Prc Form > 3

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

III. ACTUAL DELIVERIES N o.

Case No.

Diagnosis

Name of Mother

Ag e

Date of Delivery

Time of Deliv ery

Gender of Baby

Name of Hospital

Type of Delivery

Supervised by: Name & Signature of Qualified Clinical Instructor

1

Home Delivery

Pregnancy Uterine 40 weeks Age of Gestation Cephalic in Labor Gravida 1 Para 0 (G1P0)

Virginia Pagaling Cu

21

February 27, 2007

8:30 AM

Female

Tanqui Health Center

Normal Spontaneous Delivery with Right Medio-Lateral Episiotomy (RMLE)

Charmaine S. Abenes

2

Home Delivery

Pregnancy Uterine 39 weeks Age of Gestation Cephalic in Labor Gravida 4 Para 3 (G4P3)

Asnairah Moctar Macapunag

37

January 6, 2007

10:46 AM

Male

Cabaroan Health Center

Normal Spontaneous Delivery

Charmaine S. Abenes

20060033127

Pregnancy Uterine 40 weeks Age of Gestation Cephalic in Labor Gravida 2 Para 1 (G2P1)

Marnelle Oca

18

4

20060015243

Pregnancy Uterine 39 ½ weeks Age of Gestation Cephalic in Labor Gravida 1 Para 0 (G1P0)

Ednalyn Cabanit Obaña

5

20060010595

Pregnancy Uterine 40 weeks Age of Gestation Cephalic in Labor Gravida 1 Para o (G1P0)

Dinalyn Madayag Baladad

3

City of San Fernando, La Union

PRC #: 0266421 PNA #:16309 MAN units: 42 units

City of San Fernando, La Union

December 23, 2006

4:41 AM

Male

27

June 30, 2006

11:54 PM

21

May 4, 2006

7:50 AM

PRC #: 0266421 PNA #:16309 MAN units: 42 units

Ilocos Training and Regional Medical Center (ITRMC)

Normal Spontaneous Delivery with Right Medio-Lateral Episiotomy (RMLE)

Charmaine S. Abenes

Male

Ilocos Training and Regional Medical Center (ITRMC)

Normal Spontaneous Delivery with Right Medio-Lateral Episiotomy (RMLE)

Charmaine S. Abenes

Female

Ilocos Training and Regional Medical Center (ITRMC)

Normal Spontaneous Delivery with Right Medio-Lateral Episiotomy (RMLE)

Charmaine S. Abenes

PRC #: 0266421 PNA #:16309 MAN units: 42 units

PRC #: 0266421 PNA #:16309 MAN units: 42 units

PRC #: 0266421 PNA #:16309 MAN units: 42 units

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 Date Signed: ________________________ _____________________ Degree: BSN, RN, MAN RN, MPH, MAN a. PRC No.: 0209483 125448

Approved by: FLORDELIZA R. BOBILES, RN, MAN Signature over printed name of Assistant Chief Nurse Date Signed: _____________________

MARITES G. CALUGAN, RN, MAN Signature over printed name of Chief Nurse Date Signed: ________________________

Signature over 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: 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

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: