EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. SCRUB FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : JOHN KENNETH P. SANTOS

( Printed Name & Signature of Student )

Date Performed and Time started 07-28-10 / 8:28 P.M 07-29-10 / 9:46 P.M 08-06-10 / 6:25 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

M.C.D.G - 153214 E.D.D. - 153271 E.F.R. - 153563

Emergency Low Cervical Cesarean Section Cholecystectomy Emergency Exploratory Laparotomy, Truncal Vagotomy with Sphincteroplasty

Louis Ray R. Santos, R.N. Louis Ray R. Santos, R.N. Levie G. Roncal, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. SCRUB FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : JENNELYN JOY G. DOLLOSA

( Printed Name & Signature of Student )

Date Performed and Time started 08-11-10 / 7:45 P.M 03-03-11 / 3:20 P.M 03-07-11 / 6:25 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

J.G.C. - 153458 L.C.S. - 164953 M.S.S. - 162298

Emergency Exploratory Laparotomy; Appendectomy Cholecystectomy Below Knee Amputation Left

Ian Benedict R. Barin, R.N. Maria Victoria T. Datu, R.N. Maria Victoria T. Datu, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. SCRUB FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : VAL ANGELO D. BUGAY

( Printed Name & Signature of Student )

Date Performed and Time started 07-31-10 / 3:28 P.M 07-31-10 / 10:25 P.M 02-04-11 / 11:25 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

L.C.M. - 153314 J.G.C. - 153307 J.B.M. - 132958

Emergency Low Cervical Cesarean Section Emergency Appendicial Exploratory Laparotomy Cholecystectomy

Louis Ray R. Santos, R.N. Louis Ray R. Santos, R.N. Maria Victoria T. Datu, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Highest Degree Earned:

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. SCRUB FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : IAN GLENN D.BADILLO

( Printed Name & Signature of Student )

Date Performed and Time started 08-05-10 / 7:49 P.M 08-07-10 / 9:14 P.M 07-07-11 / 6:27 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

M.B.C. - 153472 J.V.R. - 153589 J.L.D. - 128392

Emergency Low Cervical Cesarean Section Right Partial Hip Replacement Anthroplasty Total Abdominal Hysterectomy; Bilateral Salphingoooperectomy

Ian Benedict R. Barin, R.N. Ian Benedict R. Barin, R.N. Ma. Soledad R. Lamira, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Time: Highest Degree Earned:

Time:

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. SCRUB FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : LESLIE C. MONTEFALCON

( Printed Name & Signature of Student )

Date Performed and Time started 07-30-10 / 4:04 P.M 07-30-10 / 10:12 P.M 03-07-11 / 10:53 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

T.M.M. - 153228 C.Y.C. - 153249 R.S.V. - 162809

Low Transverse Cesarean Section; Bilateral Tubal Ligation Thyroidectomy Near Total Right Isthmusectomy Emergency Salphingoooperectomy Right; Tubal Ligation Left

Louis Ray R. Santos, R.N. Maria Victoria T. Datu, R.N. Maria Victoria T. Datu, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Date document is signed: Time: Highest Degree Earned:

Date document is signed: Time:

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

ICNB Form IMMEDIATED CARE OF THE NEWBORN FORM

Prepared by:
Name of Student : JOHN KENNETH P. SANTOS

( Printed Name & Signature of Student )

Date Performed and Time started 08-27-10 / 7:28 P.M 09-17-10 / 6:41 P.M 10-01-10 / 8:31 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

Nurse on Duty
( Name & Signature ) (if midwife on Duty, Signiture not requiered)

SUPERVISED BY
Clinical Instructor Name & Signature

T.P.C. - 061217 J.H.C. - 154534 C.A.R. - 156069

Delivery Room Delivery Room Delivery Room

Carmen Remo R.M. Carmen Remo R.M. Marry Ann Ducut R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. :

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. :

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233

98006 October 22, 2014 7845

Valid Until: Date document is signed: Time: Highest Degree Earned:

December 6, 2013

Valid Until: Date document is signed: Time:

Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

ICNB Form IMMEDIATED CARE OF THE NEWBORN FORM

Prepared by:
Name of Student : JENNELYN JOY G. DOLLOSA

( Printed Name & Signature of Student )

Date Performed and Time started 01-28-10 / 9:15 P.M 09-23-10 / 6:41 P.M 09-23-10 / 8:31 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

Nurse on Duty
( Name & Signature ) (if midwife on Duty, Signiture not requiered)

SUPERVISED BY
Clinical Instructor Name & Signature

J.R.M. - 145810 M.H.T. - 155749 I.A.T. - 156055

Delivery Room Delivery Room Delivery Room

Anita P. Baltazar R.M Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until:

Chief Nurse
PRC I.D. No. : Valid Until:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015

98006 October 22, 2014

PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

62233 December 6, 2013

PNA No. : Valid Until: Date document is signed: Time:

7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

ICNB Form IMMEDIATED CARE OF THE NEWBORN FORM

Prepared by:
Name of Student : VAL ANGELO D. BUGAY

( Printed Name & Signature of Student )

Date Performed and Time started 01-23-10 / 8:19 P.M 09-23-10 / 6:37 P.M 09-25-10 / 8:31 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

Nurse on Duty
( Name & Signature ) (if midwife on Duty, Signiture not requiered)

SUPERVISED BY
Clinical Instructor Name & Signature

M.R.D. - 145852 M.C.P. - 155792 C.D.F. - 155847

Delivery Room Delivery Room Delivery Room

Anita P. Baltazar R.M Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. :

Chief Nurse
PRC I.D. No. :

School Administrator
98006
Date document is signed:

0357815

Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

August 8, 2015 62233 December 6, 2013

Valid Until: PNA No. : Valid Until: Date document is signed: Time:

October 22, 2014 7845 Lifetime

Time:

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

ICNB Form IMMEDIATED CARE OF THE NEWBORN FORM

Prepared by:
Name of Student : IAN GLENN D. BADILLO

( Printed Name & Signature of Student )

Date Performed and Time started 07-11-10 / 3:16 P.M 09-25-10 / 3:16 P.M 06-30-11 / 5:38 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

Nurse on Duty
( Name & Signature ) (if midwife on Duty, Signiture not requiered)

SUPERVISED BY
Clinical Instructor Name & Signature

C.D.R. - 153211 D.B.R. - 154475 M.J.A.N. - 167357

Delivery Room Delivery Room Delivery Room

Marry Ann Ducut R.M. Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator

Chief Nurse

School Administrator

PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

0357815 August 8, 2015 62233 December 6, 2013

PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

98006 October 22, 2014 7845 Lifetime

Date document is signed: Time:

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

ICNB Form IMMEDIATED CARE OF THE NEWBORN FORM

Prepared by:
Name of Student : LESLIE C. MONTEFALCON

( Printed Name & Signature of Student )

Date Performed and Time started 08-27-10 / 3:16 P.M 08-28-10 / 9:14 P.M 11-22-10 / 7:18 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

Nurse on Duty
( Name & Signature ) (if midwife on Duty, Signiture not requiered)

SUPERVISED BY
Clinical Instructor Name & Signature

C.L.R. - 154498 M.S.G. - 154515 M.L.I.G. - 158213

Delivery Room Delivery Room Delivery Room

Carmen Remo R.M. Carmen Remo R.M. Marry Ann Ducut R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

D.R. Form ACTUAL DELIVERY

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : JOHN KENNETH P. SANTOS

( Printed Name & Signature of Student )

Date Performed and Time started 09-25-10 / 7:11 A.M 09-25-10 / 7:49 A.M 09-25-10 / 11:37 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

D.R. Nurse on Duty

(Name and Signiture) (If Midwife on Duty, signiture not Required

SUPERVISED BY
Clinical Instructor Name & Signature

D.M.V.H. - 155816 R.O.R. - 155817 E.T.D. - 155823

Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

Carmen Remo R.M. Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:

