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OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFUERZO_____ __________________________________________________________________________ ________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY___________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :__NOT APPLICABLE___ ___________________ School Graduated From: _NOT APPLICABLE__Year: NOT APPLICABLE_________________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________ Date of Operation
Case No.
1.
December 16, 2007
2.
No.
II. Minor Operations Operation Type of Performed Anesthesia
Name of Surgeon
Name of Hospital
Intravenous Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Bilateral Tubal Ligation
Spinal Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Lacerated Wound Right Temporal
Suturing of Wound
Local Anesthesia
Dr. Mark Louie
Batangas Regional Hospital
Alilio John Hilbert
Infected Wound Left Foot
Debridement
Local Anesthesia
Dr. Edmund Reyes
Batangas Regional Hospital
Mark Kien Macalalad
Uncircumcised Penis
Circumcission
Local Anesthesia
Dra. Clareta Dita
Batangas Regional Hospital
Name of Patient
Diagnosis
1160712 6558
Jonalyn Mendoza
Incomplete Abortion Gravida3 Para2
Dilatation and Curettage
November 19, 2007
1119071 34348
Amante Nonita
Bilateral Tubal Ligation Gravida6 Para3
3.
May 13 ,2008
369700
Catilo Benedict
4.
May 13, 2008
369935
5.
May 13, 2008
369937
Prepared by: CAPLIS, ERWIN REFUERZO__ Signature over printed Name of Student Supervised by: MARCELLUS C. BELISARIO, RN,MAN Signature over printed name of Faculty Date Signed: ____________________ Degree: RN,MAN________ _ PRC No: 0349993___________ ___ Valid Until: September 12, 2012__ PNA No: 19636 ______________ Valid Until:_Liifetime ____
Noted by: Mr s. MA RIS OL G AR CIA -MAN IP OL , RN, MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN, MAN________________
a.)
PRC NO: _0296870_____________ Valid Until: September 2012______ b.) PNA NO: __025883 _____________ Valid Until:_December 2009 ______
Name of Qualified CI
Signature of Qualified CI
Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636
Marcellus C. Belisario PRC No: O349993 PNA No: 19636 Jonel Ramirez RN, MAN PRC No; 450849 PNA No: 2256 Jonel Ramirez RN, MAN PRC No: 450849 PNA No: 2256 Jonel Ramirez RN,MAN PRC No: 450849 PNA No: 2256
Concurred by: AMOR CALAYAN, RN,RM,MAN,PH.D.__ Signature over printed name of Chief Nurse
Concurred by: MINERVA N. ESPINO, RN, ____ __ Signature over printed name of Chief Nurse
Approved by: NELIA R. CAPULONG,_RN,RM,MAN____ Signature over printed name of Dean
Date Signed: ______________________ Degree:_BSN,RM,MAN,RN, PhD_______ a.) PRC NO: _151514 ______ Valid Until: August 2010__________ b.) PNA NO: _038801____ _________ Valid Until: December 2009_______
Date Signed: _______________________
Date Signed: ______________________
Degree:_RN,BSN___________________
Degree:_BSN,RN, RM, MAN_________
a.) PRC NO: 0090530_________________ Valid Until: October 10, 2009_________ b.) ANSAP NO: ______________________ Valid Until: _______________________ c.) PNA NO: _19638 ________________ Valid Until: Lifetime _______
a.)
,
PRC NO: 0041904______________ Valid Until: July 31, 2012______ __ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ b.) ADPCN NO:_0627______________ Valid Until: December 2009_______
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFEURZO __________________________________________________________________________________-__________________ Name and Address of School: OUR LADY OF FATIMA UNIVERSITY #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY___________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033 Year: 2001_____________________________________________ First Course (if any) :_NOT APPLICABLE____ ___________________ School Graduated From: NOT APPLICABLE____Year: NOT APPLICABLE_______________________ Year of Admission in the Bachelor of Science in Nursing Program: 2003___________________________________________________________________________________ Year Graduated (BSN Program): 2009______________________________________________________________________________________________________________
No. 1.
Date of Operation December 13, 2007
Case No.
