Xavier University - Prc Form
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Xavier University - Prc Form as PDF for free.
More details
- Words: 2,646
- Pages: 12
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation Level (if any): None Date of School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Number
Case Number
1
248374
2
3
4
5
224755 248554
245826
241938
Prepared by: ___PAULA HELENA ROJAS ABA___ Name of Student
Diagnosis Delivery Term Spontaneous to an alive baby girl 2.8 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 1 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 2 Parity 1 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 0 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 3 Parity 3 Delivery Term Spontaneous to an alive baby girl 3.0 kilograms with APGAR Score of 9 cephalic Gravida 4 Parity 3
Name of Patient
Age
Lady June Balacuit
21
April 21, 2009
5:25pm
Marilyn Fernandez
25
April 24, 2009
Jonalyn Balatero
23
Eusebia Ragot
Riza Pagaran
Type of Delivery
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
10:20p m
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
April 26, 2009
1:30pm
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
27
May 2, 2009
12:43a m
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
30
May 3, 2009
10:00p m
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
.
Valid Until: November 22, 2010
b.)
_________MRS. CHRISTY G. DABLO________ Clinical Coordinator Date Signed: . Degree: BSN, RN, MN, MAN .
PNA No.: 066620 . Valid Until: December 31, 2009 .
Concurred by:
PRC No.: 0222342 .
Not Applicable
Name of Hospital
Noted by:
a.)
III. HANDLED DELIVERIES Time Gende Date of of r of Delivery Delive Baby ry
Year Granted:
___________MRS. JULIANA L. JAVIER___________
Supervised by: Name & Signature of Qualified C.I.
Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN . a.) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
Approved by: ________DR. RAMONA HEIDI C. PALAD________ Dean College of Nursing Xavier University- Ateneo de Cagayan Date Signed: Degree: BSN, RN, MAN, MAed, PhD .
a.)
PRC No.: 0053722 . Valid Until: August 31, 2012 .
b.)
PNA No.: 11836 . Valid Until: Lifetime .
c.) .
ADPCN No.: 0063 . Valid Until: October 31, 2010
.
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation Level (if any): None Date of School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Number
1
Case Number
508349
2
229708
3
226758
4
1891
5
226258
Diagnosis
Name of Patient
Age
Inevitable Abortion, G4P3 (3003)
Marivic Aguiton
27
Delivery Term Spontaneous to an alive baby girl 3.0 kilograms with APGAR Score of 9 cephalic Gravida 4 Parity 3 Delivery Term Spontaneous to an alive baby boy 2.6 kilograms with APGAR score of 9 cephalic Gravida 1 Para 1 (1001) Delivery Term Spontaneous to an alive baby girl 3.4 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 0 Delivery Term Spontaneous to an alive baby girl 3 kilograms with APGAR Score of 9 cephalic Gravida 2 Parity 1
Prepared by:
IV. DELIVERIES ASSISTED Time Gende Date of of r of Delivery Deliver Baby y May 8, 2008
Male
___MRS.CHRISTY G. DABLO_______ Clinical Coordinator
Type of Delivery
Northern Mindanao Medical Center
Normal Spontaneous Vaginal Delivery
42
April 23, 2009
9:45am
Female
Gingoog District Hospital
Maria Bernadette Oncada
19
April 25, 2009
7:43am
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
Jodeza Peligro
25
April 27, 2009
5:23pm
Female
Gingoog City Women & Puericulture Center
Normal Spontaneous Vaginal Delivery
Delma Faith Aviancio
24
May 3, 2009
6:00pm
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
Valid Until: December 31, 2009 .
a.) _
Name of Hospital
Angelita Sabuga
. Degree: BSN, RN, MN, MAN . Noted by:
Not Applicable
Normal Spontaneous Vaginal Delivery
Date Signed:
___ PAULA HELENA ROJAS ABA____ Name of Student
1:26pm
Year Granted:
PRC No.: 0222342 . Valid Until: November 22, 2010 .
b.)
PNA No.: 066620 .
Concurred by:
Supervised by: Name & Signature of Qualified Clinical Instructor
Mrs. Jessica D. Bunao, BSN, RN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
__ DR. DOROTHEA N. ROQUE_____ Chief Nurse Northern Mindanao Medical Center Date Signed: . Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 .
Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by: _______MRS. JULIANA L. JAVIER______ Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN .
____DR. RAMONA HEIDI C. PALAD_____ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: . Degree: BSN, RN, MAN, MAEd, PhD .
a.)
. Valid Until: August 31, 2012 .
a.)
