ND-GP-019-1

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF HEALTH
ILOCOS TRAINING AND REGIONAL MEDICAL CENTER
SANFERNANDO CITY, LA UNION
NURSING SERVICE

NURSING ENDORSEMENT FORM

WARD OR UNIT: MEDICAL ANNEX 1ST FLOOR LEFT WING LAST CENSUS: ________
DATE: _03/26/2021 SHIFT:() 7AM-3PM () 3PM- 11PM (/) 11PM- 7AM
ROOM/ NAME OF PATIENT/ DIET IV FLUID/ PROCEDURE SPECIAL ENDORSEMENT
BED No. DIAGNOSIS BLOOD

PERALTA, LEONARDO

L103
BICYTOPENIA SOFT
PNSS X 8HRS
ERF
OPS 3/23NEGATIVE

OANDASAN LUZ
MELINDA NGT
SUBARRACHNOID 1600/ PNSS1 X 12
L104 HEMORRHAGE PROB SEC TO
RAPTURE ANEURYSM 6
OPNS 3/25/2021

L105

L106a
RAQUEDAN,
SAMSON
BAIE, COVID CONFIRMED LSLF PNSS1L X 16
OPNS 3/21/2021 POSITIVE

MONES, LEONARDO
L106
b DAT
CHF CAP MR
C PNSS X KVO
SAP
OPNS 3/11 POSITIVE
RPT OPNS 3/27 (-) CIF

FUENTES ROMEO
CAP MR
DAT
L106 PNSS X 16
OPNS 3/12 POSITIVE W/
C OPNS 3/18 POSITIVE HRS
SAP
RPT OPNS 3/26 (-) CIF

L106 SERNA JONATHAN

D CKD 5 SEC TO CGN COVID
CONFIRM
3/23/2021 POSITIVE DAT NO LINE

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 RUNAS, DARWIN DAT
L106E
Submultiple scalp laceration W/ NL
POSITIVE SAP

DE GUZMAN,
MARIANO
NGT
OF
L107 CNS INFXN. TB VS PNSSX 8HRS
1200/
BAC. MEN
6
OPS 3/23

CHAN, SOCORRO
AGE
L108 DAT PLRS X 8H
OPS 3/24

PRIVATE: DR. ASPIRAS

L109

L110

DUCUSIN, MELCHOR
CAP-MR, COPD, HPN LSLF PNSSX 16
OPS 3/25

NAME & SIGNATURE OF OUTGOING STAFF NAME & SIGNATURE OF INCOMING STAFF

SPECIAL ENDORSEMENT TO THE INCOMING SHIFT (pls update every now & then)
1. GLUCOMETER FOR JO – personal property of Maam Beth Cadaoas (CSR Staff)
2. DOOR @ ROOM L109 & R107 – still for JOB ORDER, no available doorknob accdg. To
MAINTENANCE
3. MEMO PHIC REQ.- for D/C patient Req. as ff: MED SHEET, TPR, V/S MON SHEET, I/O
SHEET with the cases of: CAP MR, UTI, AGE & SEPSIS

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 ND-GP-019-1

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF HEALTH
ILOCOS TRAINING AND REGIONAL MEDICAL CENTER
SANFERNANDO CITY, LA UNION
NURSING SERVICE

NURSING ENDORSEMENT FORM

WARD OR UNIT: MEDICAL ANNEX 1ST FLOOR RIGHT WING LAST CENSUS: ______
DATE: 03/25/2021 SHIFT: () 7AM-3PM ( ) 3PM- 11PM (/) 11PM- 7AM

ROOM/
NAME OF PATIENT/
BED DIET IV FLUID/ BLOOD PROCEDURE SPECIAL ENDORSEMENT
DIAGNOSIS
No.

R 100
LRDR
OB

CALIBUSO LOURDES
BAIAE CAP MR COVID
R101
SUSPECT
DAT PNSS1L X 16
OPNS 3/24/2021

R 102

ARBOLLENTE
DOLORES
R 103 HAP BICYTOPENIA PROB MDS DAT PNSS1L X 16
APLASTIC ANEMIA COVID
SUSPECT
OPNS 3/24/2021

SOTELO FRANCISCO
CAP MR PTB
PLRS X 12H
R104 DM
OPNS 3/16 NEGATIVE

OPNS 3/23 POSITIVE

R105

GUTIEREZ, MARIBEL MGH-STEPDOWN

R 106
A DAT D5LRS X8H
OPNS 3/25 POSITIVE

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 NEBRES, ESTRELLA
PNSS X 16
LSLF W/
R106 B CVD PROB. INF
SAP SD: NICARD-
HOLD
OPS 03/20/2021POSITIVE

R106C

GACUSANA
DALMACIO
PULMO MASS RIGHT PROB
MALIGNANT WITH PROB BONE AND
R107 LUNG METASTASIS SCC SEC R/O DAT PNSS1L X 160
PTB R/O POH OBSTRUCTIVE
PNEUMONIA TO CONSIDER
OPNS 3/25/2021

R108

CASTILLO, ROSITA
HL
R109 CAP-MR, HPN UD

OPNS 3/25

DUCLAYAN FATIMA PNSS1L X 16

NON HEALING WOUND

R110 A DM
OPNS 3/24/2021

NAME & SIGNATURE OF OUTGOING STAFF NAME & SIGNATURE OF INCOMING STAFF

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