I. Major Operations Operation Type of Performed Anesthesia
Name of Surgeon
Name of Hospital
Spinal Anesthesia
Dra. Ma. Grace Agnes Bautista
Bulacan Maternity and Childrens Hospital
Caesarian Section
Spinal Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Exploratory Laparotomy
Subarachnoid Anesthesia
Dr. Aristotle Arellano
Batangas Regional Hospital
Combined Spinal and Epedural Anesthesia
Dr. Jose Tenorio
Batangas Regional Hospital
Jonel Ramirez RN,MAN PRC No: 450849 PNA No: 2256
Subarachnoid Anesthesia
Dr. Aristotle Arellano
Batangas Regional Hospital
Jonel Ramirez RN,MAN PRC No: 450848 PNA NO: 2256
Name of Patient
Diagnosis
132732
Basillo Ruth
Pregnancy Uterine 37 weeks gestation Cephalic in Labor Para6
Caesarian Section
Pregnancy Uterine Full Term, cephalic in Labor Gravida3 Para1
2.
December 19, 2007
088171
Ma. Thersa Castro
3.
August 27, 2008
381315
Rodel Dayte
4.
August 29, 2008
373456
Jose Benemer
Cholelithiasis
5.
August 29, 2008
364339
Edgardo Paner
Exploratory Laparotomy colostomy
Prepared by: CAPLIS, ERWIN REFUERZO___ Signature over printed Name of Student Supervised by: JONEL RAMIREZ, RN,MAN ______ Signature over printed name of Faculty Date Signed: ____________________ Degree: RN,MAN________________ PRC No: 450849_________________ Valid Until: September 2010_____
PNA No: 2256 _____________ Valid Until: December 2009
Ruptured Appendix
Noted by: MRS. MARISOL GARCIA-MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN, MAN________________ b.) PRC NO: _0296870_____________ Valid Until: September 2012______ b.) PNA NO: __025883______________ Valid Until:_December 2009______
Cholecystectomy
Closure of colostomy
Name of Qualified CI
Signature of Qualified CI
Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636 Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636 Jonel Ramirez RN,MAN PRC No;450849 PNA No: 2256
Concurred by: _MINERVA ESPINO, RN ____ Signature over printed name of Chief Nurse
Concurred by: AMOR CALAYAN RN,RM,MAN,PH.D. Signature over printed name of Chief Nurse
Date Signed: ______________________ Degree:_BSN,RN___________________ a.) PRC NO:_0090530________________ Valid Until: October 10, 2009________ b.) ANSAP NO: _____________________ Valid Until: ______________________ c.) PNA NO: 19638 _______________ Valid Until: _Lifetime _______
Date Signed: _______________________ Degree:_BSN, RN_RM,MAN, PH.D._____ a.) PRC NO: _151514 _____________ Valid Until: _August 2010____________ b.) PNA NO: _038801 ______________ Valid Until: _December 2009_______
Approved by: NELIA R. CAPULONG, RN,RM,MAN__ Signature over printed name of Dean Date Signed: ______________________ Degree:_BSN RN,RM, MANMAN______ c.) PRC NO: 0041904______________ Valid Until: July 31, 2012 _______ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ c.) ADPCN NO:_0627________________ Valid Until: December 2009_________
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CALIS ERWIN REFUERZO _______________________________________________________________________________ __________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY____________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :NOT APPLICABLE_________________ School Graduated From: NOT APPLICABLE__Year:__NOT APPLICABLE________________________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________ III. Actual Deliveries Date of Time of Gender Delivery Delivery of Baby
Case No.
Diagnosis
Name of Mother
1.
142607
Pregnancy Uterine Full Term Gravida 2, Para 0, 39 weeks Age of Gestation, Cephalic in Labor
Melissa Corpus
27
Jily 23, 2007
2:06 am
2.
161401
Pregnancy Uterine Full Term Gravida 2, Para 1 39 weeks Age of Gestation, Cephalic in Labor
Aquino Karen
26
June 3, 2008
3.
621134
Pregnancy Uterine Full Term Gravida 4, Para 3, 39 weeks Age of Gestation, Cephalic in Labor
Sally Almodan
34
4.
398629
Pregnancy Uterine Full Term Gravida 1, Para 0, 38 weeks Age of Gestation, Cephalic in Labor
Maricar Ruego
5.
398586
Pregnancy Uterine Full Term Gravida 2, Para 1 38 weeks Age of Gestation, Cephalic in Labor
Celerina Arias
No.
