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UNION CHRISTIAN COLLEGE
Widdoes St., San Fernando City, 2500 La Union OR Form 1A

(072) 700-09-06, (072) 888-33-40, www.ucc.edu.ph O.R. SCRUB FORM
ACCREDITED BY: ACSCU-AAI LEVEL III (2015-2020)
Major
SURGICAL SCRUB in ILOCOS TRAINING AND REGIONAL MEDICAL CENTER, Parian, San Fernando City, La Union
Prepared by: ___________________

Darlyn Hernandez Peralta
Patient's INITIAL only

Date Performed and Time O.R. Nurse On Duty SUPERVISED BY Clinical
SURGICAL PROCEDURE PERFORMED
Started Case Number (Name & Signature only) Instructor Name and Signature
April 08, 2019 M.B. Emergency Primary Low Transverse Caesarian ________________ ______________
8:57 am 2016-0113041 Section Mariss Campos, RN Only Hufana, RN
April 02, 2019 J.O. ___________________ ______________

11:29 am 2010-0014958 Mesh Herniorraphy, Left Mark Arthur Galera, RN Rodel Suyat, RN
April 01, 2019 R.D. Open Osteoclasis Fibula, Closed Reduction Internal _____________________ ______________
12:10 pm 2018-0045494 Fixation, Left Charie Mae Mapanao, RN Only Hufana, RN
_____________________ ______________________
Noted by: CHARMAINE S. ABENES Approved by: MARITES B. CADAM-US
Focal Person, RLE PRC # 0266421 Valid Until 08/06/2020 Dean, PRC # 0250177 Valid Until 10/21/2021
Date Document is signed: _________ Time _____________ Date Document is signed: ________ Time ______________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
UNION CHRISTIAN COLLEGE OR Form 1B
Widdoes St., San Fernando City, 2500 La Union O.R. CIRCULATING
(072) 700-09-06, (072) 888-33-40, www.ucc.edu.ph FORM
SURGICAL CIRCULATING in ILOCOS TRAINING AND REGIONAL MEDICAL CENTER, Parian, San Fernando City, La Union
F
Prepared by: ______________________ FORM O.R.
Darlyn Hernandez Peralta MINOR FORM

Date Performed and Time O.R. Nurse On Duty SUPERVISED BY Clinical Instructor
SURGICAL PROCEDURE PERFORMED
Started Case Number (Name & Signature only) Name and Signature
April 08, 2019 M.O. ______________

12:05 pm 2010-0029275 Total Thyroidectomy Sandra Kaye Calica, RN Only Hufana, RN
April 01, 2019 A.D. Open Reduction Internal Fixation with Tension ______________
7:38 am 2019-0009924 Band Wiring Olecrenon, Left Mark Anthony Advincula, RN Only Hufana, RN
March 25, 2019 R.O. Emergency Low Transverse Cesarean Section _______________________ ______________
11:25 pm 2017-0034240 John Andrew K. Palacay, RN Rodel Suyat, RN
_____________________ ______________________
Date Document is signed: _________ Time _____________ Date Document is signed: ________ Time ______________
UNION CHRISTIAN COLLEGE D. R. FORM
Widdoes St., San Fernando City, 2500 La Union ACTUAL DELIVERY
ACTUAL DELIVERY in ILOCOS TRAINING AND REGIONAL MEDICAL CENTER PARIAN, SAN FERNANDO CITY, LA UNION
Prepared by: ___________________

Abdul Jalil Salnay Naga

D.R. Nurse on Duty (Name &
Date Performed and Time Case Number (not applicable SUPERVISED BY Clinical Instructor
PROCEDURE PERFORMED Signature) (If Midwife on Duty,
Started for Birthing/Lying-In Name and Signature
Signature not Required)
Clinics/Homes)
September 16, 2019 M.S. Normal Spontaneous Delivery __________________ ___________________

12:29 pm 2019-0029269 Jamaeca Lagrana, RN Charmaine Abenes, RN
September 10, 2019 C.C. Normal Spontaneous Delivery with Right _______________________ ___________________
9:18 am 2019-0012050 Mediolateral Episiotomy Kristi Anne Erika Ramos, RN Charmaine Abenes, RN
September 03, 2019 M.G. Normal Spontaneous Delivery __________________ _____________

9:25 am 2019-0030918 Alphine Descargar, RN Only Hufana, RN
July 4, 2019 M.D. Normal Spontaneous Delivery __________________ ___________________

