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MANILA DOCTORS HOSPITAL

RECORD OF OPERATION
astName: First Name: Middle Name: MRN: Room/Bed#:
LAPRY RAYO 2| 7444|
Date of Birth: Citizenship:
Age: Religion: +1LIPHO
Second Assistant:
Surgeon: First Assistant:
. lcM) oLALIA/ DA.PHUPCAATHODk. 6kA NAaNG
Anesthesiologist: Assistant: #o#E
Time ended:
Anesthetic: Method: Time began: 0q004
bUPINA CAHB Time Operation Ended:
Circulating Nurse: Instrument Nurse: Tlme Operation Started:
LBNAY ACA PULCO
Pre-operative Diagnosis:

Operative Diagnosis:

Operation Performed:
PostyanhyAd Drains:

Classification: Specimen:
Major
Minor
OPERATIVE TECHNIQUE
Fppw65

pOSInon
Pohend In jak IKhifU R
DroKoslagldoky vnk diapta ipering ldchiea
Acpis orgscpak. inscd.EX*rnal
L

Anat rcnacor0/0att Me inKrnas operNg HOSPITAL


WAMILADOCORS
ond puobd
SOEPARTJET
Anal pau blaud. Paheut tolelar
a pwXAAUU
ACALKZ
etKAGN
iMARY GRCEw
HEH pRINT NAME
JAN 29. 0
DATE
CERTIFIED TRUE COPY

Setahet la, 2023


Date (day/month/year)
name
Surgeon signature over printed
NNS-F-027, B
00012003

PAGE 10F 2
HMR-F-023, B
Page 0301/2023

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