OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: YNARES, DY MARTIN LOPEZ

Name and Address of School: Our Lady of Fatima University #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACUCUA LEVEL II Year Granted: APRIL 10, 2002
Date School/Program was Recognized: APRIL 25, 2001 Number: 033 Year: 2001
First Cource (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):

I. Major Operations
Type of Name of Name of Signature of
No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Supervised by Qualified CI
Anesthesia Surgeon Hospital Qualified CI
Monitored Balagtas Wilowena A. Angeles RN, MAN
August 11, 2009 Cataract Mature Left Cataract Extraction Left Dr. Ronaldo
1 01907 Cirilo Faustino Sullera
Eye Eye
Anesthesia
Fernando
Doctors PRC NO. 304439
Care Hospital PNA NO. 026818

Monitored Balagtas Wilowena A. Angeles RN, MAN

August 30, 2010 Cataract Mature Right Cataract Extraction Right Dr. Ronaldo
2 02429 Francisca Gerna
Eye Eye
Anesthesia
Fernando
Doctors PRC NO. 304439
Care Hospital PNA NO. 026818

5
Approved by:

NELIA R. CAPULONG RN, RM, MAN

Prepared by: Noted by: Concurred by: Concurred by: Signature over printed name of Dean
Date Signed:
DY MARTIN L. YNARES MARISOL GARCIA-MANIPOL, RN, MAN Degree: BSN RM MAN
Signature over printed name of student Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse a.) PRC NO: 0041904
Date Signed: Date Signed: Date Signed: Valid Until: JULY 31 2012
Supervised by: Degree: BSN MAN Degree: BSN Degree: b.) PNA NO: 18698
a.) PRC NO: 0296870 a.) PRC NO: a.) PRC NO: Valid Until: Lifetime
Valid Until: September 2012 Valid Until: Valid Until: c.) ADPCN NO: 0627
Signature over printed name of Faculty b.) PNA NO: 013487 b.) PNA NO: b.) PNA NO: Valid Until:
Date Signed: Valid Until: Valid Until: Valid Until:
Degree: c.) ANSAP NO:
a.) PRC NO: Valid Until:
Valid Until:
b.) PNA NO:
Valid Until:
 OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: YNARES, DY MARTIN LOPEZ

Name and Address of School: Our Lady of Fatima University #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACUCUA LEVEL II Year Granted: APRIL 10, 2002
Date School/Program was Recognized: APRIL 25, 2001 Number: 033 Year: 2001
First Cource (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):

II. Minor Operations

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

March 12, Eduardo Dr. Jaime

1 2010
005
Villanueva
Pleural Effusion Thoracentesis Local Anesthesia
Antonino
Romel Cruz Hospital Rodelio Catahan

Wilowena A. Angeles RN, MAN

April 19, Lacerated Wound Upper Dr. Herbert Balagtas Doctors
2 2010
72906 Jayvee Regosa
Lip
Suturing & Dressing Local Anesthesia
Ampuan Hospital
PRC NO. 304439
PNA NO. 026818

Wilowena A. Angeles RN, MAN

May 2, Ariel Villanueva Debridment Suturing & Dr. Maria Percipi Balagtas Doctors
3 2010
73132
Jr.
Avulsed Left Thumb
Dressing
Local Anesthesia
Daguno Hospital
PRC NO. 304439
PNA NO. 026818

June San Jose District

4 9,2010
107233 Aldrin Alcantara Redundant Preduce Circumcision Local Anesthesia Dr. Alan Japor
Hospital
Norelyn Q. Jamis

October Dr. Agnes Diosdado Macapagal

5 25,2010
0467 Ivy Salarda Incomplete Abortion Dilatation & Curettage Local Anesthesia
Fernando Memorial Hospital
Tina P. Gueco
Approved by:

NELIA R. CAPULONG, RN, RM, MAN

Prepared by: Noted by: Concurred by: Concurred by: Signature over printed name of Dean
Date Signed:
DY MARTIN L. YNARES MARISOL GARCIA-MANIPOL, RN, MAN Degree: BSN RM MAN
Signature over printed name of student Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse a.) PRC NO: 0041904
Date Signed: Date Signed: Date Signed: Valid Until: JULY 31 2012
Supervised by: Degree: BSN MAN Degree: Degree: b.) PNA NO: 18698
a.) PRC NO: 0296870 a.) PRC NO: a.) PRC NO: Valid Until: Lifetime
Valid Until: September 2012 Valid Until: Valid Until: c.) ADPCN NO: 0627
Signature over printed name of Faculty b.) PNA NO: 013487 b.) PNA NO: b.) PNA NO: Valid Until:
Date Signed: Valid Until: Valid Until: Valid Until:
Degree: c.) ANSAP NO:
a.) PRC NO: Valid Until:
Valid Until:
b.) PNA NO:
Valid Until:
 OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: YNARES, DY MARTIN LOPEZ

Name and Address of School: Our Lady of Fatima University #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACUCUA LEVEL II Year Granted: APRIL 10, 2002
Date School/Program was Recognized: APRIL 25, 2001 Number: 033 Year: 2001
First Cource (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):

III. Actual Deliveries

Case Name of Date of Time of Gender Supervised by:
No. Diagnosis Age Name of Hospital Type of Delivery
No. Mother Delivery Delivery of Baby Signature of Qualified C.I.

5
Approved by:

NELIA R. CAPULONG, RN, RM, MAN

Prepared by: Noted by: Concurred by: Concurred by: Signature over printed name of Dean
Date Signed:
DY MARTIN L. YNARES MARISOL GARCIA-MANIPOL, RN, MAN Degree: BSN RM MAN
Signature over printed name of student Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse a.) PRC NO: 0041904
Date Signed: Date Signed: Date Signed: Valid Until: JULY 31 2012
Supervised by: Degree: BSN MAN Degree: Degree: b.) PNA NO: 18698
a.) PRC NO: 0296870 a.) PRC NO: a.) PRC NO: Valid Until: Lifetime
Valid Until: September 2012 Valid Until: Valid Until: c.) ADPCN NO: 0627
Signature over printed name of Faculty b.) PNA NO: 013487 b.) PNA NO: b.) PNA NO: Valid Until:
Date Signed: Valid Until: Valid Until: Valid Until:
Degree: c.) ANSAP NO:
a.) PRC NO: Valid Until:
Valid Until:
b.) PNA NO:
Valid Until:
 OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: YNARES, DY MARTIN LOPEZ

Name and Address of School: Our Lady of Fatima University #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACUCUA LEVEL II Year Granted: APRIL 10, 2002
Date School/Program was Recognized: APRIL 25, 2001 Number: 033 Year: 2001
First Cource (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):

IV. Deliveries Assisted

Case Date of Time of Gender Name of Supervised by:
No. Diagnosis Name of Mother Age Type of Delivery
No. Delivery Delivery of Baby Hospital Signature of Qualified C.I.
Diosdado
Anna Gay
106028 Pelvic Uterine Full Term 38-39 weeks October 26, Macapagal Normal Spontaneous
1 Age of Gestation Gravida 1 Parity 0
Felanbel 20
2010
11:00 am Male
Memorial Delivery
Tina P. Gueco
Pamodulan
Hospital
Diosdado
Pelvic Uterine Full Term 38-39 weeks Mariel Lampa October Macapagal Normal Spontaneous
2 106053
Age of Gestation Gravida 2 Parity 1 Magcalas
19
29,2010
10:27 am Female
Memorial Delivery
Tina P. Gueco
Hospital

5
Approved by:

NELIAApproved
R. CAPULONG, RN, RM, MAN
Prepared by:
Prepared by: Noted
Notedby: by: Concurred by: Concurred by: Concurred by: ConcurredConcurred
by: by: by:
Signature over printed name of Dean
Kreezane Bethany Mones Afuang Marisol Garcia-Manipol, RN, MAN Felicitas Nery, RN, MAN Josephine B. Leonardo, RN, Ph.D Rosalinda L. Flores, RN, MAN Date Signed:
Nelia R. Capulong, RN, MAN
DY MARTIN
Signature L.name
over printed YNARES
of student MARISOL GARCIA-MANIPOL, RN, MAN
Signature over printed name of Chief Nurse
Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Degree: BSNoverRM
Signature MAN
printed name of Dean

