Ateneo De ZamboangaUniversity

College of Nursing


Name:
Level:
Section:

MAJOR (SCRUB)

DATE/
CASES
AREA CASE NUMBER

PATIENT'S NAME/
AGE/GENDER

OPERATION
PERFORMED
CLINICAL
INSTRUCTOR/
SIGNATURE
MAY 20,2013

1
ZCMC 28657 H.P.A.
40/Female
Low tranverse caesarean
section,extracted an alive baby
boy at 7:15am with apgar
score of 9

HelenP.abiera,
RN,MN

September12,2013

2
Doctors Hosp. 65434 E.R. Mastectomy,Left
EvaRelao
,RN,MN
October1,2013

3
WMCC 12345 E.R. Herniorrhapy with mesh,Left
GisellaClimaco
Nov.2,2014

4






MAJOR(CIRCULATING)

DATE/
CASES
AREA CASE NUMBER

PATIENT'S NAME/
AGE/GENDER

OPERATION
PERFORMED
CLINICAL
INSTRUCTOR/
SIGNATURE

















MINOR(SCRUB)

DATE/
CASES
AREA CASE NUMBER

PATIENT'S NAME/
AGE/GENDER

OPERATION
PERFORMED
CLINICAL
INSTRUCTOR/
SIGNATURE






MINOR (CIRCULATING)
DATE/
CASES
AREA CASE NUMBER

PATIENT'S NAME/
AGE/GENDER

OPERATION
PERFORMED
CLINICAL
INSTRUCTOR/
SIGNATURE