LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

I. Major Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital Supervised by:

Name/Signature of Qualified C.I.

1 July 8, 2010 182392 Marjorie Benesen Abaya

Pregnancy Uterine Delivery to an alive baby boy Meconium Stain classical II Gravida 2 Parity 2

(2002)

Classical Caesarian Section Spinal Anesthesia Dr. Victoriano Rosario Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

2 July 9, 2010 182263 Violeta Carolino Corilla

Partial Colonic Obstruction Secondary to Rectosigmoid New

Growth

Exploratory Laparotomy, Hartman’s Operation

Spinal Anesthesia Dr. Jose Cacho Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

3 July 16, 2010 182633-R Monette Bautista Dacones

Pregnancy Uterine Full Term Previous Caesarian Section Delivery to an alive baby boy

Gravida 2 Parity 2 (2002)

Low Transverse Caesarian Section II

Spinal Anesthesia Dr. Fidelez Ochave Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

4 July 30, 2010 183195 Ariel Pulusan Dayao Mandibular Fracture Open Reduction with Internal Fixation, Plating

General Anesthesia Dr. Ronnie Mamaril Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

MA. CONCEPCION H. MIRANDA Chief NurseWestern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N a). PRC No. : 0068019 Valid Until : March 26, 2011 b). PNA No. : 10441 Valid Until : Lifetime c). ANSAP No. : 0374 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA P. CARRERA Qualified Faculty Western Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0311104 Valid Until : March 21, 2012 b). PNA No. : 061983 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

I. Major Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital Supervised by:

Name/Signature of Qualified C.I.

1 September 18, 2010 11-17-79 Mercedita Nacion Cinco Closed Spiral Fracture Femur Left Open Reduction with Internal

Fixation, Plating Spinal

Anesthesia Dr. Salvador Rodrigo Eastern Pangasinan District Hospital Mrs. Rosalie Marron

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

ROSALIA R. MATEO Chief NurseEastern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N. a). PRC No. : 0099313 Valid Until : September 14, 2012b). PNA No. : 12125 Valid Until : Lifetime c). ANSAP No. : 0491 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Eastern Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

II. Minor Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of HospitalSupervised by:

Name/Signature of Qualified C.I.

1 July 22, 2010 182852-R Irene Ignacio Garcia

Pregnancy Uterine Full Term, Cephalic delivered to an alive

baby boy( Family Planning Acceptor Gravida 4 Parity 4 (4004)

Bilateral Tubal Ligation Pomeroy

Technique

Sub-Arachnoid Block Dr. Fedelez Ochave Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

2 July 30, 2010 183167 Euseeff Delia Mirante

Acute Appendicitis, Suppurative Stage

Emergency Appendectomy

Peritoneal MoppingSpinal Anesthesia Dr. Jose Cacho Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

3 July 30, 2010 183174 Mary Jahl A. Rabara

Final Family Complete Bilateral Tubal Ligation (Family Planning

Acceptor Gravida 4 Parity 3 (40030

Bilateral Tubal Ligation Pomeroy

TechniqueLocal Anesthesia Dr. Macaraeg Western Pangasinan

District Hospital Mrs. Violeta Gutierrez

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

MA. CONCEPCION H. MIRANDA Chief NurseWestern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N a). PRC No. : 0068019 Valid Until : March 26, 2011 b). PNA No. : 10441 Valid Until : Lifetime c). ANSAP No. : 0374 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA P. CARRERA Qualified Faculty Western Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0311104 Valid Until : March 21, 2012 b). PNA No. : 061983 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

II. Minor Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of HospitalSupervised by:

Name/Signature of Qualified C.I.

1 January 22, 2010 29407 Arvin Torio Lacerated Wound 6 centimeter at Left Frontal Area Suturing Local Anesthesia Dr. Leo Bautista Region 1 Medical Center Mr. Herminigildo Bumacod Jr.

2 January 29, 2010 49164 Jojo Mercado Lacerated Wound 6 centimeter Parieto Occipital at Right Area Suturing Local Anesthesia Dr. Mayeen Fernandez Region 1 Medical Center Mr. Herminigildo Bumacod Jr.

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

ROSAURO P. CATABAY OIC - Chief NurseRegion I Medical CenterDate signed : Degree : B.S.N.R.N., M.AN. a.) PRC No. : 0157085 Valid Until : October 28, 2010 b.) PNA No. : 12121 Valid Until : Lifetime c.) ANSAP No. : 0498 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA G. FAMA Qualified Faculty Region I Medical CenterDate signed : Degree : B.S.N., R.N.,M.A.N. a). PRC No. : 0282241 Valid Until : January 5, 2013 b). PNA No. : 16919 Valid Until : Lifetime

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

II. Minor Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of HospitalSupervised by:

Name/Signature of Qualified C.I.

1 February 6, 2010 03854 Lovely Joy C. De Vera Abscess Right Foot Incision and

Drainage Local Anesthesia Dr. Earl Javier Mapandan Community Hospital Mrs. Grecilda Oclay

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

GRACE Z. JOVELLANOS Chief NurseMapandan Community HospitalDate Signed : Degree : R.N., M.A.N. in progressa) PRC No. : 0064042 Valid Until : September 16, 2011b) PNA No. : 013853 Valid Until : October 31, 2010 c) ANSAP No. : 09-0050 Valid Until : December 31, 2010_

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Mapandan Community HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

II. Minor Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of HospitalSupervised by:

Name/Signature of Qualified C.I.

1 March 23, 2010 3-1523110 Gwen Dela Cruz Soriano

Gravida 1 Parity 0 (0010) Abortion Incomplete

Completion Curettage Local Anesthesia Dr. Josephine Guiang Lingayen District Hospital Ms. Marie Kris Santos

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

LANI CRUZ Chief Nurse Lingayen District HospitalDate signed : a). PRC No. : 0131408 Valid Until : November 25, 2010 b). PNA No. : 029075 Valid Until : December 31, 2010 c). ANSAP No. : 090082 Valid Until : December 31, 2010

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA P. CARRERA Qualified Faculty Lingayen District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0311104 Valid Until : March 21, 2012 b). PNA No. : 061983 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITYCollege of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

III. Actual Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of Delivery

Gender of Baby Name of Hospital Type of Delivery

Supervised by:Name/Signature of

Qualified C.I.

1 02620Pregnancy Uterine Full Term 39 weeks Age of

Gestation, Cephalic delivered to an alive baby boy Gravida 1 Parity 1 (1001)

Lara Pinto Vinluan 18 December 22, 2009 12:20 am Male Mapandan Community

HospitalNormal Spontaneous

Delivery Ms. Jessiel Santorum

2 00294Pregnancy Uterine Full Term 39 weeks Age of

Gestation, Cephalic delivered to an alive baby girl Gravida 1 Parity 1 (1001)

Marilou T. Poscablo 19 February 5, 2010 10:12 am Female Mapandan Community

HospitalNormal Spontaneous

Delivery Mrs. Grecilda Oclay

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

GRACE Z. JOVELLANOS Chief NurseMapandan Community HospitalDate Signed : Degree : R.N., M.A.N. in progressa) PRC No. : 0064042 Valid Until : September 16, 2011b) PNA No. : 013853 Valid Until : October 31, 2010 c) ANSAP No. : 09-0050 Valid Until : December 31, 2010_

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Mapandan Community HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITYCollege of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

III. Actual Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of Delivery

Gender of Baby Name of Hospital Type of Delivery

Supervised by:Name/Signature of

Qualified C.I.

1 180009Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 12

Parity 11 (110111)

Nilda De Guzman Lacibal 40 April 12, 2010 2:10 pm Male Western Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Violeta Gutierrez

2 182467Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 1

Parity 1 (1001)

April Corpuz Montemayor 17 July 10, 2010 2:09 pm Male Western Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Violeta Gutierrez

3 183164Pregnancy Uterine 36-37 weeks Age of Gestation, Cephalic delivered to alive an

baby girl Gravida 1 Parity 1 (1001)

Ailyn Bagonza Delizo 17 July 30, 2010 11:38 am Female Western Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Violeta Gutierrez

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

MA. CONCEPCION H. MIRANDA Chief NurseWestern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N a). PRC No. : 0068019 Valid Until : March 26, 2011 b). PNA No. : 10441 Valid Until : Lifetime c). ANSAP No. : 0374 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA P. CARRERA Qualified Faculty Western Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0311104 Valid Until : March 21, 2012 b). PNA No. : 061983 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

IV. Assisted Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of

DeliveryGender of

Baby Name of Hospital Type of DeliverySupervised by:

Name/Signature of Qualified C.I.

1 10-88-38Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 1

Parity 1 (1001)

Precy H. Ferrer 23 September 9, 2010 10:15 pm Male Eastern Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Rosalie Marron

2 11-23-13Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 3

Parity 3 (3003)

Bevilyn Vicente Dilan 34 September 25, 2010 8:42 pm Male Eastern Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Rosalie Marron

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

ROSALIA R. MATEO Chief NurseEastern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N. a). PRC No. : 0099313 Valid Until : September 14, 2012b). PNA No. : 12125 Valid Until : Lifetime c). ANSAP No. : 0491 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Eastern Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

IV. Assisted Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of

DeliveryGender of

Baby Name of Hospital Type of DeliverySupervised by:

Name/Signature of Qualified C.I.

1 183109Pregnancy Uterine Full Term, Cephalic

delivered to an alive baby girl, Pre-eclampsia Gravida 1 Parity 1 (1001)

Magelyn Mendez Biguas

20 July 30, 2010 7:59 am Female Western Pangasinan District Hospital

Normal Spontaneous Delivery Mrs. Violeta Gutierrez

2 183226Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 2

Parity 2 (2002)

Arlyn Abella Adanza 33 July 31, 2010 2:20 pm Male Western Pangasinan

District Hospital Normal Spontaneous

Delivery Mrs. Violeta Gutierrez

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

MA. CONCEPCION H. MIRANDA Chief NurseWestern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N a). PRC No. : 0068019 Valid Until : March 26, 2011 b). PNA No. : 10441 Valid Until : Lifetime c). ANSAP No. : 0374 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

ALMA P. CARRERA Qualified Faculty Western Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0311104 Valid Until : March 21, 2012 b). PNA No. : 061983 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

V. Cord Dressing

No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Supervised by:Name &Signature of Qualified C.I.

1 24-15-54 August 8, 2010 Al Crisostomo Caturo Gural Male Ritchel Caturo Gucal 29 Pangasinan Provincial Hospital Ms. Maria Jasmin Tugade

2 24-30-87 August 14, 2010 Arvin Morales Bulatao Male Marivic Ferrer Bulatao 23 Pangasinan Provincial Hospital Ms. Maria Jasmin Tugade

3 24-47-08 August 27, 2010 Tonilyn R. Nanñasca Female Merlina R. Nanñasca 39 Pangasinan Provincial Hospital Ms. Maria Jasmin Tugade

4 24-97-94 August 28, 2010 Baby Girl De Loyola Female Maribel D. De Loyola 33 Pangasinan Provincial Hospital Ms. Maria Jasmin Tugade

5 24-62-18 September 3, 2010 Romeo Alburo Pabillaran Male Margie A. Pabillaran 23 Pangasinan Provincial Hospital Ms. Maria Jasmin Tugade

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

GLORIA M. ERIVE Assistant Chief NursePangasinan Provincial Hospital Date signed : Degree : R.N., M.A.N. a.) PRC No. : 0082420 Valid Until : December 5, 2010 b.) PNA No. : 11972 Valid Until : Lifetime c.) ANSAP No. : 0469 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JODI S. DELA CRUZ Qualified Faculty Pangasinan Provincial HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0179039 Valid Until : February 22, 2012 b). PNA No. : 061503 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITYCollege of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

III. Actual Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of Delivery

Gender of Baby Name of Hospital Type of Delivery

Supervised by:Name/Signature of

Qualified C.I.

1 02620Pregnancy Uterine Full Term 39 weeks Age of

Gestation, Cephalic delivered to an alive baby boy Gravida 1 Parity 1 (1001)

Lara Pinto Vinluan 18 December 22, 2009 12:20 am Male Mapandan Community

HospitalNormal Spontaneous

Delivery Ms. Jessiel Santorum

2 00294Pregnancy Uterine Full Term 39 weeks Age of

Gestation, Cephalic delivered to an alive baby girl Gravida 1 Parity 1 (1001)

Marilou T. Poscablo 19 February 5, 2010 10:12 am Female Mapandan Community

HospitalNormal Spontaneous

Delivery Mrs. Grecilda Oclay

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

GRACE Z. JOVELLANOS Chief NurseMapandan Community HospitalDate Signed : Degree : R.N., M.A.N. in progressa) PRC No. : 0064042 Valid Until : September 16, 2011b) PNA No. : 013853 Valid Until : October 31, 2010 c) ANSAP No. : 09-0050 Valid Until : December 31, 2010_

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Mapandan Community HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITYCollege of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

III. Actual Deliveries

No. Case No. Diagnosis Name of Mother Age Date of Delivery Time of Delivery

Gender of Baby Name of Hospital Type of Delivery

Supervised by:Name/Signature of

Qualified C.I.

1 112233Pregnancy Uterine Full Term, Cephalic delivered to an alive baby boy Gravida 1

Parity 1 (1001)

Rosie Valenzuela Diga 27 September 23, 2010 9:00 pm Male Eastern Pangasinan

District HospitalNormal Spontaneous

Delivery Mrs. Rosalie Marron

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

ROSALIA R. MATEO Chief NurseEastern Pangasinan District HospitalDate Signed : Degree : R.N., M.A.N. . a) PRC No. : 0099313 Valid Until : September 14, 2012b) PNA No. : 12125 Valid Until : Lifetime c) ANSAP No. : 0491 Valid Until : Lifetime _

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Eastern Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010

LYCEUM-NORTHWESTERN UNIVERSITY College of Nursing

As adapted from the form of PRC

Prepared by: DE GUZMAN, KIMBERLY M. Accreditation Level: (if any) Not Applicable Year Granted: Not Applicable Date School/Program was Recognized: June 14 , 1982 Number: GR No . 087 Year: Series 1982 First Course (if any): Not Applicable School Graduated From: Not Applicable Year: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2007 Year Graduated (BSN Program): 2011

II. Minor Operations

No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of HospitalSupervised by:

Name/Signature of Qualified C.I.

1 September 23, 2010 112233 Rosie Valenzuela

Diga Right Mediolateral Episiotomy Episiorrhapy Local Anesthesia Dr. Josephine Guiang Eastern PangasinanDistrict Hospital Mrs. Rosalie R. Marron

Prepared by:

DE GUZMAN, KIMBERLY M.Name of Student(Signature Over Printed Name)

Concurred by:

ROSALIA R. MATEO Chief NurseEastern Pangasinan District HospitalDate signed : Degree : R.N., M.A.N. a). PRC No. : 0099313 Valid Until : September 14, 2012b). PNA No. : 12125 Valid Until : Lifetime c). ANSAP No. : 0491 Valid Until : Lifetime

Noted by:

CRESENCIO C. QUINTO JR. Clinical Coordinator Date signed : Degree : B.S.N., R.N., M.A.N. a). PRC No. : 0292288 Valid Until : July 18, 2011 b). PNA No. : 013897 Valid Until : October 31, 2010

Supervised by:

JOCELYN G. MACARAEG Qualified Faculty Eastern Pangasinan District HospitalDate Signed : Degree : B.S.N., R.N., M.A.N.a). PRC No. : 0254320 Valid Until : September 23, 2012b). PNA No. : 018456 Valid Until : October 31, 2010

Approved by:

MRS. VIRGINIA V. MENDOZA Dean, College of NursingDate Signed : Degree : R.N., M.A.Ed., M.A.N., Ed.D.a) PRC No. : 0042414 Valid Until : April 29, 2011 b) PNA No. : 378 Valid Until : Lifetime c) ADPCN No. : 190 Valid Until : December 31, 2010