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WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C.. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
I. MAJOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
1 11:20Am 12:45pm Novemb
er 26,2009
15348 Renayong, Norlia Primary LowTransverse
Caesarian Section
Spinal Henrietta Lucasan The DoctorsHospital
Incorporated
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO BELLE PAPARON MA. LOURDES B. MAGBANUA EDITA BAYONETA HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _ ____________ Date Signed__________________ Date Signed: _ ____________ Date Signed: _ ________Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: CN, RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0086493 a) PRC No.: 0157222 a) PRC No.: 0125661 a) PRC No.: 0056974
Valid Until: August 22, 2010 Valid Until: September 21, 2010 Valid Until: August 08, 2012 Valid Until:November 15, 2011
b) PNA No.: 10553 b) PNA No.: 9706 b) PNA No.: 19677 b) PNA No.: 045219
Valid Until: Lifetime Valid Until: Lifetime Valid Until: Lifetime ValidOctober 31, 2010
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WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
I. MAJOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
2 11:35am 1:25pm January 3, 2010 10-005 Barrios, Reynald ExploratoryLaparotomy;Evacuation of
massiveHemoperitonium;Jejunorrhaphy;Copious Lavage;
Drain
GeneralEndotrachealAnesthesia
Jose Libo-on III Teresita LopezJalandoni Provinc
Hospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO RAFAEL MARMOLEJO MA. LOURDES B. MAGBANUA MA. TERESA O. SEVERINO HELEN V. CORNAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _ ____________ Date Signed__________________ Date Signed: _ ____________ Date Signed: _ ________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0260390 a) PRC No.: 0157222 a) PRC No.: 0101938 a) PRC No.: 0056974
Valid Until: June 27, 2010 Valid Until: September 21, 2010 Valid Until: April 27, 2011 Valid Until:November 15, 2011
b) PNA No.: 045285 b) PNA No.: 9706 b) PNA No.: 17418 b) PNA No.: 045219
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Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C.. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
I. MAJOR SCRUBS
No.
Time
Started
Time
Ended
Date of
Operation
Case
No. Name of Patient
Operation
Performed Type of Anesthesia Name of Surgeon Name of Hospit3 7:05am 8:15am January 17,
2010011527
34Millana, Mary Appendectomy,
Pelvic LaparotomySalpingo
Oophorectomy
GeneralEndotrachealAnesthesia
Morata Exmundo Corazon LocsiMontelibano
Memorial RegionHospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO ALBIE L. DUMASIS MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _ ____________ Date Signed__________________ Date Signed: _ ____________ Date Signed: _ ________
Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0367755 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Val id Unti l: Apri l 15, 2011 Val id Until : September 21, 2010 Val id Unti l: May 24, 2011 Valid Until :November 15, 2011
b) PNA No.: 021547 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
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WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBS
COLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
I. MAJOR SCRUBS
No. TimeStarted TimeEnded Date ofOperation CaseNo. Name of Patient OperationPerformed Type of Anesthesia Name of Surgeon Name of Hospit
4 8:15am 10:10am March 10, 2010 01216091
Javellana, Louela TotalThyroidectomy with
RecurrentLaryngeal Nerve
Preservation
General Marie Manganti Corazon LocsiMontelibano
Memorial RegionHospital
5 1:10pm 3:05pm March
10, 2010 01217621
Rotas, Kim Outer Dental Orif-Mandibular
Maxillary Fixation
General Chad Hilado Corazon LocsiMontelibano
Memorial RegionHospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO TRINA PANTALEON MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _ ____________ Date Signed__________________ Date Signed: _ ____________ Date Signed: _ ________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed D
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Place: Bacolod City a) PRC No.: 0461440 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974Valid Until: March 22, 2013 Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:
November 15, 2011b) PNA No.: 044577 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219
Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: ___________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
II. MINOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
1 7:30pm 7:45pm May 23, 2009 41591 Lamis, Loreto Suturing WoundLeft Forehead
Local Jose Libo-on III Teresita LopezJalandoni Provinc
Hospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO FERRER T. GO MA. LOURDES B. MAGBANUA MA. TERESA O. SEVERINO HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0378916 a) PRC No.: 0157222 a) PRC No.: 0101938 a) PRC No.: 0056974
Valid Until: December 21, 2011 Valid Until: September 21, 2010 Valid Until: April 27, 2011 Valid Until: Novemb15, 2011
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b) PNA No.: 021555 b) PNA No.: 9706 b) PNA No.: 17418 b) PNA No.: 045219Valid Until: _October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: ___________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros University
Accreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002Year Graduated from the BSN Program: 2010
II. MINOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
2 1:55PM 2:00PM June 29, 2009 01119006
Pulao, Juditha CompletionCurettage
IntravenousSedation
April Gentugaya Corazon LocsiMontelebano
Memorial RegionHospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO ROSELYN D. GERIA MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________
