COLEGIO DE DAGUPAN

Formerly COMPUTRONIX COLLEGE

COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

I. MAJOR OPERATIONS
Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Total Abdominal Bilateral
Sub-arachnoid Cuison Hospital
1 03-16-2010 10-03-92 Delia Catalan Abad Myoma Uterine Hysterectomy and Dr. Maria Salome Romero
Block Incorporated Miss Sheila Soriano
SalpingoOophorectomy

Concurred by: Approved by: Noted by:

MR. CONRAD JULIUS CUISON MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
CUISON HOSPITAL INCORPORATED COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN in progress Degree: RN, MAN,EdD Degree: RN, RM, MAN
a. PRC No.:0538912 Valid Until: April 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.:061515 Valid Until: March 4, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 10-0147 Valid Until: December 31, 2012 c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA. ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

I. MAJOR OPERATIONS
TYPES OF Supervised by: Name and
DATE OF NAME OF OPERATION
NO. CASE NO. DIAGNOSIS ANESTHES NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PATIENTS PERFORMED
IA Instructors
Sub-
Ernesto Generalized Peritonitis Secondary to Exploratory Laparotomy Evacuation of
1 08-08-2010 1851 arachnoid Dr. Maria Camila Rosario Region 1 Medical Center
FrinGarduque Blunt Abdominal Injury Hemo-peritoneum.Spleenectomy Lavage
Block Mr. Alain Jason Generale
Pregnancy Uterine 37 5/7 Weeks Age Low Transverse Caesarean Section Sub-
2 08-13-2010 92637 Jennifer PerezBasa of Gestation Breech Delivered to a Live Baby Girl, Bilateral arachnoid Dr. Mary Kahreen Ramos Region 1 Medical Center
Mr. Alain Jason Generale
Gravida: 3 Para:3 Tubal Ligation Block
Pregnancy Uterine 39 6/7 Weeks Sub-
Jocelyn
3 08-20-2010 94320 Age of Gestation, Prolonged 2nd Low Transverse Caesarean Section
arachnoid Dr. Sheryl Aquino Region 1 Medical Center
TorenoApacis
Stage of Labor Block Mr. Alain Jason Generale
Sub-
Stab Wound 2cm Supraumbilical Area
4 08-25-2010 95617 Simon Dela CruzJr. Exploratory Laparotomy with Myorraphy arachnoid Dr. Mayeen Fernandez Region 1 Medical Center
Penetrating; Perforating
Block Mr. Alain Jason Generale
Noted by:
Concurred by: Approved by:

Mr. Rosauro P. Catabay MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
REGION 1 MEDICAL CENTER COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN Degree: RN, MAN, EdD Degree: RN, RM, MAN

a. PRC No.:0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
 ________________________
MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Anacleto Peralta Lacerated Wound at Right Cuison Hospital
1 03-17-2010 098 Suturing Local Anesthesia Dr. ConradoCuison Miss Sheila Soriano
Mamaril Foot; 4cm Incorporated

PregnancyUterine 38
Weeks Age of Gestation
Doreen Dumagas Sub-arachnoid Cuison Hospital
2 03-19-2010 10-04-18 Previous Caesarean Bilateral Tubal Ligation Dr. Maria Salome Rosario Miss Sheila Soriano
Cuison Block Incorporated
Section, Family Planning
Acceptor

Concurred by: Approved by: Noted by:

MR. CONRAD JULIUS CUISON MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
CUISON HOSPITAL INCORPORATED COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN in progress Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.:0538912 Valid Until: April 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.:061515 Valid Until: March 4, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 10-0147 Valid Until: December 31, 2012 c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Medina, Allan Lester V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Multiple Lacerated Wound
Manaoag Community
1 03-23-2010 6175 Karylle NicoleCorpuz at Right Hand with Incision and Drainage Local Anesthesia Dr. Marie Jen BenignoUy
Hospital
Presence of Abscess Mrs. Jessica Reyes
Diabetic Right Foot with
Manaoag Community
2 03-24-2010 6048 FloydCabingas Gangreenenous sores at Debridement Dr. V. Petrola
Hospital
sole aspect Mrs. Jessica Reyes
Concurred by: Approved by: Noted by:

MR. DENNIS N. CALIMLIM MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
MANAOAG COMMUNITY HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN in progress Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.:09-0055 Valid Until: December 31, 2012 c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Post Menstrual
Bleeding Secondary
Polypectomy, Intravenous Dr. Caryl Queen Region 1 Medical
1 03-23-2011 136757 Mercedita Javier Endocervical Polyp Miss Lizette B. Ching
Rule Out Endometrial Curettage Sedation Bugaoan Hospital
Pathology
Concurred by: Approved by: Noted by:

MR. ROSAURO P. CATABAY MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
REGION 1 MEDICAL CENTER COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN Degree: RN, MAN,EdD Degree: RN, RM, MAN
a. PRC No.: 0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

III. DELIVERIES HANDLED

Supervised by: Name and
DATE OF TIME OF GENDER
NO. CASE NO. DIAGNOSIS NAME OF MOTHER AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
Pregnancy Uterine Full
Manaoag Community Normal Spontaneous
1. 6814 Term Cephalic, Delivered Wilma G. Velasco 19 03-21-2010 9:21am Male Mrs. Jessica Reyes
Hospital Delivery
to an Alive Baby Boy
Concurred by: Approved by: Noted by:

