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DEE HWA LIONG COLLEGE FOUNDATION Sapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac,Duquit, Mabalacat, Pampanga___________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition – March 21__________ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
I. Major Operations
No.Date of
OperationCase No.
Name of Patient
Diagnosis Operation PerformedType of
AnesthesiaName of Surgeon
Name of HospitalName of
O.R. Scrub Nurse
Signature of O.R. Scrub Nurse
1.Colloidal Adenomatous
Goiter LeftTotal Lobectomy Left Thyroid Gland
General Anesthesia
Dr. Allan M. Magday
Jose B. Lingad Memorial Regional Hospital
Elizabeth L. Lazatin, RN
2.Diabetes Milletus Foot
Gangrene LeftAbove Knee Amputation
Spinal Anesthesia
Dr. Julius C. Bumadilla
Jose B. Lingad Memorial Regional Hospital
Marissa C. Fronda, RN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION Sapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student _ __________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
I. Major Operations
No.Date of
OperationCase No.
Name of Patient
Diagnosis Operation PerformedType of
AnesthesiaName of Surgeon
Name of HospitalName of
O.R. Scrub Nurse
Signature of O.R. Scrub Nurse
3.
Gravida 4, Para 4, Pregnancy Uterine 38
5/7 weeks Age of Gestation, Previous
Cessarean Section 3x2˚ Hydrocephalus in beginning labor
Emergency, Classical Cessarean Section III
Spinal Anesthesia
Dra. Daisy May L. Santos
Jose B. Lingad Memorial Regional Hospital
Mark Louie S. Puyat, RN
Prepared by: Noted by: Concurred by: Approved by:
__________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 7368_____________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION Sapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: __________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition - March 21___________ Number: HER-023 ___________Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
I. Major Operations
No.Date of
OperationCase No.
Name of Patient
Diagnosis Operation PerformedType of
AnesthesiaName of Surgeon
Name of HospitalName of
O.R. Scrub Nurse
Signature of O.R. Scrub Nurse
4.
Gravida 2, Para 2, Status post Low
Segment Cessarean Section
Low Segment Cessarean Section II
Spinal Anesthesia
Dr. Reynaldo S. Alipio
Escolastica Romero District Hospital
Elvira A, Morales, RN
5. Gallbladder Stone CholecystectomySpinal and intravenous Anesthesia
Dr. Jaime P. Flores
Escolastica Romero District Hospital
Elvira A. Morales, RN
Prepared by: Noted by: Concurred by: Approved by:
__________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: July 2008_____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 11901_______________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008______ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: __________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition_- March 21_________ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
II. Minor Operation
No.Date of
OperationCase No.
Name of Patient DiagnosisOperation Performed
Type of Anesthesia
Name of Surgeon
Name of HospitalName of O.R. Scrub Nurse
Signature of O.R. Scrub
Nurse
1.Post Partum Gravida 3,
Para 3,Bilateral Tubal
LigationLocal
AnesthesiaDra. Jaimie A. Ocampo
Jose B. Lingad Memorial Regional
Hospital
Ma. Josefina S. Basilio, RN
2.Prolapsed Submucus
MyomaFructional Curretage
Spinal Anesthesia
Dra. Imelda S. Calonzo
Jose B. Lingad Memorial Regional
Hospital
Marissa C. Fronda, RN
3.Acute Appendicitis
Suppurative AppendixEmergency
AppendectomySpinal
AnesthesiaDr. Julius C. Bumadilla
Jose B. Lingad Memorial Regional
Hospital
Marissa C. Fronda, RN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN__ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
II. Minor Operation
No.Date of
OperationCase No.
Name of Patient DiagnosisOperation Performed
Type of Anesthesia
Name of Surgeon
Name of HospitalName of O.R. Scrub Nurse
Signature of O.R. Scrub
Nurse
4.
Gravida 1, Para 1, Pregnancy Uterine Full term, Delivered spontaneously to a live baby
boy
Right Mediolateral episiotomy +
repair
Local Anesthesia
Dr.Zennon V. Ponce
Escolastica Romero District Hospital
Cristina S. Lagman, RN
5. Uncircumcised Penis CircumcisionLocal
AnesthesiaDra. Carlota M. Gutierres
Escolastica Romero District Hospital
Jane L. Barrera RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
_________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No.: 0254235________________ a.) PRC No.: 57881_____________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. :1901________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008_____ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition - March 21__ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
V. Cord Dressing
No.Case No.
Date Performed
Name of BabyGender of
BabyName of Mother Age Name of Hospital
Supervised by:Name & Signature of Qualified C.I.
1. Baby Boy Peralta Male 37 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN
2.Baby Boy
DuinagraciaMale 41 y/o Escolastica Romero District Hospital
Agnes N.Alipio RN, MAN3. Baby Boy Pagusan Male 26 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No.: 0254235_______________ a.) PRC No.: 57881______________ a.) PRC No. 0054482______________ Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________ b.) PNA No.: 43057_________________ b.) PNA No.: 11901________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008___ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition - March 21____ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
V. Cord Dressing
No.Case No.