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Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 01434420 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: May 13, 2011 Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:November 15, 2011
b) PNA No.: 012541 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: December 31, 2009 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: ___________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros University
Accreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002Year Graduated from the BSN Program: 2010
II. MINOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
3 3:20am 3:25am January 28,2010
01154620
Linco, FrancelleRillane
Close Reduction;Application of LongArm Posterior Mold,
Right
IntravenousSedation
Ian Villar Corazon LocsiMontelibano
Memorial RegionHospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MARILYN P. ORTALIZ MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________
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Date: February 25, 2010 Degree: RN, MAN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0337642 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: November 6, 2013 Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until: Novemb15, 2011
b) PNA No.: 045719 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: _October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: ___________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros University
Accreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002Year Graduated from the BSN Program: 2010
II. MINOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
4 3:30pm 3:40pm 01156837
Galdo, Niko Suturing of Wound Local Gladys Pailano Corazon LocsiMontelibano
Memorial RegionHospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO CLAIRE CASTRO MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________
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Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed. D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:November 15, 2011
b) PNA No.: _____________ b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: ____________ Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: ___________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
II. MINOR SCRUBS
No.TimeStarted
TimeEnded
Date ofOperation
CaseNo.
Name of PatientOperationPerformed
Type of Anesthesia Name of Surgeon Name of Hospit
5
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO CLAIRE CASTRO MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEAN
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CTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed. D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0337642 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:November 15, 2011
b) PNA No.: _____________ b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: ____________ Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________
Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
III. ACTUAL DELIVERIES
No.CaseNo.
Diagnosis Name of Mother AgeDate ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
1 01119476
Pregnancy UterineFull Term Gravida 3
Para 3
Deocares, Nenita 35 June 29,2009
12:14 pm Male Corazon LocsinMontelibano
Memorial RegionalHospital
NormalSpontaneous
Vaginal Deliver
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO ROSELYN D. GERIA MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________
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Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0143420 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Val id Unti l: May 13, 2011 Valid Until : September 21, 2010 Val id Unti l: May 24, 2011 Valid Until :November 15, 2011
b) PNA No.: 012541 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: Decembaer 21,2009 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
III. ACTUAL DELIVERIES
No.CaseNo.
Diagnosis Name of Mother AgeDate ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
2 00-00-46
Pregnancy UterineFull Term Gravida 2
Para 2
Tormis, Lily Ann 33 December11, 2009
7:58 am Male Well Family MidwifeClinic Rosario
Mabini
NormalSpontaneous
Vaginal Deliver
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MA. CECILIA IGNALAGUE MA. LOURDES B. MAGBANUA HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEAN
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CTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:November 15, 2011
b) PNA No.: b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: Valid Until: Lifetime Valid Until: Lifetime Valid
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________
Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002Year Graduated from the BSN Program: 2010
III. ACTUAL DELIVERIES
No. Case No. Diagnosis Name of Mother AgeDate ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
3 01162070
Pregnancy UterineFull Term Gravida 5
Para 5
Cordero. Jocelyn 35 March 15,2010
2:18 pm Female Corazon LocsinMontelibano
Memorial RegionalHospital
NormalSpontaneous
Vaginal Deliver
4 01161890
Pregnancy UterineFull Term Gravida 3
Para 3
Bayles, Dorina 31 March 15,2010
5:36 pm Male Corazon LocsinMontelibano
Memorial RegionalHospital
NormalSpontaneous
Vaginal Deliver
5 001164031
Pregnancy UterineFull Term Gravida 1
Para 1
Angeles, Jennifer 20 March 28,2010
2:12 pm Female Corazon LocsinMontelibano
Memorial RegionalHospital
NormalSpontaneous
Vaginal Deliver
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Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MOLY V. CALAMAY MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0262640 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: November 6, 2012 Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:
November 15, 2011b) PNA No.: 044699 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219
Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
IV. ASISTED DELIVERIES
No.CaseNo.