Prepared by: CAPLIS, ERWIN REFUERZO__ Signature over printed Name of Student Supervised by: NORBERTA C. ALCARION,RN,RM,MAN Signature over printed name of Faculty Date Signed: ___________________ Degree: _BSN,RN,RM, MAN _ PR C No : 170101 __________
Valid Until; June 6, 2012____ PNA No : 1077 ___________ Valid Un til: December 2009
Noted by: Mrs. MARISOL GARCIA- MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN,RN, MAN____________
c.)
PRC NO: _0296870_____________ Valid Until: September 2012 _____ b.) PNA NO: __025883 ____________ Valid Until: December 2009______
Age
Supervised by: Name and Signature of Qualified C.I.
Name of Hospital
Type of Delivery
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Rosanie C. Moro RN,PH.D PRC No: 66491 PNA NO: 25665
12:10 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Rosanie C. Moro RN,PH.D PRC No: 66491 PNA No: 25665
November 16, 2008
7:30 pm
Male
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
24
January 3, 2009
11:00 pm
Female
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
21
January 4, 2009
7:40 pm
Female
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
Concurred by: ESTELITA B. LORENZO RN,RM,MAN Signature over printed name of Chief Nurse Date Signed: _______________________ Degree:_RN,RM,MAN __________ a.) PRC NO: _0111348________________ Valid Until: September 3, 2011_______ b.) PNA NO: 1078 _____________ Valid Until: _December 2009_________
Concurred by: JOSEPHINE B. LEONARDO_RN,MAN,PH.D. Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: BSN,RN,MAN, PH.D_______ a.) PRC NO: 0081174__________ Valid Until:_ April 3, 2011_____ b.) PNA NO: _15614______________
Valid Until:_Lifetime_____
Approved by: NELIA R. CAPULONG, RN, RM, MAN__ Signature over printed name of Dean Date Signed: ______________________ Degree:_BSN, RM, MAN_____________
d.)
PRC NO: 0041904______________ Valid Until: July 31, 2012________ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ c.) ADPCN NO:_0627________________ Valid Until: December 2009_________
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFEURZO ________________________________________________________-_______________________________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY______________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 200 Number: 033 Year: 2001_______________________________________________________________________ First Course (if any) :__NOT APPLICABLE___________________________ School Graduated From: _NOT APPLICABLE____Year: NOT APPLICABLE _________________ Year of Admission in the Bachelor of Science in Nursing Program: 2003___________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________
No.
Case No.
1.
143095
2.
161278
3.
161827
4.
152775
5.
398629
Diagnosis Pregnancy Uterine Full Term Gravida 3, Para 2, 38 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1, 39 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1, 38 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 1, Para 0, 40 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1 40 weeks Age of Gestation, Cephalic in Labor
Prepared by: CAPLIS, ERWIN REFUERZO___ Supervised by: ROSANIEover C. MORO PH.D._____ Signature printed,_RN, Name of Student Signature over printed name of Faculty _______________________________ Date Signed: ____________________ Degree: BSN, RN,PH.D ______
PRC No: 66491 _________ Valid Until; November 8, 2009 PNA No: 25665 ___________ Valid Until: December 2009____
IV. Deliveries Assisted Date of Time of Gender Delivery Delivery of Baby
Name of Mother
Age
Name of Hospital
Ma. Farat Seasat
28
August 1, 2007
3:15 am
Male
Novaliches District Hospital
Normal Spontaneous Delivery
Aquino Doloures
25
June 2, 2008
11;15 am
Male
Novaliches District Hospital
Normal Spontaneous Delivery
Allama Sherry
25
June 1o, 2008
8:12 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Serino,Mery Kris
18
July 8, 2008
9:30 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Jovlyn Riego
27
January 5, 2009
2:01 am
Male
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Supervised by: Name and Signature of Qualified C.I.