MR. DENNIS N. CALIMLIM MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
MANAOAG COMMUNITY HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN in progress Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 09-0055 Valid Until: December 31, 2012 c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

III. DELIVERIES HANDLED

GENDER Supervised by: Name and
CASE NAME OF DATE OF TIME OF
NO. DIAGNOSIS AGE OF NAME OF HOSPITALS TYPE OF Signature of Qualified
NO. MOTHER DELIVERY DELIVERY
BABY DELIVERY Clinical Instructors

Pregnancy Uterine Full Term Cephalic, Delivered 37 02-10-2011 2:52am Male Region 1 Medical Center Normal Spontaneous Miss Rosanta Ellasus
1. 128596 Jennifer Ortiz
to an Alive Baby Boy Delivery

Pregnancy Uterine Full Term Cephalic, Delivered

to an Alive Baby Boy 27 03-22-2011 8:27pm Male Region 1 Medical Center Normal Spontaneous Miss Lizette B. Ching
2. 136678 Gretchen Turao
Delivery

Pregnancy Uterine Full Term Cephalic, Delivered

to an Alive Baby Boy Elizabeth 31 03-23-2011 4:20pm Male Region 1 Medical Center Normal Spontaneous Miss Lizette B. Ching
3. 136694
Bangal Delivery

Pregnancy Uterine Full Term Cephalic, Delivered

to an Alive Baby Boy 29 03-23-2011 11:04pm Male Region 1 Medical Center Normal Spontaneous
4 136867 Myra Baniqued Miss Lizette B. Ching
Delivery

Concurred by: Approved by: Noted by:

MR. ROSAURO P. CATABAY MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
REGION 1 MEDICAL CENTER COLLEGE OF NURSING COLLEGE OF NURSING
Date Signed: Date Signed: Date Signed:
Degree: RN, MAN Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.: 0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012
Prepared by:
________________________
MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

IV. DELIVERIES ASSISTED

Supervised by: Name and
NAME OF DATE OF TIME OF GENDER
CASE NO. DIAGNOSIS AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
MOTHER DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
Pregnancy Uterine Preterm Delivered Cephalic, Normal Spontaneous
1 127655 Rachelle Iglesia 18 02-04-2011 2:16pm Male Region 1 Medical Center
to a Stillbirth Baby Boy Delivery MrsRosanta Ellasus
Pregnancy Uterine Full Term Cephalic, Normal Spontaneous
2 136689 Merle Del Campo 42 03-21-2011 9:10 pm Female Region 1 Medical Center
Delivered to an Alive Baby Girl Delivery Miss Lizette Leah B. Ching
Pregnancy Uterine Full Term Cephalic, Normal Spontaneous
3 136381 Sheryl Agustin 22 03-23-2011 9:48pm Boy Region 1 Medical Center
Delivered to an Alive Baby Boy Delivery Miss Lizette Leah B. Ching

Pregnancy Uterine Preterm Cephalic, Delivered Normal Spontaneous

4 52109 Michele Meneses 28 03-26-2011 3:15 Girl Region 1 Medical Center Mrs Rosanta Ellasus
to a Stillbirth Baby Girl Delivery

5 Region 1 Medical Center Normal Spontaneous

Delivery

Concurred by: Approved by: Noted by:

MR. ROSAURO P. CATABAY MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
REGION 1 MEDICAL CENTER COLLEGE OF NURSING COLLEGE OF NURSING
Date Signed: Date Signed: Date Signed:
Degree: RN, MAN Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.: 0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

V. CORD DRESSING
DATE OF GENDER OF Supervised by: Name and Signature of Qualified
NO. CASE NO. NAME OF BABY NAME OF MOTHER AGE NAME OF HOSPITALS
PERFORMED BABY Clinical Instructors

1 6804 03-25-2010 Baby Boy Aquino Male Assuncion Aquino 28 Manaoag Community Hospital Mrs. Jessica Reyes

Concurred by: Approved by: Noted by:

MR. DENNIS N. CALIMLIM MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
MANAOAG COMMUNITY HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN in progress Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 09-0055 Valid Until: December 31, 2012 c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
 MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable
Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

V. CORD DRESSING
DATE OF GENDER OF Supervised by: Name and Signature of Qualified
NO. CASE NO. NAME OF BABY NAME OF MOTHER AGE NAME OF HOSPITALS
PERFORMED BABY Clinical Instructors

Miss RosantaEllasus
1 128935 02-11-2010 Baby Boy Balolong Male LiwayBalolong 20 Region 1 Medical Center

2 609757 03-22-2011 Baby Boy Bacani Male Marjorie Bacani 26 Region 1 Medical Center
Miss Lizette Leah B. Ching

3 83647 03-24-2011 Baby Boy Romero Male Ivy RacelQuinto Romero 26 Region 1 Medical Center Miss RosantaEllasus

4 128553 03-25-2011 Baby Boy Mangsat Male Wilma Mangsat 35 Region 1 Medical Center Miss RosantaEllasus

Concurred by: Approved by: Noted by:

MR. ROSAURO P. CATABAY MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA

Chief Nurse Dean Clinical Coordinator, Level IV
REGION 1 MEDICAL CENTER COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: RN, MAN Degree: RN, MAN, EdD Degree: RN, RM, MAN
a. PRC No.: 0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014
b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011
c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:
________________________
MEDINA, ALLAN LESTER V.