Diagnosis Name of Mother AgeDate ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
1 01119498
Pregnancy UterineFull Term Gravida 4
Para 4
Canlas, Sally 28 June 29,2009
11:06 am Female Corazon LocsinMontelibano
Memorial RegionalHospital
NormalSpontaneous
Vaginal Deliver
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
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JOAN C. HERMOSO ROSELYN D. GERIA MA. LOURDES B. MAGBANUA JORESLYN P. BALA-AN HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _ ____________ Date Signed__________________ Date Signed: _ ____________ Date Signed: _ ________Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN, Ed D Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0143420 a) PRC No.: 0157222 a) PRC No.: 0091019 a) PRC No.: 0056974
Valid Until: May 13, 2011 Valid Until: September 21, 2010 Valid Until: May 24, 2011 Valid Until:November 15, 2011
b) PNA No.: 012541 b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219Valid Until: December 31, 2009 Valid Until: Lifetime Valid Until: Lifetime Valid Until:
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
IV. ASSISTED DELIVERIES
No. Case No. Diagnosis Name of Mother AgeDate ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
2 0900030
74
Pregnancy Uterine
Full Term Gravida 2Para 2
Cruz, Divina dela 27 July 23,
2009
1:00 am Baby Boy Normal
SpontaneousVaginal Delivery
3 090003080
Pregnancy UterineFull Term Gravida 2
Para 2
Medina, Margarette 25 July 23,2009
05:20 am Baby Girl NormalSpontaneousVaginal Delivery
-
8/8/2019 Joan Scrubs
15/19
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MA. CHERRYL C. GENERALES MA. LOURDES B. MAGBANUA HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: Degree: RN, MN, Ed D
Place: Bacolod City a) PRC No.: a) PRC No.: 0157222 a) PRC No.: a) PRC No.: 0056974Valid Until: Valid Until: September 21, 2010 Valid Until: Valid Until:
November 15, 2011b) PNA No.: b) PNA No.: 9706 b) PNA No.: 03079 b) PNA No.: 045219
Valid Until: Valid Until: Lifetime Valid Until: Lifetime ValidOctober 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBS
COLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
IV. ASSISTED DELIVERIES
No. CaseNo.
Diagnosis Name of Mother Age Date ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
4 09-3593 Pregnancy Uterine FullTerm Gravida 11 Para
11
Quianola, Mary Ann 33 August 24,2009
7:18 pm Female Teresita LopezJalandoni Provincial
Hospital
NormalSpontaneous
Vaginal Deliver
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8/8/2019 Joan Scrubs
16/19
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO RUTCHEL M. MONDIA MA. LOURDES B. MAGBANUA MA. TERESA O. SEVERINO HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN, MN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: a) PRC No.: 0157222 a) PRC No.: 0101938 a) PRC No.: 0056974
Valid Until: Valid Until: September 21, 2010 Valid Until: July 11, 2011 Valid Until: Novemb
15, 2011b) PNA No.: b) PNA No.: 9706 b) PNA No.: 17418 b) PNA No.: 045219
Valid Until: Valid Until: Lifetime Valid Until: Lifetime ValidOctober 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO, JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
IV. ASSISTED DELIVERIES
No. CaseNo.