Date Performed
Name of BabyGender of
BabyName of Mother Age Name of Hospital
Supervised by:Name & Signature of Qualified C.I.
4. Baby Boy Asures Male 35 y/o Jose B. Lingad Memorial Regional Hospital Nerissa A. Mercado, RN, MAN
5. Baby Boy Sulano Male 28 y/o Jose B. Lingad Memorial Regional HospitalNerissa A. Mercado, RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
___________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 7368_______________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until:Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga___________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
III. Actual DeliveriesNo.
Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of Hospital Type of DeliverySupervised by:
Name & Signature of Qualified C.I.
1.
Gravida 3, Para 3, Pregnancy Uterine delivered spontaneously
to a live baby boy, 39 weeks Age of Gestation, cephalic
September 18, 2006
2:17 pm MaleJose B. Lingad
Memorial Regional Hospital
Normal Spontaneous
DeliveryAnna Jane B. Lozano RN,
MAN
2.
Gravida 7, Para 6, Pregnancy Uterine delivered spontaneously
to a live baby boy, 40 weeks Age of Gestation, cephalic
November 15, 2007
1: 50 pm MaleJose B. Lingad
Memorial Regional Hospital
Normal Spontaneous
DeliveryAnna Jane B. Lozano RN,
MAN Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328________________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang_Maisac, Duquit, Mabalacat, Pampanga __________________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition- March 21__ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
III. Actual DeliveriesNo.
Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of HospitalType of Delivery
Supervised by: Name & Signature of
Qualified C.I.
3.
Gravida 3, Para 3, Pregnancy Uterine delivered spontaneously to a live baby boy 38 – 39 weeks
Age of Gestation, cephalic
MaleEscolastica Romero
District Hospital
Normal Spontaneous
Delivery
Cynthia F. Deogracias, RN, MAN
4.
Gravida 1, Para 1, Pregnancy Uterine delivered spontaneously to a live baby boy 40 weeks Age
of Gestation, cephalic
MaleEscolastica Romero
District Hospital
Normal Spontaneous
Delivery
Cynthia F. Deogracias, RN, MAN
5.
Gravida 1, Para 1, Pregnancy Uterine delivered spontaneously to a live baby girl 40 weeks Age
of Gestation, cephalic
FemaleEscolastica Romero
District Hospital
Normal Spontaneous
Delivery
Cynthia F. Deogracias, RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008__ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized: Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
IV. Deliveries AssistedNo.
Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of Hospital Type of DeliverySupervised by:
Name & Signature of Qualified C.I.
1.Gravida 3, Para 3, Pregnancy
Uterine delivered spontaneously to a live baby girl
FemaleJose B. Lingad
Memorial Regional Hospital
Normal Spontaneous
DeliveryAnna Jane B. Lozano RN,
MAN Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328_______________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 6378________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: _Lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
IV. Deliveries AssistedNo.
Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of HospitalType of Delivery
Supervised by: Name & Signature of
Qualified C.I.
2.
Gravida 2, Para 2, Pregnancy Uterine delivered spontaneously to a live baby boy 40 weeks Age
of Gestation, cephalic
MaleEscolastica Romero
District Hospital
Normal Spontaneous
DeliveryCynthia F. Deogracias,
RN, MAN
3.
Gravida 1, Para 1, Pregnancy Uterine delivered spontaneously to a live baby boy 39 - 40 weeks
Age of Gestation, cephalic
MaleEscolastica Romero
District Hospital
Normal Spontaneous
Delivery
Cynthia F. Deogracias, RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008____ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATIONSapang Maisac, Duquit, Mabalacat, Pampanga
Name of Student: ___________________________________________________________________________________________________Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _______________________________ Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________Date School/ Program was Recognized:Government Recognition- March 21__ _ Number: HER-023 ___________ Year: 2007_____________________First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________ Year Graduated (BSN Program): 2008________________________________________________________________________________________________________
IV. Deliveries AssistedNo.
Case No. DiagnosisName of Mother
AgeDate of
DeliveryTime of Delivery
Gender of Baby
Name of HospitalType of Delivery
Supervised by: Name & Signature of
Qualified C.I.
4.
Gravida 1, Para 1, Pregnancy Uterine delivered spontaneously to a live baby girl 38-39 weeks
Age of Gestation, cephalic
Female Escolastica Romero District Hospital
Normal Spontaneous
DeliveryCynthia F. Deogracias,
RN, MAN
5.
Gravida 1, Para 1, Pregnancy Uterine delivered spontaneously to a live baby girl 39 - 40 weeks
Age of Gestation, cephalic
FemaleEscolastica Romero District Hospital
Normal Spontaneous
Delivery
Cynthia F. Deogracias, RN, MAN
Prepared by: Noted by: Concurred by: Approved by:
____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator NurseDate Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________ Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________ Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________ b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________ Valid Until: December 2008__________ Valid Until: December 2008 ___ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________Valid Until: 2008 _________________