Type of Delivery
Rosanie C. Moro RN,PhD PRC No: 66491 PNA NO: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
Noted by: Mrs. MAR ISO L GAR CI A- M AN IPO L, RN, MAN Signature over printed name of Clinical Coordinator
Concurred by: JO SE PH INE B . LE ON ARD O_ RN, MAN, Ph. D . Signature over printed name of Chief Nurse
Concurred by: ESTELITA B. LORENZO RN,RM,MAN Signature over printed name of Chief Nurse
Date Signed: ___________________ Degree:_BSN, RN, MAN__________
Date Signed: ____________________ Degree:__BSN.,RN,MAN,PH.D_______
Date Signed: ______________________
d.)
a.) PRC NO: __0081174____________ Valid Until: _April 3, 2011________
a.) PRC NO: _0111348_______________ Valid Until: _September 3, 2011_____ b.) PNA NO: _1078 __________ Valid Until: ___December 2009 ___
PRC NO: _0296870__________ Valid Until: September 2012__ b.) PNA NO: __025883___________ Valid Until:__December 2009__
b.) PNA NO: __15614______________ Valid Until: _Lifetime___________
Degree:_RN, RM, MAN______________
Approved by: NELIA R. CAPULONG RN,RM,MAN Signature over printed name of Dean Date Signed: __________________ Degree:_RN, RM, MAN___________
e.)
PRC NO: 0041904__________ Valid Until: July 31, 2012_____ b.) PNA NO: 18698______________ Valid Until: Lifetime_________ c.) ADPCN NO:_0627__ ________ Valid Until: December 2009___
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFUERZO_________________________________________________________________________________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY_____________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :_NOT APPLICABLE____ ____________________ School Graduated From: _NOT APPLICABLE_____Year: NOT APPLICABLE____________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): __2009___________________________________________________________________________________________________________V. Cord Dressing No.
Case No.
Date Performed
1.
142608
July 24, 2007
Baby Girl Ritchelle
Female
Rirchelle Gelbolingo
28
Novaliches District Hospital
Rosanie C. Moro RN,PhD PRC No: 66491 PNA NO: 25665
2.
161279
June 2, 2008
Baby Boy Mauricio
Male
Mauricio Leanie
22
Novaliches District Hospital
Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665
3.
398815
January 5, 2009
Baby Girl Joli
Female
Joli Gabalda San Juan
23
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
4.
358616
January 5, 2009
Baby Boy Coredes
Male
Teresita Coredes
25
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
5.
398603
January 5, 2009
Baby Boy Mangao
Male
Mery Joy Mangao
21
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077Approved by:
Prepared by: CAPLIS, ERWIN REFUERZO___ Supervised by: NORBERTA C. ALCARION, RN,M,MAN Signature over printed name of Faculty Date Signed: ____________________ Degree: BSN,RM,RN,MAN__________
PRC No: 170101___________ Valid Until; June 6, 2012_____ PNA No: 1077_____________ Valid Until: December 2009
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Noted by: Mrs. MARISOL GARCIA- MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ___________________ Degree:_BSN,RN , MAN___________ e.) PRC NO: _0296870___________ Valid Until: September 2012___ b.) PNA NO: 025883 ____________ Valid Until:_December 2009_____
Supervised by: Signature of Qualified C.I.
Concurred by: ESTELITA B. LORENZO_RN,RM,MAN__ Signature over printed name of Chief Nurse
Concurred by: JOSEPHINE B. LEONARDO RN,MN,PH.D. Signature over printed name of Chief Nurse
Date Signed: ____________________
Date Signed: ________________________ Degree: RN,MAN,PH.D_______________ a.) PRC NO: __0081174______________ Valid Until: _April 3, 2011 ______ b.) PNA NO: ___15614 _____________ Valid Until:___Lifetime ___________
Degree:_BSN,RM, RN, MAN
_______
a.) PRC NO: ___0111348__________ Valid Until: _September 3, 2011__ b.) PNA NO: __1078_____________ Valid Until: __December 2009_____
NELIA R. CAPULONG RN,RM.MAN Signature over printed name of Dean Date Signed: __________________ Degree:_BSN,RN, RM, MAN______ f.) PRC NO: 0041904__________ Valid Until: July 31, 2012____ b.) PNA NO: 18698______________ Valid Until: Lifetime__________ .) ADPCN NO:_0627_____________ Valid Until: December 2009____
Name of Student: CAPLIS, ERWIN REFUERZO_____ __________________________________________________________________________ ________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY___________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :__NOT APPLICABLE___ ___________________ School Graduated From: _NOT APPLICABLE__Year: NOT APPLICABLE_________________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________ Date of Operation
Case No.
1.
December 16, 2007
2.
No.