Diagnosis Name of Mother Age Date ofDelivery
Time ofDelivery
Gender of Baby Name of Hospital Type of Deliver
5 28032 Gravida 3 Para 3 Malacon, Gina 40 March 6,2010
9:47 am Male The DoctorsHospital
Incorporated
NormalSpontaneous
Vaginal Deliver
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8/8/2019 Joan Scrubs
17/19
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MOLY V. CALAMAY MA. LOURDES B. MAGBANUA EDITA BAYONETA HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN, Degree: RM, RN, RT , MAN, Ph. D Degree: CN, RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: 0262640 a) PRC No.: 0157222 a) PRC No.: 0125661 a) PRC No.: 0056974
Valid Until: November 6, 2012 Valid Until: September 21, 2010 Valid Until: August 8, 2012 Valid Until:
November 15, 2011b) PNA No.: 044699 b) PNA No.: 9706 b) PNA No.: 19677 b) PNA No.: 045219
Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid Until:October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004
Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
V. CORD DRESSING
No.Case
No.
Date Performed Time of Delivery Gender of Baby Name of Mother Age Name of Hospital
1 09-6422 November 27, 2009 7:15 am Male Gamboa, Joy 31 Teresita Lopez JalandoniProvincial Hospital
2 09-6426 November 27, 2009 12:29 pm Male Gilotin, Meriam 32 Teresita Lopez JalandoniProvincial Hospital
3 09-6431 November 27,2009 3:39 pm Female Natabio, Ma. Jinky Teresita Lopez JalandoniProvincial Hospital
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8/8/2019 Joan Scrubs
18/19
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO HELEN A. PO MA. LOURDES B. MAGBANUA MA. TERESA O.SEVERINO HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.:0052508 a) PRC No.: 0157222 a) PRC No.: 0101938 a) PRC No.: 0056974
Valid Until: December 28, 2011 Valid Until: September 21, 2010 Valid Until: Aril 27. 2011 Valid Until: Novemb15, 2011
b) PNA No.: 032431 b) PNA No.: 9706 b) PNA No.: 17418 b) PNA No.: 045219Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime Valid
October 31, 2010
WEST NEGROS UNIVERSITY(Formerly WEST NEGROS COLLEGE) SPECIFIED FORMS & SCRUBSCOLLEGE OF NURSING As per PRC Resolution No. 357 Series 2004Burgos St., Bacolod City and PRC-BON Memorandum No. 01, S.2008
Name of Student: HERMOSO JOAN C. First Course (if any): ______________________________ Year: _________Date of School Program was Recognized: ____Effective_SY 1995 - 1996_______________ School Graduated from: West Negros UniversityAccreditation Level: _________________________________________________________ Year of Admission in the BSN Program: 2002
Year Graduated from the BSN Program: 2010
V. CORD DRESSING
No.CaseNo.
Date Performed Time of Delivery Gender of Baby Name of Mother Age Name of Hospital
4 09-300 November 29, 2009 8:45 am Male Villamero, Veronica 29 Dr. Jose C. Locsin MemorialMaternity Clinic
5 09-301 November 29, 2009 3:08 pm Female Piamonte, Roxanne 18Dr. Jose C. Locsin Memorial
Maternity Clinic
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8/8/2019 Joan Scrubs
19/19
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
JOAN C. HERMOSO MARICAR BEGASA MA. LOURDES B. MAGBANUA MA. TERESA O.SEVERINO HELEN V. CORREANAME OF EXAMINEE CLINICAL INSTRUCTOR CLINICAL COORDINATOR CHIEF NURSE DEANCTC Number: 06387976 Date Signed: _____________ Date Signed__________________ Date Signed: _____________ Date Signed: _________Date: February 25, 2010 Degree: RN Degree: RM, RN, RT, MAN, Ph. D Degree: RN, MN Degree: RN, MN, Ed DPlace: Bacolod City a) PRC No.: a) PRC No.: 0157222 a) PRC No.: 0101938 a) PRC No.: 0056974
Valid Until: Valid Until: September 21, 2010 Valid Until: Aril 27. 2011 Valid Until: Novemb15, 2011
b) PNA No.: b) PNA No.: 9706 b) PNA No.: 17418 b) PNA No.: 045219Valid Until: Valid Until: Lifetime Valid Until: Lifetime Valid
October 31, 2010
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