Cebudoc Handle Prc Form

Republic of the Philippines

PROFESSIONAL REGULATION COMMISSION Cebu Regional Office

Cebu Doctors’ University

COLLEGE OF NURSING

# 1 Dr. P.V. Larrazabal Jr. Avenue, North Reclamation 6014 Mandaue City, Cebu, Philippines

Name of Student: MENDEZ, WILFRED ANGELO BLANCO __________________________________________________________________________________________________________ Accreditation Level (if any): Level III PAASCU_____________________ Year Granted: DECEMBER 15, 2008__________________________________________________________________ Date School/Program was Recognized: June 13, 1978__________________ Number: 154________________________________________________________ Year: 1978________________ First Course (if any): N/A_____________________________ School Graduated From: N/A________________________________________________________ Year: N/A_________________ Year of Admission in the Bachelor of Science in Nursing Program: 2005_________________________________________________________________________________________________ Year Graduated (BSN Program): 2009____________________________________________________________________________________________________________________________ III. Actual Deliveries No.

1.

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.

212836

Pregnancy Uterine Full Term

Elvie Pedrablanca

22

May 22, 2008

8:50 am

Female

Cebu Doctors’ University Hospital

Normal Spontaneous Vaginal Delivery

Mrs. Evelyn L. Ramas, B.S.N., R.N., M.A.N.

Prepared by:_

MENDEZ, WILFRED ANGELO BLANCO___ Name & Signature

Supervised By:

Noted By:

MRS. EVELYN L. RAMAS

Concurred By: MRS. DOLORES M. SALDIVIA

Approved By:

MRS. EDNA JOCELYN S. CABALLERO

DR.OFELIA F. SISNO

Signature over printed Name of Faculty Date Signed:

Signature over printed Name of Clinical Coordinator Date Signed:

Signature over printed name of Chief Nurse Date Signed:

Signature over printed Name of Dean Date Signed:

Degree:

BSN, RN, MAN

Degree:

BSN, RN, MAN

Degree:

BSN, RN, MAN

Degree:

a.) PRC No.:

0089450

a.) PRC No.:

0114598

a.) PRC No.:

0092453

a.) PRC No.:

Valid Until: b.) PNA No.: Valid Until:

December 19, 2009 10104 LIFETIME

Valid Until: b.) PNA No.: Valid Until:

April 24, 2011 3876 LIFETIME

Valid Until: b.) PNA No.: Valid Until:

October 19, 2009 5751 LIFETIME

RN, MN, MaEd, PhD Valid Until:

b.) PNA No.: Valid Until: c.) ADPCN No.: Valid Until:

16513 August 21, 2009 6399 LIFETIME 138 2009

I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct, and complete statement pursuant to provisions of pertinent laws, rules, and regulations of the republic of the Philippines. ________________________ Signature of Applicant Subscribed and sworn to before me this ____day of _______________________20____, ________________________________________________, Philippines.