II. Minor Operations Operation Type of Performed Anesthesia
Name of Surgeon
Name of Hospital
Intravenous Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Bilateral Tubal Ligation
Spinal Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Lacerated Wound Right Temporal
Suturing of Wound
Local Anesthesia
Dr. Mark Louie
Batangas Regional Hospital
Alilio John Hilbert
Infected Wound Left Foot
Debridement
Local Anesthesia
Dr. Edmund Reyes
Batangas Regional Hospital
Mark Kien Macalalad
Uncircumcised Penis
Circumcission
Local Anesthesia
Dra. Clareta Dita
Batangas Regional Hospital
Name of Patient
Diagnosis
1160712 6558
Jonalyn Mendoza
Incomplete Abortion Gravida3 Para2
Dilatation and Curettage
November 19, 2007
1119071 34348
Amante Nonita
Bilateral Tubal Ligation Gravida6 Para3
3.
May 13 ,2008
369700
Catilo Benedict
4.
May 13, 2008
369935
5.
May 13, 2008
369937
Prepared by: CAPLIS, ERWIN REFUERZO__ Signature over printed Name of Student Supervised by: MARCELLUS C. BELISARIO, RN,MAN Signature over printed name of Faculty Date Signed: ____________________ Degree: RN,MAN________ _ PRC No: 0349993___________ ___ Valid Until: September 12, 2012__ PNA No: 19636 ______________ Valid Until:_Liifetime ____
Noted by: Mr s. MA RIS OL G AR CIA -MAN IP OL , RN, MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN, MAN________________
a.)
PRC NO: _0296870_____________ Valid Until: September 2012______ b.) PNA NO: __025883 _____________ Valid Until:_December 2009 ______
Name of Qualified CI
Signature of Qualified CI
Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636
Marcellus C. Belisario PRC No: O349993 PNA No: 19636 Jonel Ramirez RN, MAN PRC No; 450849 PNA No: 2256 Jonel Ramirez RN, MAN PRC No: 450849 PNA No: 2256 Jonel Ramirez RN,MAN PRC No: 450849 PNA No: 2256
Concurred by: AMOR CALAYAN, RN,RM,MAN,PH.D.__ Signature over printed name of Chief Nurse
Concurred by: MINERVA N. ESPINO, RN, ____ __ Signature over printed name of Chief Nurse
Approved by: NELIA R. CAPULONG,_RN,RM,MAN____ Signature over printed name of Dean
Date Signed: ______________________ Degree:_BSN,RM,MAN,RN, PhD_______ a.) PRC NO: _151514 ______ Valid Until: August 2010__________ b.) PNA NO: _038801____ _________ Valid Until: December 2009_______
Date Signed: _______________________
Date Signed: ______________________
Degree:_RN,BSN___________________
Degree:_BSN,RN, RM, MAN_________
a.) PRC NO: 0090530_________________ Valid Until: October 10, 2009_________ b.) ANSAP NO: ______________________ Valid Until: _______________________ c.) PNA NO: _19638 ________________ Valid Until: Lifetime _______
a.)
,
PRC NO: 0041904______________ Valid Until: July 31, 2012______ __ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ b.) ADPCN NO:_0627______________ Valid Until: December 2009_______
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFEURZO __________________________________________________________________________________-__________________ Name and Address of School: OUR LADY OF FATIMA UNIVERSITY #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY___________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033 Year: 2001_____________________________________________ First Course (if any) :_NOT APPLICABLE____ ___________________ School Graduated From: NOT APPLICABLE____Year: NOT APPLICABLE_______________________ Year of Admission in the Bachelor of Science in Nursing Program: 2003___________________________________________________________________________________ Year Graduated (BSN Program): 2009______________________________________________________________________________________________________________
No. 1.
Date of Operation December 13, 2007
Case No.
I. Major Operations Operation Type of Performed Anesthesia
Name of Surgeon
Name of Hospital
Spinal Anesthesia
Dra. Ma. Grace Agnes Bautista
Bulacan Maternity and Childrens Hospital
Caesarian Section
Spinal Anesthesia
Dra. Pricilla Quiambao
Bulacan Maternity and Childrens Hospital
Exploratory Laparotomy
Subarachnoid Anesthesia
Dr. Aristotle Arellano
Batangas Regional Hospital
Combined Spinal and Epedural Anesthesia
Dr. Jose Tenorio
Batangas Regional Hospital
Jonel Ramirez RN,MAN PRC No: 450849 PNA No: 2256
Subarachnoid Anesthesia
Dr. Aristotle Arellano
Batangas Regional Hospital
Jonel Ramirez RN,MAN PRC No: 450848 PNA NO: 2256
Name of Patient
Diagnosis
132732
Basillo Ruth
Pregnancy Uterine 37 weeks gestation Cephalic in Labor Para6
Caesarian Section
Pregnancy Uterine Full Term, cephalic in Labor Gravida3 Para1
2.
December 19, 2007
088171
Ma. Thersa Castro
3.
August 27, 2008
381315
Rodel Dayte
4.
August 29, 2008
373456
Jose Benemer
Cholelithiasis
5.
August 29, 2008
364339
Edgardo Paner
Exploratory Laparotomy colostomy
Prepared by: CAPLIS, ERWIN REFUERZO___ Signature over printed Name of Student Supervised by: JONEL RAMIREZ, RN,MAN ______ Signature over printed name of Faculty Date Signed: ____________________ Degree: RN,MAN________________ PRC No: 450849_________________ Valid Until: September 2010_____
PNA No: 2256 _____________ Valid Until: December 2009
Ruptured Appendix
Noted by: MRS. MARISOL GARCIA-MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN, MAN________________ b.) PRC NO: _0296870_____________ Valid Until: September 2012______ b.) PNA NO: __025883______________ Valid Until:_December 2009______
Cholecystectomy
Closure of colostomy
Name of Qualified CI
Signature of Qualified CI
Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636 Marcellus C. Belisario RN,MAN PRC No: 0349993 PNA No: 19636 Jonel Ramirez RN,MAN PRC No;450849 PNA No: 2256
Concurred by: _MINERVA ESPINO, RN ____ Signature over printed name of Chief Nurse
Concurred by: AMOR CALAYAN RN,RM,MAN,PH.D. Signature over printed name of Chief Nurse
Date Signed: ______________________ Degree:_BSN,RN___________________ a.) PRC NO:_0090530________________ Valid Until: October 10, 2009________ b.) ANSAP NO: _____________________ Valid Until: ______________________ c.) PNA NO: 19638 _______________ Valid Until: _Lifetime _______
Date Signed: _______________________ Degree:_BSN, RN_RM,MAN, PH.D._____ a.) PRC NO: _151514 _____________ Valid Until: _August 2010____________ b.) PNA NO: _038801 ______________ Valid Until: _December 2009_______
Approved by: NELIA R. CAPULONG, RN,RM,MAN__ Signature over printed name of Dean Date Signed: ______________________ Degree:_BSN RN,RM, MANMAN______ c.) PRC NO: 0041904______________ Valid Until: July 31, 2012 _______ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ c.) ADPCN NO:_0627________________ Valid Until: December 2009_________
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CALIS ERWIN REFUERZO _______________________________________________________________________________ __________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY____________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :NOT APPLICABLE_________________ School Graduated From: NOT APPLICABLE__Year:__NOT APPLICABLE________________________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________ III. Actual Deliveries Date of Time of Gender Delivery Delivery of Baby
Case No.
Diagnosis
Name of Mother
1.
142607
Pregnancy Uterine Full Term Gravida 2, Para 0, 39 weeks Age of Gestation, Cephalic in Labor
Melissa Corpus
27
Jily 23, 2007
2:06 am
2.
161401
Pregnancy Uterine Full Term Gravida 2, Para 1 39 weeks Age of Gestation, Cephalic in Labor
Aquino Karen
26
June 3, 2008
3.
621134
Pregnancy Uterine Full Term Gravida 4, Para 3, 39 weeks Age of Gestation, Cephalic in Labor
Sally Almodan
34
4.
398629
Pregnancy Uterine Full Term Gravida 1, Para 0, 38 weeks Age of Gestation, Cephalic in Labor
Maricar Ruego
5.
398586
Pregnancy Uterine Full Term Gravida 2, Para 1 38 weeks Age of Gestation, Cephalic in Labor
Celerina Arias
No.
Prepared by: CAPLIS, ERWIN REFUERZO__ Signature over printed Name of Student Supervised by: NORBERTA C. ALCARION,RN,RM,MAN Signature over printed name of Faculty Date Signed: ___________________ Degree: _BSN,RN,RM, MAN _ PR C No : 170101 __________
Valid Until; June 6, 2012____ PNA No : 1077 ___________ Valid Un til: December 2009
Noted by: Mrs. MARISOL GARCIA- MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ______________________ Degree:__BSN,RN, MAN____________
c.)
