7/28/2019 PRC FORM_ OR

1/5

ANDRES BONIFACIO COLLEGECollege Park, Dipolog City, Philippines

Telephone No.(065) 212-9776/ Fax No. (065) 212-9178 / web-site: www.abcollege.edu.ph

Name of Student: CHARLITO C. LUAB JR.

SUMMARY OF MAJOR OPERATIONS ASSISTED (Scrub Nurse)

No.

Date of

Operationand

Time

Assisted

CaseNo.

Name

ofPatients

Initial(only)

DiagnosisOperationPerformed

Typeof

Anesthesia

Nameof

Surgeon

Nameof

Hospital

Name and Signatureof

O. R. Nurse

Supervised by:Name and Signature of C. I

1.

August 16,2012

4:59 P.M.

03-29-

38A. U.

Pregnancy uterinefull term 36 weeks

age of gestationplacenta previa

Primary lowsegment

transverse

cesarean sectionwith bilateral

tubal ligation

Spinal

Anesthesia

Dr.

Norman G.Silao

ZDSMCThelma A. Apatan, R.N.,

M.N., MPA

Shmesani Marie A. Alavanza

BSN, R.N., M.N.

2.

November

15, 20128:55 P.M.

03-74-64

M. G. Ectopic pregnancyPelvic laparotomy

right salpingo-

oophorectomy

SpinalAnesthesia

Dr. AvenidaVista

ZDSMC Thelma A. Apatan, R.N.,

M.N., MPA

Shmesani Marie A. Alavanza

BSN, R.N., M.N.

3.

November

17, 201210:40 A.M.

03-39-

92M. G. Prolapsed submucous

uterine myomaVaginal

MyomectomyGeneral

Anesthesia

Dr.

Norman G.Silao

ZDSMCThelma A. Apatan, R.N.,

M.N., MPAShmesani Marie A. Alavanza

BSN, R.N., M.N.

7/28/2019 PRC FORM_ OR

2/5

ANDRES BONIFACIO COLLEGECollege Park, Dipolog City, Philippines

Telephone No.(065) 212-9776/ Fax No. (065) 212-9178 / web-site: www.abcollege.edu.phCommission on Higher Education Region IX, Zamboanga Peninsula Government Recognition No. 002 Series of 2006

SURGICAL SCRUB in Zamboanga del Sur Medical Center, Pagadian City, Zamboanga del SurHospital/Municipality/City/Province

Prepared by:

Printed Name with Signature of Student: CHARLITO C. LUAB JR.

Date Performed

andTime Started

Patients Initial

(only)

Case Number

SURGICAL PROCEDURE PERFORMED O. R. Nurse on Duty

SUPERVISED BY:

Clinical InstructorName and Signature

August 16,

20124:59 P.M.

A. U.03-29-38

Primary low segment transversecesarean section with bilateral

tubal ligationThelma M. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N., M.N.

November 15,2012

8:55 P.M.

M. G.03-74-64

Pelvic laparotomy right salpingo-oophorectomy

Thelma M. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N., M.N.

November 17,

201210:40 A.M.

M. G.

03-39-92Vaginal Myomectomy Thelma M. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N., M.N.

Noted by: SHARON B. CABIGAS, R.N., M.N. Approved by: EVELYN A. LUNA, R.N., MPHClinical Coordinator, PRC I.D. No. 0349540Valid Until: March 16, 2013 Dean, PRC I.D. No. 0082222Valid Until: May 31, 2015Date Document is signed: Time: Date Document is signed: Time: _____________

Please Specify Highest Nursing Degree Earned: Master in Nursing Please Specify Highest Nursing Degree Earned: Master in Public Health

O. R. Form 1AO. R. SCRUB FORM

Major

7/28/2019 PRC FORM_ OR

3/5

ANDRES BONIFACIO COLLEGE

College Park, Dipolog City, PhilippinesTelephone No.(065) 212-9776/ Fax No. (065) 212-9178 / web-site: www.abcollege.edu.ph

Name of Student: CHARLITO C. LUAB JR.

SUMMARY OF MAJOR OPERATIONS ASSISTED (Circulating Nurse)

No.

Date of

Operationand

Time

Assisted

CaseNo.

Name

ofPatients

Initial(only)

DiagnosisOperationPerformed

Typeof

Anesthesia

Nameof

Surgeon

Nameof

Hospital

Name and Signatureof

O. R. Nurse

Supervised by:Name and Signature of C. I.

1.

May 22,2012

11:42A.M.

02-79-

17R. C. Cleft Palate Cheiloplasty

Local

Anesthesia

Dr.Joseph

Acosta/D

r. AuritoC.

Ampong

ZDSMC Thelma M. Apatan, R.N.,M.N., MPA

Shmesani Marie A. Alavanza, BSN,R.N., M.N.

2.

May 22,2012

6:40 P.M.

02-78-

63P. B.

Anterior neck

nodes withcolloidal

adenomatous

goiter

Subtotal

thyroidectomy

General

Anesthesia

Dr. Eric

Talens/Dr. Al

Jamiri

Radjid

ZDSMCThelma M. Apatan, R.N.,

M.N., MPA

Shmesani Marie A. Alavanza, BSN,

R.N., M.N.

3.

May 22,

201210:48P.M.

02-78-69

S. A. CalculousCholecystitis

CholecystectomyGeneral

Anesthesia

Dr. Eric

Talens/Dr. Al

Jamiri

Radjid

ZDSMCThelma M. Apatan, R.N.,

M.N., MPAShmesani Marie A. Alavanza, BSN,

R.N., M.N.

7/28/2019 PRC FORM_ OR

4/5

ANDRES BONIFACIO COLLEGECollege Park, Dipolog City, Philippines

Telephone No.(065) 212-9776/ Fax No. (065) 212-9178 / web-site: www.abcollege.edu.phCommission on Higher Education Region IX, Zamboanga Peninsula Government Recognition No. 002 Series of 2006

SURGICAL SCRUB in Zamboanga del Sur Medical Center, Pagadian City, Zamboanga del SurHospital/Municipality/City/Province

Prepared by:

Printed Name with Signature of Student: CHARLITO C. LUAB JR.

Date Performed

andTime Started

Patients Initial

(only)

Case Number

SURGICAL PROCEDURE PERFORMED O. R. Nurse on Duty

SUPERVISED BY:

Clinical InstructorName and Signature

May 22, 2012

11:42 A.M.R. C.

02-79-17Cheiloplasty Thelma A. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N.,

M.N

May 22, 20126:40 P.M.

P. B.

02-78-63Subtotal thyroidectomy Thelma A. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N.,

M.N.

May 22, 201210:48 P.M.

S. A.02-78-69

Cholecystectomy Thelma A. Apatan, R.N., M.N., MPA Shmesani Marie A. Alavanza, BSN, R.N.,

M.N.

Noted by: SHARON B. CABIGAS, R.N., M.N. Approved by: EVELYN A. LUNA, R.N., MPHClinical Coordinator, PRC I.D. No. 0349540Valid Until: March 16, 2013 Dean, PRC I.D. No. 0082222Valid Until: May 31, 2015Date Document is signed: Time: Date Document is signed: Time:

Please Specify Highest Nursing Degree Earned: Master in Nursing Please Specify Highest Nursing Degree Earned: Master in Public Health

O. R. Form 1BO. R. CIRCULATING

FORM

7/28/2019 PRC FORM_ OR

5/5