAGNOSIS
MOTHER¶S INITIALSAGE DATE of
DELIVERY TIME of
DELIVERY GENDER of BABY TYPEof DELIVERY
NAME of HOSPITAL QuaCASE NO.
1
2
3
4
5
LEGEND:
Noted by: PROF. ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011PNA No.: 029069 Valid Until: October 31, 2010Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by:Chief Nurse
PRC I.D. No.: Valid Until:PNA No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Approved by: PROF. MARIA TERESA R. FAJARDDean
PRC I.D. No.: 0160104 Valid Until: SepPNA No.: 013739 Valid Until: OctADPCN No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Supervised by:Clinical Instructor
Date signed:Degree:PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
8/8/2019 Final Caseload Forms Blank (2)
http://slidepdf.com/reader/full/final-caseload-forms-blank-2 7/7
UNIVERSITY OF PANGASINANCOLLEGE OF NURSING
Arellano St., Dagupan CityPhone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: [email protected]; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)
V. IMMEDIATE NEWBORN CORD CARE
No. DATE PERFORMEDTIME OF
DELIVERYBABY¶S INITIALS
GENDER of BABY MOTHER¶S INITIALS AGE NAME of HOSPITAL QualCASE NO.
1 August 16, 2010 4:21 pmBaby R
Female K.S.R 26Bam10-09
LEGEND: Dr. Marcelo M. Chan Memorial Hospital
Noted by: PROF. ZENAIDA M. BAUTISTA Clinical Coordinator
PRC I.D. No.: 0133422 Valid Until: July 27, 2011PNA No.: 029069 Valid Until: October 31, 2010Date document is signed: Time:Please specify Highest Nursing Degree Earned:
Concurred by:Chief Nurse
PRC I.D. No.: Valid Until:PNA No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Approved by: PROF. MARIA TERESA R. FAJARDDean
PRC I.D. No.: 0160104 Valid Until: SepPNA No.: 013739 Valid Until: OctADPCN No.: Valid Until:Date document is signed: Please specify Highest Nursing Degree Earned:
Supervised by:Clinical Instructor
Date signed:Degree:PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
U
Prepared by:
JOAN T. OVIEDO Student