PRC NO: _0296870_____________ Valid Until: September 2012 _____ b.) PNA NO: __025883 ____________ Valid Until: December 2009______
Age
Supervised by: Name and Signature of Qualified C.I.
Name of Hospital
Type of Delivery
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Rosanie C. Moro RN,PH.D PRC No: 66491 PNA NO: 25665
12:10 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Rosanie C. Moro RN,PH.D PRC No: 66491 PNA No: 25665
November 16, 2008
7:30 pm
Male
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
24
January 3, 2009
11:00 pm
Female
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
21
January 4, 2009
7:40 pm
Female
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
Concurred by: ESTELITA B. LORENZO RN,RM,MAN Signature over printed name of Chief Nurse Date Signed: _______________________ Degree:_RN,RM,MAN __________ a.) PRC NO: _0111348________________ Valid Until: September 3, 2011_______ b.) PNA NO: 1078 _____________ Valid Until: _December 2009_________
Concurred by: JOSEPHINE B. LEONARDO_RN,MAN,PH.D. Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: BSN,RN,MAN, PH.D_______ a.) PRC NO: 0081174__________ Valid Until:_ April 3, 2011_____ b.) PNA NO: _15614______________
Valid Until:_Lifetime_____
Approved by: NELIA R. CAPULONG, RN, RM, MAN__ Signature over printed name of Dean Date Signed: ______________________ Degree:_BSN, RM, MAN_____________
d.)
PRC NO: 0041904______________ Valid Until: July 31, 2012________ b.) PNA NO: 18698__________________ Valid Until: Lifetime______________ c.) ADPCN NO:_0627________________ Valid Until: December 2009_________
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFEURZO ________________________________________________________-_______________________________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY______________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________ Date School/Program was Recognized: April 25, 200 Number: 033 Year: 2001_______________________________________________________________________ First Course (if any) :__NOT APPLICABLE___________________________ School Graduated From: _NOT APPLICABLE____Year: NOT APPLICABLE _________________ Year of Admission in the Bachelor of Science in Nursing Program: 2003___________________________________________________________________________________ Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________
No.
Case No.
1.
143095
2.
161278
3.
161827
4.
152775
5.
398629
Diagnosis Pregnancy Uterine Full Term Gravida 3, Para 2, 38 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1, 39 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1, 38 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 1, Para 0, 40 weeks Age of Gestation, Cephalic in Labor Pregnancy Uterine Full Term Gravida 2, Para 1 40 weeks Age of Gestation, Cephalic in Labor
Prepared by: CAPLIS, ERWIN REFUERZO___ Supervised by: ROSANIEover C. MORO PH.D._____ Signature printed,_RN, Name of Student Signature over printed name of Faculty _______________________________ Date Signed: ____________________ Degree: BSN, RN,PH.D ______
PRC No: 66491 _________ Valid Until; November 8, 2009 PNA No: 25665 ___________ Valid Until: December 2009____
IV. Deliveries Assisted Date of Time of Gender Delivery Delivery of Baby
Name of Mother
Age
Name of Hospital
Ma. Farat Seasat
28
August 1, 2007
3:15 am
Male
Novaliches District Hospital
Normal Spontaneous Delivery
Aquino Doloures
25
June 2, 2008
11;15 am
Male
Novaliches District Hospital
Normal Spontaneous Delivery
Allama Sherry
25
June 1o, 2008
8:12 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Serino,Mery Kris
18
July 8, 2008
9:30 am
Female
Novaliches District Hospital
Normal Spontaneous Delivery
Jovlyn Riego
27
January 5, 2009
2:01 am
Male
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Normal Spontaneous Delivery
Supervised by: Name and Signature of Qualified C.I.
