MINDANAO STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES

MARAWI CITY
www.msumain.edu.ph
AMAI PAKPAK MEDICAL CENTER, MARAWI CITY, LANAO DEL SUR
Hospital, Municipality/City/Province
ODC Form 2A
Prepared by: ADZAR, ALYEAH C. O.R. MAJOR
Printed Name and Signature of Student: ADZAR, ALYEAH C. FORM
Date Performed Patient’s INITIALS SUPERVISED BY
SURGICAL PROCEDURE O.R. Nurse on Duty
and (only) Clinical Instructor
PERFORMED (Name and Signature)
Time Started Case Number Name and Signature

November 30, 2018 R. E. Repeat Low Transverse APPLE S. FIRMO, RN RANDY IAN F. GALLEGO, RN, MN
8:25 AM 2018-03-73-40 Caesarean Section (LCTS) PRC ID No: 0850780 PRC ID No: 0590564
Valid Until: October 16, 2024 Valid Until: June 17, 2022

RANDY IAN F. GALLEGO, RN, MN

December 14, 2018 M. A. Hernia Inguinal Indirect Right QUEENIE JANE J. RAMEL, RN
PRC ID No: 0590564
9:10 AM 2018-03-99-42 Reducible Herniorraphy PRC ID No: 0827388
Valid Until: June 17, 2022
Valid Until: August 6, 2023

December 19, 2018 H. H. Repeat Caesarean Section with WHOOPI CAROLINE ESTROSOS, RN RANDY IAN F. GALLEGO, RN, MN
6:55 AM 2018-01-60-07 Bilateral Tubal Ligation PRC ID No: 0816223 PRC ID No: 0590564
Valid Until: November 18, 2022 Valid Until: June 17, 2022

Noted by: Approved by:

RAQUEL DEL ROSARIO- MACARAMBON, RN, MSN NAIMA D. MALA, RN, MN, MAN, Ph.D
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No.: 0270747 Valid Until: July 2022 Dean, PRC I.D. No.: 0348709 Valid Until: September 3, 2021
Date document is signed: Time: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Master of Science in Nursing Please specify Highest Nursing Degree Earned: Doctor of Philosophy

MINDANAO STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES
MARAWI CITY
www.msumain.edu.ph
AMAI PAKPAK MEDICAL CENTER, MARAWI CITY, LANAO DEL SUR
Hospital, Municipality/City/Province
ODC Form 2B
Prepared by: ADZAR, ALYEAH C. O.R. MINOR
Printed Name and Signature of Student: ADZAR, ALYEAH C. FORM
Date Performed Patient’s INITIALS SUPERVISED BY
SURGICAL PROCEDURE O.R. Nurse on Duty
and (only) Clinical Instructor
PERFORMED (Name and Signature)
Time Started Case Number Name and Signature

HASSAN BJ T. MARABONG, RN RAQUEL D. MACARAMBON, RN, MSN

December 17, 2019 S. U. J.
Excision PRC ID No: 0804101 PRC ID No: 0270747
1:33 PM 1242-71
Valid Until: October 10, 2022 Valid Until: July 2022

HASSAN BJ T. MARABONG, RN NAMERA T. DATUMANONG, RN

January 20, 2020 C. A.
Excision PRC ID No: 0804101 PRC ID No: 0854927
1:00 PM 1031-40
Valid Until: October 10, 2022 Valid Until: October 30, 2021

WANISAH D. CALANDADA, RN NAMERA T. DATUMANONG, RN

January 23, 2020 H. A.
Wound Suturing PRC ID No: 0845684 PRC ID No: 0854927
2:35 PM 1291-59
Valid Until: February 18, 2024 Valid Until: October 30, 2021

Noted by: Approved by:

RAQUEL DEL ROSARIO- MACARAMBON, RN, MSN NAIMA D. MALA, RN, MN, MAN, Ph.D
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No.: 0270747 Valid Until: July 2022 Dean, PRC I.D. No.: 0348709 Valid Until: September 3, 2021
Date document is signed: Time: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Master of Science in Nursing Please specify Highest Nursing Degree Earned: Doctor of Philosophy

MINDANAO STATE UNIVERSITY

COLLEGE OF HEALTH SCIENCES
MARAWI CITY
www.msumain.edu.ph
AMAI PAKPAK MEDICAL CENTER, MARAWI CITY, LANAO DEL SUR
Hospital/Home/Lying-in, Municipality/City/Province
ODC Form 1C
Prepared by: ADZAR, ALYEAH C. CORD CARE
Printed Name and Signature of Student: ADZAR, ALYEAH C. FORM
Patient’s Immediate Newborn Cord Care D.R. Nurse on Duty
Date Performed SUPERVISED BY
INITIALS (only) Performed (Name and Signature)
and Clinical Instructor
(Indicate where preformed e.g. DR, (If Midwife on Duty, Signature Not
Time Started Case Number Name and Signature
Nursery, NICU, or Home) Required)
DR
HC- 35 cm
AMALIAH M. GAMPONG, RN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
January 21, 2018 B. B. G. CC- 34 cm
PRC ID No: 0877096 PRC ID No: 0470647
11:15 AM 2018-00-18-23 AC- 32 cm
Valid Until: Valid Until: September 12, 2023
WT- 3.6 kg
HT- 53 cm
DR
HC- 32 cm
RASHMIA A. ABBAS, RN, MAN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
February 18, 2018 B. G. S. CC- 27 cm
PRC ID No: 0132594 PRC ID No: 0470647
1:48 PM 2018-00-29-00 AC- 30 cm
Valid Until: January 1, 2024 Valid Until: September 12, 2023
WT- 2.9 kg
HT- 50 cm
DR
HC- 38 cm
RASHMIA A. ABBAS, RN, MAN ANNIE M. MERO, RN, RM, MN
February 11, 2018 B. G. M. CC- 35 cm
PRC ID No: 0132594 PRC ID No: 0089826
11:33 AM 2018-00-29-09 AC- 31 cm
Valid Until: January 1, 2024 Valid Until: May 27, 2022
WT- 3.1 kg
HT- 55 cm

