RLE Manual Edited
RLE Manual Edited
RLE Manual Edited
At the termination of the course, this book will attest the entire Related Learning Experience of the student.
LEVEL II MASTER PLAN OF STUDENT'S RELATED LEARNING EXPERIENCE
AY 2019-2020
University of Cebu Medical Center St. Vincent General Hospital Visayas Community Medical Center
OPD OPD OPD
DR DR DR
Nursery Nursery Nursery
Pedia Pedia Pedia
OB/Gyne OB/Gyne OB/Gyne
University of Cebu Medical Center St. Vincent General Hospital Visayas Community Medical Center
ER ER ER
OR
OB/Gyne
INTERDEPARTMENTAL CLEARANCE
Number of
Date of Area of Instructor’s Date of Clearance
Institution Shift Rotation Grade Tardiness and
Assignment Assignment Signature and Remarks
Absences
INTERDEPARTMENTAL CLEARANCE
Number of
Date of Area of Instructor’s Date of Clearance
Institution Shift Rotation Grade Tardiness and
Assignment Assignment Signature and Remarks
Absences
INTERDEPARTMENTAL CLEARANCE
Number of
Date of Area of Instructor’s Date of Clearance
Institution Shift Rotation Grade Tardiness and
Assignment Assignment Signature and Remarks
Absences
REPLACEMENT/ COMPLETION DUTIES
No. Date Patient’s Name Age Time of Sex of Type of Attending Supervising Evaluator’s Name
Delivery Newborn Delivery Physician Instructor’s and Signature
Name and
Signature
SUMMARY OF ASSISTED DELIVERIES
No. Date Patient’s Name Age Time of Type of Attending Physician Supervising Evaluator’s Name
Delivery Delivery Instructor’s Name and Signature
and Signature
1111
No. Date Patient’s Name Age Parity BOW Ruptured Attending Supervising Evaluator’s Name
Time Physician Instructor’s and Signature
Name and
Signature
Name of Client Case No. Age Parity Address Method Accepted Supervising
Instructor’s Name
and Signature
ANTEPARTUM
1.
2.
3.
4.
5.
POST PARTUM
1.
2.
3.
4.
5.
Major Scrub Date Name of Patient Case Surgery Diagnosis Surgeon Remarks
No. Number Performed
Major Scrub Date Name of Patient Case Surgery Diagnosis Surgeon Remarks
No. Number Performed
(Circulating
Nurse)
Minor Scrub Date Name of Patient Case Surgery Diagnosis Surgeon Remarks
No. Number Performed
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
STUDENT’S PROGRESS REPORT
Inclusive Dates Agency Clinical Instructor’s Notes on Inclusive Agency Clinical Instructor’s Notes on
and Student’s Performance Dates and Student’s Performance
Assigned Area Assigned Area
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Parity : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
Anesthesia : __________________________________________________________
OB – Resident : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
(Show computation of EDC, LMP and AOG at the back of this page)
DELIVERY ROOM CASES
Age : __________________________________________________________
Address : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Diagnosis : __________________________________________________________
__________________________________________________________
__________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
OB Score : __________________________________________________________
Sex : __________________________________________________________
Religion : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
____________________ ____________________
Signature of Wife Signature of Husband
Age : __________________________________________________________
Address : __________________________________________________________
OB Score : __________________________________________________________
Sex : __________________________________________________________
Religion : __________________________________________________________
LMP : __________________________________________________________
EDC : __________________________________________________________
AOG : __________________________________________________________
____________________ ____________________
Signature of Wife Signature of Husband
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
____________________ ____________________
Level Chairperson Evaluator
OPERATING ROOM CASES
SCRUB
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________
Age : __________________________________________________________
Address : __________________________________________________________
Anesthesiologist : __________________________________________________________