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Name of Registered Nurse     PRC Number __________________
Name of Hospital Offering IV Training      Provider No.  _______________
Date of IV Training Program Attended  !"#$      Venue %    

I.Ê Initializing/ Maintaining Peripheral IV Infusions

&'()*' &+)&'()*' ,) &') (+) (*-


./'(*
(') 01) 2) &')
(,*&'/)3)(*')-&+) (5)*2)
 &**/.& )'(()-&(*)4)5)1' 
[  MACARIO  OCTOBER  PLAIN NORMAL RIGHT GAUGE 
ARIMATEA YEARS    AM SALINE BASILIC VEIN  LITER gtts/min LEON C. BATUGAL RN MSN   

OLD SOLUTOIN
   MONICA DURIAN [ OCTOBER  PM PLAIN NORMAL RIGHT GAUGE 
YEARS    SALINE CEPHALIC  LITER gtts/min LEON C. BATUGAL RN MSN   

OLD SOLUTOIN VEIN


[ 
ROGELIO [ OCTOBER  PM PLAIN NORMAL RIGHT GAUGE
PASCUA YEARS    SALINE CEPHALIC [ LITER gtts/min LEON C. BATUGAL RN MSN   

OLD SOLUTOIN VEIN

II.Ê Administering Intravenous Drugs

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(,*&'/)3)(*')-&+) (5)*2)
 *51&')- )'(()-&(*)4)5)1' 
[  CHONA  YEARS OCTOBER [ AM FAMOTIDINE  mg DENGUE HEMORRHAGIC
ALLAPITAN OLD    FEVER STAGE LEON C. BATUGAL RN MSN   

[ 
ROGELIO PASCUA [ YEARS OCTOBER [ AM OMEPRAZOLE  mg UPPER GASTROINTESTINAL
OLD    BLEEDING PEPTIC ULCER   

DISEASE LEON C. BATUGAL RN MSN


   MONICA DURIAN [ YEARS OCTOBER AM CEFTRIAXONE gm PULMONARY NEW GROWTH
OLD      

LEON C. BATUGAL RN MSN


III.Ê Administering and Maintaining Blood Components

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[
 ARTEMIO [ OCTOBER  TYPE ³O´ RIGHT GAUGE [ ANEMIA
BORDEY YEARS    PACKED RED BLOOD METACARPAL   

OLD CELLS at gtts/min VEIN LEON C. BATUGAL RN MSN


  ROSITA ABELLA  OCTOBER  TYPE ³O´ LEFT GAUGE [ ANEMIA
YEARS    PACKED RED BLOOD METACARPAL SECONDARY TO
OLD CELLS at gtts/min VEIN OCCULT LEON C. BATUGAL RN MSN   

GASTROINTESTINAL
BLEEDING

Submitted By KENNEDY A. DELA CRUZ Date Submitted OCTOBER   Re eived By _____________________ Approved By OLIVIA SB. GONZALESRNRMMSNMAN
Dire tor of Nursing Servi es
Signature Over Printed Name