Prc Form > 5
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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
V. CORD DRESSING No .
Case No.
Date Performed
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Supervised by: Name & Signature of Qualified Clinical Instructor
1
74
February 20, 2007
Maria Janine C. Hidalgo
Male
Mary Jane Calica Hidalgo
33
Bethany Hospital Inc.
Jennifer Alice G. Abaga
2
Home Delivery
November 15, 2006
Raiza Mae A. Casil
Female
Amalia Asuncion Casil
36
Ilocanos Sur Health Center City of San Fernando, La Union
Jennifer Alice G. Abaga
3
Well Baby
July 27, 2006
Beverly Jane D. Arguilles
Female
Jonalyn Domondon Arguilles
18
Ilocos Training and Regional Medical Center (ITRMC)
Jennifer Alice G. Abaga
4
Well Baby
July 21, 2006
Glaydel B. Caluza
Female
Gloria Bagsawan Caluza
29
Ilocos Training and Regional Medical Center (ITRMC)
Jennifer Alice G. Abaga
Betty Peralta Olano
26
5
Home Delivery
July 9, 2006
Marc Benz P. Vinluan
Male
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
Jennifer Alice G. Abaga PRC #: 0216745 PNA #:17944 MAN units: 33 units
Santiago Norte Health Center City of San Fernando, La Union
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 Signature over printed Name of Dean Date Signed: ________________________ ________________________ Degree: BSN, RN, MAN MAN a. PRC No.: 0209483
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: ________________________
Date Signed:
Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
Degree: BSN, RN, MPH,
a. PRC NO.: 0114833
a. PRC NO.: 0166707
a. PRC NO.: 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
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
V. CORD DRESSING No .
Case No.
Date Performed
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Supervised by: Name & Signature of Qualified Clinical Instructor
1
74
February 20, 2007
Maria Janine C. Hidalgo
Male
Mary Jane Calica Hidalgo
33
Bethany Hospital Inc.
Jennifer Alice G. Abaga
2
Home Delivery
November 15, 2006
Raiza Mae A. Casil
Female
Amalia Asuncion Casil
36
Ilocanos Sur Health Center City of San Fernando, La Union
Jennifer Alice G. Abaga
3
Well Baby
July 27, 2006
Beverly Jane D. Arguilles
Female
Jonalyn Domondon Arguilles
18
Ilocos Training and Regional Medical Center (ITRMC)
Jennifer Alice G. Abaga
4
Well Baby
July 21, 2006
Glaydel B. Caluza
Female
Gloria Bagsawan Caluza
29
Ilocos Training and Regional Medical Center (ITRMC)
Jennifer Alice G. Abaga
Betty Peralta Olano
26
5
Home Delivery
July 9, 2006
Marc Benz P. Vinluan
Male
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
PRC #: 0216745 PNA #:17944 MAN units: 33 units
Jennifer Alice G. Abaga PRC #: 0216745 PNA #:17944 MAN units: 33 units
Santiago Norte Health Center City of San Fernando, La Union
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 Signature over printed Name of Dean Date Signed: ________________________ ________________________ Degree: BSN, RN, MAN MAN a. PRC No.: 0209483
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: ________________________
Date Signed:
Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
Degree: BSN, RN, MPH,
a. PRC NO.: 0114833
a. PRC NO.: 0166707
a. PRC NO.: 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
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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