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UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 I. MAJOR OPERATIONS
No.
DATE of OPERATION
TIME OF OPERATION STARTEDENDED
NAME OF PATIENT CASE NO.
OPERATION PERFORMED
DIAGNOSIS
TYPE of NAME of NAME of Name and Signature of Qualified ANESTHESIA SURGEON HOSPITAL Clinical Instructor
1
2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 II. MINOR OPERATIONS
No.
DATE of OPERATION
TIME OF OPERATION STARTEDENDED
NAME OF PATIENT CASE NO.
OPERATION PERFORMED
DIAGNOSIS
TYPE of NAME of NAME of Name and Signature of Qualified ANESTHESIA SURGEON HOSPITAL Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 III. ACTUAL DELIVERIES
No.
CASE NO.
DIAGNOSIS
NAME of MOTHER
AGE
DATE of DELIVERY
TIME of DELIVERY
GENDER of BABY
NAME of HOSPITAL
TYPE of DELIVERY
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 IV. DELIVERIES ASSISSTED
No.
CASE NO.
DIAGNOSIS
NAME of MOTHER
AGE
DATE of DELIVERY
TIME of DELIVERY
GENDER of BABY
NAME of HOSPITAL
TYPE of DELIVERY
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 V. CORD DRESSING
No.
Case No.
DATE PERFORMED
TIME of DELIVERY
NAME of BABY
GENDER of NAME of BABY MOTHER
AGE
NAME of HOSPITAL
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 I. MAJOR OPERATIONS
No.
DATE of OPERATION
TIME OF OPERATION STARTEDENDED
NAME OF PATIENT CASE NO.
OPERATION PERFORMED
DIAGNOSIS
TYPE of NAME of NAME of Name and Signature of Qualified ANESTHESIA SURGEON HOSPITAL Clinical Instructor
1
2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 II. MINOR OPERATIONS
No.
DATE of OPERATION
TIME OF OPERATION STARTEDENDED
NAME OF PATIENT CASE NO.
OPERATION PERFORMED
DIAGNOSIS
TYPE of NAME of NAME of Name and Signature of Qualified ANESTHESIA SURGEON HOSPITAL Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 III. ACTUAL DELIVERIES
No.
CASE NO.
DIAGNOSIS
NAME of MOTHER
AGE
DATE of DELIVERY
TIME of DELIVERY
GENDER of BABY
NAME of HOSPITAL
TYPE of DELIVERY
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 IV. DELIVERIES ASSISSTED
No.
CASE NO.
DIAGNOSIS
NAME of MOTHER
AGE
DATE of DELIVERY
TIME of DELIVERY
GENDER of BABY
NAME of HOSPITAL
TYPE of DELIVERY
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
UNIVERSITY OF PANGASINAN COLLEGE OF NURSING DAGUPAN CITY NAME OF STUDENT: Name and Address of School:
SANTOS, Paul Christian Padama University of Pangasinan Arellano St., Dagupan City Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976
University Seal
First Course (if any): School graduated from: Year: Year of admission in the BSN Program: June 2007 Year graduated from BSN Program: 2010 V. CORD DRESSING
No.
Case No.
DATE PERFORMED
TIME of DELIVERY
NAME of BABY
GENDER of NAME of BABY MOTHER
AGE
NAME of HOSPITAL
Name and Signature of Qualified Clinical Instructor
1 2 3 4 5 LEGEND: Prepared by:
Concurred by: PAUL CHRISTIAN P. SANTOS Student
_____,Chief Nurse Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Supervised by:
Noted by:
Date Signed: Degree: a). PRC No.: b). PNA No.:
Valid Until: Valid Until:
Approved by: ZENAIDA M. BAUTISTA Clinical Coordinator
Clinical Instructor Date Signed: Degree: a). PRC No.: b). PNA No.: c). ANSAP No.:
Valid Until: Valid Until: Valid Until:
BSN-RN, MAN 0133422 Valid Until: July 27, 2011 029069 Valid Until: December 31, 2009 09-0054 Valid Until: December 31, 2009
MELANIA C. CENON Dean Date Signed: Degree: a). PRC No.: b). PNA No.: c). ADPCN No.:
BSN-RN, MAN, MAEd, PhD 0100236 Valid Until: January 06, 2012 17978 Valid Until: Lifetime Member 0185 Valid Until: December 31, 2009
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