Noted by: Approved by:

RAQUEL DEL ROSARIO- MACARAMBON, RN, MSN NAIMA D. MALA, RN, MN, MAN, Ph.D
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No.: 0270747 Valid Until: July 2022 Dean, PRC I.D. No.: 0348709 Valid Until: September 3, 2021
Date document is signed: Time: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Master of Science in Nursing Please specify Highest Nursing Degree Earned: Doctor of Philosophy
MINDANAO STATE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
MARAWI CITY
www.msumain.edu.ph
AMAI PAKPAK MEDICAL CENTER, MARAWI CITY, LANAO DEL SUR
Hospital/Home/Lying-in, Municipality/City/Province
ODC Form 1A
Prepared by: ADZAR, ALYEAH C. ACTUAL DELIVERY
Printed Name and Signature of Student: ADZAR, ALYEAH C. FORM
Patient’s INITIALS D.R. Nurse on Duty
Date Performed SUPERVISED BY
(only) (Name and Signature)
and PROCEDURE PERFORMED Clinical Instructor
(If Midwife on Duty, Signature Not
Time Started Case Number Name and Signature
Required)

Pregnancy Uterine Delivered, RASHMIA A. ABBAS, RN, MAN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
January 21, 2017 J. D.
Normal Spontaneous Vaginal PRC ID No: 0132594 PRC ID No: 0470647
2:00 PM 2018-00-00-22
Delivery Valid Until: January 1, 2024 Valid Until: September 12, 2023

Pregnancy Uterine Delivered, SITTIE JANENA R. ABANTAS, RN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
February 2, 2018 S. G.
Normal Spontaneous Vaginal PRC ID No: 0875237 PRC ID No: 0470647
4:50 PM 2018-00-03-04
Delivery Valid Until: January 14, 2020 Valid Until: September 12, 2023

Pregnancy Uterine Delivered, RASHMIA A. ABBAS, RN, MAN ANNIE M. MERO, RN, RM, MN
February 4, 2018 H. J. D.
Normal Spontaneous Vaginal PRC ID No: 0132594 PRC ID No: 0089826
9:46 AM 17-90-58
Delivery Valid Until: January 1, 2024 Valid Until: May 27, 2022

Noted by: Approved by:

RAQUEL DEL ROSARIO- MACARAMBON, RN, MSN NAIMA D. MALA, RN, MN, MAN, Ph.D
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No.: 0270747 Valid Until: July 2022 Dean, PRC I.D. No.: 0348709 Valid Until: September 3, 2021
Date document is signed: Time: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Master of Science in Nursing Please specify Highest Nursing Degree Earned: Doctor of Philosophy
MINDANAO STATE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
MARAWI CITY
www.msumain.edu.ph
AMAI PAKPAK MEDICAL CENTER, MARAWI CITY, LANAO DEL SUR
Hospital/Home/Lying-in, Municipality/City/Province
ODC Form 1B
Prepared by: ADZAR, ALYEAH C. ACTUAL DELIVERY
Printed Name and Signature of Student: ADZAR, ALYEAH C. ASSISTED FORM
Patient’s INITIALS D.R. Nurse on Duty
Date Performed SUPERVISED BY
(only) (Name and Signature)
and PROCEDURE PERFORMED Clinical Instructor
(If Midwife on Duty, Signature Not
Time Started Case Number Name and Signature
Required)

Pregnancy Uterine Delivered, RASHMIA A. ABBAS, RN, MAN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
January 21, 2017 N. M.
Normal Spontaneous Vaginal PRC ID No: 0132594 PRC ID No: 0470647
9:45 AM 202041
Delivery Valid Until: January 1, 2024 Valid Until: September 12, 2023

Pregnancy Uterine Delivered, AMALIA G. COSAIN, RN SHIRIKIT I. CASIM, RN, RM, LPT, MAN
February 11, 2018 J. M.
Normal Spontaneous Vaginal PRC ID No: 0855454 PRC ID No: 0470647
4:50 PM 2018-00-34-38
Delivery Valid Until: September 8, 2021 Valid Until: September 12, 2023

Pregnancy Uterine Delivered, AMALIA G. COSAIN, RN MA. THERESA G. NAMALATA, RN, MAN
March 16, 2018 F. P.
Normal Spontaneous Vaginal PRC ID No: 0855454 PRC ID No: 0554495
3:30 PM 2018-00-37-55
Delivery Valid Until: September 8, 2021 Valid Until: January 15, 2022

Noted by: Approved by:

RAQUEL DEL ROSARIO- MACARAMBON, RN, MSN NAIMA D. MALA, RN, MN, MAN, Ph.D
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No.: 0270747 Valid Until: July 2022 Dean, PRC I.D. No.: 0348709 Valid Until: September 3, 2021
Date document is signed: Time: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Master of Science in Nursing Please specify Highest Nursing Degree Earned: Doctor of Philosophy