Prc Form > 2
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UNION CHRISTIAN COLLEGE San Fernando City, La Union Name of Student: Aguila, Jefferson Gomez Name and Address of School: UNION CHRISTIAN COLLEGE, Widdoes Street, San Fernando City, 2500, La Union Accreditation Level (if any): Level II Date School/Program was Recognized: June 14 Number: 198 First Course (if any): Not Applicable School graduated from: Not Applicable Year of Admission in the Bachelor of Science in Nursing Program: 2003 Year Graduated (BSN Program): 2007
Year Granted: 1999 Year: 1977 Year: Not Applicable
II. MINOR OPERATIONS No .
1
2
3
4
5
Date of Operation
Case No.
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Incision and Drainage
Local Anesthesia
Jessie Miranda, MD
City Health Office
Supervised by: Name & Signature of Qualified C.I.
Name & Signature of O.R. Scrub Nurse
Flordeliza G. Galvez
PRC No.: 0164680
Flordeliza G. Galvez
PRC No.: 0348366
February 8, 2007
Emergency Medical Service (E.M.S.)
Alexander James Gapac
Carbuncle
July 8, 2006
20060015134
Owen Oribello Seli
Acute Appendicitis
Emergency Appendectomy
Subarachnoid Block
Dolores Dicdican, MD
Ilocos Training and Regional Medical Center (ITRMC)
20060008875
Redentor A. Soriano
Bronchial Asthma, Pneumonia with Moderate Exacerbation
Cut Down Insertion
Local Anesthesia
Edward Passi, MD
Ilocos Training and Regional Medical Center (ITRMC)
Flordeliza G. Galvez
PRC No.: 0348392
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Emergency Medical Service (E.M.S.)
John Kirby Gregori
Redundant Prepuce
Circumcision
Local Anesthesia
Jessie Miranda, MD
City Health Office
Flordeliza G. Galvez
PRC No.: 0164680
City of San Fernando, La Union
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
84
Arturo A. Laigo
Bethany Hospital Inc.
Flordeliza G. Galvez
Cresencia Gonzales
June 22, 2006
April 29, 2006
January 4, 2006
Tendon Cyst Right Wrist
Excision of Tendon Cyst
Local Anesthesia
City of San Fernando, La Union
Maria Teresa Corpuz, MD
Emily Laroya
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Elnar Jubilo
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Divina Tabios
Emily Laroya
PRC No.: 0228817
Prepared by:
AGUILA, Jefferson G. Name of Student Noted by:
Concurred by:
NORBERTO G. PREPOSE, JR., RN, MAN CRISTETA E. BAGTANG, RN, MPH, MAN Signature over printed Name of Clinical Coordinator printed Name of Dean
Approved by: FLORDELIZA R. BOBILES, RN, MAN Signature over printed name of Assistant Chief Nurse
MARITES G. CALUGAN, RN, MAN Signature over printed name of Chief Nurse
Signature over
Date Signed: ________________________ _____________________ Degree: BSN, RN, MAN RN, MPH, MAN a. PRC No.: 0209483 125448 Valid Until: April 2, 2009 October 24, 2009 b. PNA No.: 16232 Valid Until: December 2007 Lifetime Member c. ANSAP No: 00077 356 Valid Until: Lifetime Member December 2007
Date Signed: _____________________
Date Signed: ________________________
Date Signed:
Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
Degree: BSN,
a. PRC NO.: 0114833
a. PRC NO.: 0166707
a. PRC NO.:
Valid Until: March 27, 2008
Valid Until: May 16, 2009
b. PNA No.: 17945 Valid Until: Lifetime Member
b. PNA No.: 14801 Valid Until: Lifetime Member
b. PNA No.: 3051 Valid Until:
c. ANSAP No: 01324
c. ANSAP No.: 02252
c. ADPCN No.:
Valid Until: December 2007
Valid Until: December 2007
Valid Until:
Valid Until:
Year Granted: 1999 Year: 1977 Year: Not Applicable
II. MINOR OPERATIONS No .
1
2
3
4
5
Date of Operation
Case No.
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Incision and Drainage
Local Anesthesia
Jessie Miranda, MD
City Health Office
Supervised by: Name & Signature of Qualified C.I.
Name & Signature of O.R. Scrub Nurse
Flordeliza G. Galvez
PRC No.: 0164680
Flordeliza G. Galvez
PRC No.: 0348366
February 8, 2007
Emergency Medical Service (E.M.S.)
Alexander James Gapac
Carbuncle
July 8, 2006
20060015134
Owen Oribello Seli
Acute Appendicitis
Emergency Appendectomy
Subarachnoid Block
Dolores Dicdican, MD
Ilocos Training and Regional Medical Center (ITRMC)
20060008875
Redentor A. Soriano
Bronchial Asthma, Pneumonia with Moderate Exacerbation
Cut Down Insertion
Local Anesthesia
Edward Passi, MD
Ilocos Training and Regional Medical Center (ITRMC)
Flordeliza G. Galvez
PRC No.: 0348392
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Emergency Medical Service (E.M.S.)
John Kirby Gregori
Redundant Prepuce
Circumcision
Local Anesthesia
Jessie Miranda, MD
City Health Office
Flordeliza G. Galvez
PRC No.: 0164680
City of San Fernando, La Union
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
84
Arturo A. Laigo
Bethany Hospital Inc.
Flordeliza G. Galvez
Cresencia Gonzales
June 22, 2006
April 29, 2006
January 4, 2006
Tendon Cyst Right Wrist
Excision of Tendon Cyst
Local Anesthesia
City of San Fernando, La Union
Maria Teresa Corpuz, MD
Emily Laroya
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Elnar Jubilo
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
PRC No.: 0130411 PNA No.: 16263 MAN units: 33 units
Divina Tabios
Emily Laroya
PRC No.: 0228817
Prepared by:
AGUILA, Jefferson G. Name of Student Noted by:
Concurred by:
NORBERTO G. PREPOSE, JR., RN, MAN CRISTETA E. BAGTANG, RN, MPH, MAN Signature over printed Name of Clinical Coordinator printed Name of Dean
Approved by: FLORDELIZA R. BOBILES, RN, MAN Signature over printed name of Assistant Chief Nurse
MARITES G. CALUGAN, RN, MAN Signature over printed name of Chief Nurse
Signature over
Date Signed: ________________________ _____________________ Degree: BSN, RN, MAN RN, MPH, MAN a. PRC No.: 0209483 125448 Valid Until: April 2, 2009 October 24, 2009 b. PNA No.: 16232 Valid Until: December 2007 Lifetime Member c. ANSAP No: 00077 356 Valid Until: Lifetime Member December 2007
Date Signed: _____________________
Date Signed: ________________________
Date Signed:
Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
Degree: BSN,
a. PRC NO.: 0114833
a. PRC NO.: 0166707
a. PRC NO.:
Valid Until: March 27, 2008
Valid Until: May 16, 2009
b. PNA No.: 17945 Valid Until: Lifetime Member
b. PNA No.: 14801 Valid Until: Lifetime Member
b. PNA No.: 3051 Valid Until:
c. ANSAP No: 01324
c. ANSAP No.: 02252
c. ADPCN No.:
Valid Until: December 2007
Valid Until: December 2007
Valid Until:
Valid Until:
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