7:38 am 2002-0102577 Jamaeca Lagrana, RN Charmaine Abenes, RN
April 1, 2019 G.C Normal Spontaneous Delivery with Right __________________ ___________________
2:55 pm 2019-0008726 Mediolateral Episiotomy Alphine Descargar, RN Charmaine Abenes, RN
_____________________ _____________________
Date Document is signed: _________ Time ______________ Date Document is signed: _________ Time _____________
UNION CHRISTIAN COLLEGE ICNB FORM
Widdoes St., San Fernando City, 2500 La Union IMMEDIATE CARE OF
(072) 700-09-06, (072) 888-33-40, www.ucc.edu.ph THE NEWBORN FORM
i
IMMEDIATE NEWBORN CORD CARE in ILOCOS TRAINING AND REGIONAL MEDICAL CENTER, PARIAN, SAN FERNANDO CITY, LA UNION
Prepared by: ___________________________
Kristine Casandra Yenco Corpuz
Date Performed Patient’s INITIAL only Immediate Newborn Cord Care PERFORMED Nurse on Duty (Name & SUPERVISED BY
and Indicate where performed e.g. D.R., Nursery, NICU, Signature) Clinical Instructor
Case Number
Time Started or Home (If Midwife on Duty, Signature ( Name and Signature)
(not applicable for Birthing not Required)
Homes/Lying-In Clinics/Homes)
March 04, 2019 Baby Boy R. _____________________ ___________________

09:32 am 2019-0007583 Operating Room Magerlie Ann Alvior, RN Fatima Carsola, PhD
April 22, 2019 Baby Boy P. ____________________ _______________________

09:26 am 2019-0013617 Delivery Room Magerlie Ann Alvior, RN Sandra Jane Acosta, RN
May 06, 2019 Baby Boy A. ____________________ ______________________

10:20 am 2019-0015424 Delivery Room Magerlie Ann Alvior, RN Sandra Jane Acosta, RN
May 07, 2019 Baby Boy O. __________________ ____________________

11:03 am 2019-0015563 Operating Room Marlee Nisperos, RN Only Hufana, RN, Man
May 07, 2019 Baby Girl M. Delivery Room ____________________ ___________________

12:57 pm 2019-0015573 Mary Jane Acebedo, RN Only Hufana, RN, Man
_____________________ ______________________
Date Document is signed: _________ Time ______________ Date Document is signed: ________ Time ______________
UNION CHRISTIAN COLLEGE D. R. FORM
Widdoes St., San Fernando City, 2500 La Union ASSIST DELIVERY
ASSIST DELIVERY in ILOCOS TRAINING AND REGIONAL MEDICAL CENTER PARIAN, SAN FERNANDO CITY, LA UNION
Prepared by: ___________________
Abdul Jalil Salnay Naga

Case Number (not D.R. Nurse on Duty (Name &
Date Performed and Time SUPERVISED BY Clinical Instructor
applicable for PROCEDURE PERFORMED Signature) (If Midwife on Duty,
Started Name and Signature
Birthing/Lying-In Signature not Required)
Clinics/Homes)
September 10, 2019 A.M. Normal Spontaneous Delivery with Right _______________________ ___________________
11:10 am 2019-0016455 Mediolateral Episiotomy Kristi Anne Erika Ramos, RN Charmaine Abenes, RN
September 3, 2019 R.B. __________________ _____________

1:24 pm 2018-0006800 Normal Spontaneous Delivery Alphine Descargar, RN Only Hufana, RN
September 2, 2019 E.N. Normal Spontaneous Delivery with Right __________________ ___________________
11:11 am 2007-0013847 Mediolateral Episiotomy Alphine Descargar, RN Charmaine Abenes, RN
July 5, 2019 M.B. Normal Spontaneous Delivery with Right __________________ ___________________
10:51 am 2019-0022968 Mediolateral Episiotomy Jamaeca Lagrana, RN Charmaine Abenes, RN
March 19, 2019 C.P. Normal Spontaneous Delivery with Right _________________________ ___________________
8:30 am 2019-0005737 Mediolateral Episiotomy Krisha Audrey Joy Obando, RN Charmaine Abenes, RN
_____________________ _____________________
Date Document is signed: _________ Time ______________ Date Document is signed: _________ Time _____________

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UNION CHRISTIAN COLLEGE

Widdoes St., San Fernando City, 2500 La Union OR Form 1A

Prepared by: ___________________

Patient's INITIAL only

April 02, 2019 J.O. _____

Patient's INITIAL only

April 08, 2019 M.O. ______________

Prepared by: ___________________

Patient's INITIAL only

September 16, 2019 M.S. Normal Spontaneous Delivery _

September 03, 2019 M.G. Normal Spontaneous Delivery ______ _

July 4, 2019 M.D. Normal Spontaneous Delivery _

March 04, 2019 Baby Boy R. ___ _

April 22, 2019 Baby Boy P. ___

May 06, 2019 Baby Boy A. __

May 07, 2019 Baby Boy O. __

May 07, 2019 Baby Girl M. Delivery Room __ _

Patient's INITIAL only

September 3, 2019 R.B. ______ _

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