Signature over printed name of student Date Date

Signed: over printed name of Clinical
Signature Signed:
Coordinator Date Signed:
Signature over printed name of Chief Nurse Date printed
Signature over Signed: name of Chief Nurse Date Signed:
Degree: BSN, MAN Degree: BSN, MAN Degree: BSN, MAN a.) PRC NO: 0041904
Degree: BSN, MAN
Supervised by: Degree:
Date BSN,
Signed:MAN Date Signed: Date Signed:
a.) PRC NO: 0296870 a.) PRC NO: 0095235 a.) PRC NO: 0081174 a.) PRC NO: 0082223 Valid
a.) Until:
PRC NO:JULY 31 2012
0041904
Supervised by: RN, MAN
Norelyn Q. Jamis, Degree:
Valid Until:BSN MAN 2012
September Degree:
Valid Until: January 12, 2011 Valid Until: April 3, 2011 Degree: Valid Until: November 11, 2011 b.) PNA NO:Valid 18698
Until: July 31, 2012
Signature over printed name of Faculty b.)a.)
PNAPRCNO: NO: 0296870
013487 b.) PNA NO: 7501a.) PRC NO: b.) PNA NO: 15614 a.) PRC NO:b.) PNA NO: 001098 b.) Until:
Valid PNA NO: 18698
Lifetime
Date Signed: Valid
Valid Until:Until: September
October 31, 2010 2012 Valid Until: Lifetime
Valid Until: Valid Until: Lifetime Valid Until: October 31, 2010
Valid Until: Valid Until: Lifetime
Degree: BSN, c.) ADPCN NO:NO:0627
Signature overMAN printed name of Faculty b.) PNA NO: 013487 b.) PNA NO: b.) PNA NO:
c.) ADPCN 0627
a.) PRC NO: 0267415 Valid Until:
Valid Until: December 2010
Date Signed:
Valid Until: February 27, 2013 Valid Until: Valid Until: Valid Until:
Degree:
b.) PNA NO: 001090 c.) ANSAP NO:
a.) Valid
PRCUntil:
NO:October 31, 2010 Valid Until:
Valid Until:
b.) PNA NO:
Valid Until:
 OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: YNARES, DY MARTIN LOPEZ

Name and Address of School: Our Lady of Fatima University #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACUCUA LEVEL II Year Granted: APRIL 10, 2002
Date School/Program was Recognized: APRIL 25, 2001 Number: 033 Year: 2001
First Cource (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):

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

106963
1 May 26, 2010 Baby Boy Sarmiento Male Joan Sarmiento 20 San Jose District Hospital Norelyn Q. Jamis

106030
2 October 26, 2010 Baby Boy Lunas Male Medlyn Pantig Lunas 39 Diosdado Macapagal Memorial Hospital Tina P. Gueco

106036
3 October 27, 2010 Baby Girl Dimarucut Female Lea Mendoza Dimarucut 25 Diosdado Macapagal Memorial Hospital Tina P. Gueco

106037
4 October 27, 2010 Baby Boy Abadilla Male Chris Sibug Abadilla 18 Diosdado Macapagal Memorial Hospital Tina P. Gueco

106046
5 October 28, 2010 Baby Boy Tolentino Male Janel Valera Tolentino 33 Diosdado Macapagal Memorial Hospital Tina P. Gueco
Approved by:

NELIA R. CAPULONG, RN, RM, MAN

Prepared by: Noted by: Concurred by: Concurred by: Signature over printed name of Dean
Date Signed:
DY MARTIN L. YNARES MARISOL GARCIA-MANIPOL, RN, MAN Degree: BSN RM MAN
Signature over printed name of student Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse a.) PRC NO: 0041904
Date Signed: Date Signed: Date Signed: Valid Until: JULY 31 2012
Supervised by: Degree: BSN MAN Degree: Degree: b.) PNA NO: 18698
a.) PRC NO: 0296870 a.) PRC NO: a.) PRC NO: Valid Until: Lifetime
Valid Until: September 2012 Valid Until: Valid Until: c.) ADPCN NO: 0627
Signature over printed name of Faculty b.) PNA NO: 013487 b.) PNA NO: b.) PNA NO: Valid Until:
Date Signed: Valid Until: Valid Until: Valid Until:
Degree: c.) ANSAP NO:
a.) PRC NO: Valid Until:
Valid Until:
b.) PNA NO:
Valid Until: