Format Clinical Rotation

University of Pangasinan College of Nursing Name: _________________________________ Date Started in BSN Program: ______________ Date Graduated from BSN Program: __________

Student Number: 07-2409 University Seal

CLINICAL ROTATION SY-2007-2008 Course No.

Year

Month

Department or Area of Assignment

Health Care I

2007

JuneOctober

Nursing Laboratory

Health Care I

2007

NovemberMarch

City Health Office, Dagupan City

Hospital Agency

Name of Clinical Instructor

Classroom Instruction

(Return Demonstration)

Public Health Nursing

1st Semester SY-2008-2009 Course No.

NCM 101

Year

Month

2008

June

2008

July

2008

August

2008

September

Department or Area of Assignment

Hospital Agency

Name of Clinical Instructor

2nd Semester SY-2008-2009 Course No.

NCM 102

Year

Month Hospital Agency

2008

November

2008

December

2009

January

2009

February

2009

March

Year

Month

Department or Area of Assignment

Name of Clinical Instructor

Department or Area of Assignment

Name of Clinical Instructor

Summer 2009 Course No.

NCM 103

Hospital Agency

2009

April

2009

May

Affiliation Summer 2009 Inclusive Dates

Hospital Agency

Department or Area of Assignment

Name of Clinical Instructor

National Centrum for Mental Health Philippine Orthopedic Center San Lazaro Hospital Tahanan Walang Hagdan Dr. Jose Rodriguez Memorial Hospital (TALA)

Presented to:

Approved by: Julius S. Tempra

RLE III Team Leader

Noted by: Jona G. Agatarap

RLE III Coordinator

Josefina C. Mangaliag

Level III Coordinator