Concurred by:

Approved by:

MARIA DALISAY. CANTORIA

EVELYN R. RUBIA

ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

D.R. Form ACTUAL DELIVERY

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : JENNELYN JOY G. DOLLOSA

( Printed Name & Signature of Student )

Date Performed and Time started 08-26-10 / 10:05 A.M 08-27-10 / 12:15 P.M 09-03-10 / 11:39 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

D.R. Nurse on Duty

(Name and Signiture) (If Midwife on Duty, signiture not Required

SUPERVISED BY
Clinical Instructor Name & Signature

A.C.R. - 154439 N.S.A. - 154489 E.N.A. - 154777

Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

Carmen Remo R.M. Carmen Remo R.M. Marry Ann Ducut R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

D.R. Form ACTUAL DELIVERY

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : VAN ANGELO D. BUGAY

( Printed Name & Signature of Student )

Date Performed and Time started 08-26-10 / 2:00 P.M 08-27-10 / 8:40 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

D.R. Nurse on Duty

(Name and Signiture) (If Midwife on Duty, signiture not Required

SUPERVISED BY
Clinical Instructor Name & Signature

L.S.V. - 109623 M.J.D.S. - 154479

Normal Spontaneous Delivery Normal Spontaneous Delivery

Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

01-27-11 / 08:03 A.M

M.M.C. - 161068

Normal Spontaneous Delivery

Anita P. Baltazar R.M

Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

D.R. Form ACTUAL DELIVERY

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : IAN GLENN D. BADILLO

( Printed Name & Signature of Student )

Date Performed and Time started 08-28-10 / 8:07 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

D.R. Nurse on Duty

(Name and Signiture) (If Midwife on Duty, signiture not Required

SUPERVISED BY
Clinical Instructor Name & Signature

C.R.R. - 154498

Normal Spontaneous Delivery

Carmen Remo R.M.

Ma. Elender Pulos, MAN

07-30-11 / 1:40 P.M 07-30-11 / 3:14 P.M

J.C.M. - 167348 M.J.I. - 167351

Normal Spontaneous Delivery Normal Spontaneous Delivery

Anita P. Baltazar R.M Anita P. Baltazar R.M

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: ACTUAL DELIVERY in

GOVERNMENT RECOGNIZED 2 February 28, 2009

D.R. Form ACTUAL DELIVERY

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : LESLIE C. MONTEFALCON

( Printed Name & Signature of Student )

Date Performed and Time started Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

D.R. Nurse on Duty

(Name and Signiture) (If Midwife on Duty, signiture not Required

SUPERVISED BY
Clinical Instructor Name & Signature

07-09-10 / 6:10 A.M 07-20-10 / 6:20 A.M 08-30-10 / 12:15 P.M

A.D.C.D. - 152865 J.G.O. - 152865 A.B.A. - 154617

Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

Carmen Remo R.M. Carmen Remo R.M. Carmen Remo R.M.

Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN Ma. Elender Pulos, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. CIRCULATING FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : JOHN KENNETH P. SANTOS

( Printed Name & Signature of Student )

Date Performed Patient's INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BY

and Time started 08-05-10 / 7:49 P.M 08-07-10 / 9:14 P.M 07-07-11 / 6:27 P.M

Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

PERFORMED

( Name & Signature )

Clinical Instructor Name & Signature

M.B.C. - 153472 J.V.R. - 153589 J.L.D. - 128392

Emergency Low Cervical Cesarean Section Right Partial Hip Replacement Anthroplasty Total Abdominal Hysterectomy; Bilateral Salphingoooperectomy

Ian Benedict R. Barin, R.N. Ian Benedict R. Barin, R.N. Ma. Soledad R. Lamira, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. CIRCULATING FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : IAN GLENN D.BADILLO

( Printed Name & Signature of Student )