Type of Delivery
Rosanie C. Moro RN,PhD PRC No: 66491 PNA NO: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665 Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
Noted by: Mrs. MAR ISO L GAR CI A- M AN IPO L, RN, MAN Signature over printed name of Clinical Coordinator
Concurred by: JO SE PH INE B . LE ON ARD O_ RN, MAN, Ph. D . Signature over printed name of Chief Nurse
Concurred by: ESTELITA B. LORENZO RN,RM,MAN Signature over printed name of Chief Nurse
Date Signed: ___________________ Degree:_BSN, RN, MAN__________
Date Signed: ____________________ Degree:__BSN.,RN,MAN,PH.D_______
Date Signed: ______________________
d.)
a.) PRC NO: __0081174____________ Valid Until: _April 3, 2011________
a.) PRC NO: _0111348_______________ Valid Until: _September 3, 2011_____ b.) PNA NO: _1078 __________ Valid Until: ___December 2009 ___
PRC NO: _0296870__________ Valid Until: September 2012__ b.) PNA NO: __025883___________ Valid Until:__December 2009__
b.) PNA NO: __15614______________ Valid Until: _Lifetime___________
Degree:_RN, RM, MAN______________
Approved by: NELIA R. CAPULONG RN,RM,MAN Signature over printed name of Dean Date Signed: __________________ Degree:_RN, RM, MAN___________
e.)
PRC NO: 0041904__________ Valid Until: July 31, 2012_____ b.) PNA NO: 18698______________ Valid Until: Lifetime_________ c.) ADPCN NO:_0627__ ________ Valid Until: December 2009___
OUR LADY OF FATIMA UNIVERSITY #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFUERZO_________________________________________________________________________________________ Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY_____________________ Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________ Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________ First Course (if any) :_NOT APPLICABLE____ ____________________ School Graduated From: _NOT APPLICABLE_____Year: NOT APPLICABLE____________________ Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________ Year Graduated (BSN Program): __2009___________________________________________________________________________________________________________V. Cord Dressing No.
Case No.
Date Performed
1.
142608
July 24, 2007
Baby Girl Ritchelle
Female
Rirchelle Gelbolingo
28
Novaliches District Hospital
Rosanie C. Moro RN,PhD PRC No: 66491 PNA NO: 25665
2.
161279
June 2, 2008
Baby Boy Mauricio
Male
Mauricio Leanie
22
Novaliches District Hospital
Rosanie C. Moro RN,PhD PRC No: 66491 PNA No: 25665
3.
398815
January 5, 2009
Baby Girl Joli
Female
Joli Gabalda San Juan
23
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
4.
358616
January 5, 2009
Baby Boy Coredes
Male
Teresita Coredes
25
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077
5.
398603
January 5, 2009
Baby Boy Mangao
Male
Mery Joy Mangao
21
Ospital ng Lungsod ng San Jose Del Monte Bulacan
Norberta C. Alcarion RN,RM,MAN PRC No: 170101 PNA No: 1077Approved by:
Prepared by: CAPLIS, ERWIN REFUERZO___ Supervised by: NORBERTA C. ALCARION, RN,M,MAN Signature over printed name of Faculty Date Signed: ____________________ Degree: BSN,RM,RN,MAN__________
PRC No: 170101___________ Valid Until; June 6, 2012_____ PNA No: 1077_____________ Valid Until: December 2009
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Noted by: Mrs. MARISOL GARCIA- MANIPOL, RN,MAN Signature over printed name of Clinical Coordinator Date Signed: ___________________ Degree:_BSN,RN , MAN___________ e.) PRC NO: _0296870___________ Valid Until: September 2012___ b.) PNA NO: 025883 ____________ Valid Until:_December 2009_____
Supervised by: Signature of Qualified C.I.
Concurred by: ESTELITA B. LORENZO_RN,RM,MAN__ Signature over printed name of Chief Nurse
Concurred by: JOSEPHINE B. LEONARDO RN,MN,PH.D. Signature over printed name of Chief Nurse
Date Signed: ____________________
Date Signed: ________________________ Degree: RN,MAN,PH.D_______________ a.) PRC NO: __0081174______________ Valid Until: _April 3, 2011 ______ b.) PNA NO: ___15614 _____________ Valid Until:___Lifetime ___________
Degree:_BSN,RM, RN, MAN
_______
a.) PRC NO: ___0111348__________ Valid Until: _September 3, 2011__ b.) PNA NO: __1078_____________ Valid Until: __December 2009_____
NELIA R. CAPULONG RN,RM.MAN Signature over printed name of Dean Date Signed: __________________ Degree:_BSN,RN, RM, MAN______ f.) PRC NO: 0041904__________ Valid Until: July 31, 2012____ b.) PNA NO: 18698______________ Valid Until: Lifetime__________ .) ADPCN NO:_0627_____________ Valid Until: December 2009____
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