Date Performed and Time started 07-28-10 / 8:28 P.M 07-29-10 / 9:46 P.M 08-06-10 / 6:25 P.M

Patient's INITIAL Only Case Number

( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

M.C.D.G - 153214 E.D.D. - 153271 E.F.R. - 153563

Emergency Low Cervical Cesarean Section Cholecystectomy Emergency Exploratory Laparotomy, Truncal Vagotomy with Sphincteroplasty

Louis Ray R. Santos, R.N. Louis Ray R. Santos, R.N. Levie G. Roncal, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. CIRCULATING FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:
Name of Student : VAL ANGELO D. BUGAY

( Printed Name & Signature of Student )

Date Performed and Time started 07-30-10 / 4:04 P.M 08-11-10 / 7:45 P.M 03-07-11 / 6:25 P.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

T.M.M. - 153228 J.G.C. - 153458 M.S.S. - 162298

Low Transverse Cesarean Section; Bilateral Tubal Ligation Emergency Exploratory Laparotomy; Appendectomy Below Knee Amputation Left

Louis Ray R. Santos, R.N. Ian Benedict R. Barin, R.N. Maria Victoria T. Datu, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. CIRCULATING FORM

Bataan General Hospital, Balanga City, Bataan ( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )

Prepared by:

Name of Student :

JENNELYN JOY G. DOLLOSA

( Printed Name & Signature of Student )

Date Performed and Time started 07-30-10 / 10:12 P.M 07-31-10 / 3:28 P.M 02-04-11 / 11:25 A.M Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

C.Y.C. - 153249 L.C.M. - 153314 J.B.M. - 132958

Thyroidectomy Near Total Right Isthmusectomy Emergency Low Cervical Cesarean Section Cholecystectomy

Maria Victoria T. Datu, R.N. Louis Ray R. Santos, R.N. Maria Victoria T. Datu, R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

EASTWOODS PROFESSIONAL COLLEGE OF SCIENCE AND TECHNOLOGY NURSING DEPARTMENT

Ibayo, Balanga City 2100 Bataan (047) 791-2791 (047) 237-4334

Accredited by: Level : Date of Accreditation: SURGICAL SCRUB in

GOVERNMENT RECOGNIZED 2 February 28, 2009

O.R. Form 1-A MAJOR - O.R. CIRCULATING FORM

Bataan General Hospital, Balanga City, Bataan

( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province ) Prepared by:

Name of Student : LESLIE C. MONTEFALCON

( Printed Name & Signature of Student )

Date Performed and Time started 07-31-10 / 10:25 P.M 03-03-11 / 3:20 P.M 08-06-11 / 4:12pm Patient's INITIAL Only Case Number
( not applicable for Birthing/Lying-In Clinics/Homes)

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty

( Name & Signature )

SUPERVISED BY
Clinical Instructor Name & Signature

J.G.C. - 153307 L.C.S. - 164953 A.C.A. - 168894

Emergency Appendicial Exploratory Laparotomy Cholecystectomy Exlaparotomy Ruptured Appendicitis

Louis Ray R. Santos, R.N. Maria Victoria T. Datu, R.N. Ian Benedict Barin R.N.

Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN Ferdinand B. Magnampo, MAN

Noted by:
MARIA DALISAY. CANTORIA

Concurred by:
EVELYN R. RUBIA

Approved by:
ROGELIO S. ZULUETA JR.

Clinical Coordinator
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time: Highest Degree Earned:

Chief Nurse
PRC I.D. No. : Valid Until: PNA No. : Valid Until: Date document is signed: Time:

School Administrator
Date document is signed: Time:

0357815 August 8, 2015 62233 December 6, 2013

98006 October 22, 2014 7845 Lifetime

Master of Arts in Nursing

Highest Degree Earned:

Doctor of Philosophy

.R. CIRCULATING FORM

CIRCULATING FORM

CIRCULATING FORM

CIRCULATING FORM

CIRCULATING FORM