PRC No.: 0077182 . Valid Until: December 10, 2010 .
b.)
PNA No.: 11836 . Valid Until: Lifetime .
b.)
PNA No.: 80212 . Valid Until: December 31, 2009 .
c.) . .
Concurred by: _________MS. RIZA C. DAJAO_________ Nurse Gingoog City Women & Puericulture Center Date Signed: . Degree: RM, RN . a.) PRC No.: 0349503 . Valid Until: August 25, 2012 . b.) PNA No.: 066466 . Valid Until: December 4, 2010 .
Approved by:
PRC No.: 0053722
ADPCN No.: 0063 Valid Until: October 31, 2010
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation Level (if any): None Date of School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
V. CORD DRESSING Number
Case Number
Date Performed
1
2081295
April 21, 2008
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Baby Boy Bernadez
Male
Fe Bernadez
35
Madonna and Child Hospital
2
248386
April 21, 2009
Baby Girl Ragot
Female
Marshaliza Ragot
32
Gingoog District Hospital
3
248385
April 21, 2009
Baby Boy Castil
Male
Renie Macaranas
35
Gingoog District Hospital
4
248388
April 21, 2009
Baby Boy Salugsugan
Male
Elcita Salugsugan
31
Gingoog District Hospital
5
248731
May 5, 2009
Baby Girl Pagapong
Female
Evelyn Pagapong
31
Gingoog District Hospital
Supervised by: Name & Signature of Qualified C.I.
Mrs. Rosalie A. Uriarte, BSN, RN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
Prepared by:
Noted by:
Concurred by:
Concurred by:
PAULA HELENA ROJAS ABA_____ Name of Student
________MRS.CHRISTY G. DABLO__________ Clinical Coordinator Date Signed:
_ MS. FRANCES ROSARY C. MARFORI____ Chief Nurse Madonna and Child Hospital Date Signed:
_ MRS. JULIANA L. JAVIER____ _______ Chief Nurse Gingoog District Hospital Date Signed:
. Degree: BSN, RN, MN . a.) PRC No.: 0164585 . Valid Until: October 31, 2011 . b.) PNA No.: 19685 . Valid Until: Lifetime . c.) ANSAP No.: 02507 . Valid Until: December 31, 2009 .
. Degree: BSN, RN . a. ) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
Approved by: __ DR. RAMONA HEIDI C. PALAD________ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: .
Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722
. . . . . .
Valid Until: August 31, 2012 b.) PNA No.: 11836 Valid Until: Lifetime c.) ADPCN No.: 0063 Valid Until: October 31, 2010
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation level: (If any) None Date School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
I. MAJOR OPERATIONS Num ber
Date of Operati on
Case Numbe r
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Name of Operating Room Scrub Nurse
1
Decembe r 19, 2007
480465
Gina Dagunot
Cholelithiasis with cholecystolithiasis, gangrenous gallbladder with adhesion
Cholecystectomy Lavage and Drainage
Spinal Anesthesia – Epidural Anesthesia
Dr. Elmer Zalsos
Northern Mindanao Medical Center
Pilarlita Mae S. Pagaray, BSN, RN
2
Decembe r 20, 2007
352552
Francisco Canaya
Nodular Non-toxic goiter with neck metastasis probably malignant
Total Thyroidectomy with Radical Neck Dissection, Right
General Anesthesia
Dr. Bernabe Mendoza
Northern Mindanao Medical Center
Pilarlita Mae S. Pagaray, BSN, RN
Signature of Operating Room Scrub Nurse
Eddie Yap
Healed Fracture Radius Middle Third, Right; Refracture Medial Third Ulna, Right
Removal of Implant Radius, Right; Replating of the medial third ulna, Right
General Anesthesia
Dr. Justiniano Aquilino Cyril Pimentel
Northern Mindanao Medical Center
Leni I. Gestuveo, BSN, RN
507732
Leonila Villaruel
Phylloides Tumor, Left
Simple Mastectomy, Left
General Anesthesia
Dr. Riman Ricardo
Northern Mindanao Medical Center
Almer Jan L. Zalsos, BSN, RN
006679
Clemente Salarda
Incarcerated Inguinal Hernia
Herniorrhapy, Right
Local Anesthesia
Dr. Joel Babanto
Gingoog District Hospital
Fe T. Teope, BSN, RN
3
April 24, 2008
507532
4
April 24, 2008
5
April 23, 2009
Prepared by:
Supervised by:
Noted by:
Concurred by:
PAULA HELENA ROJAS ABA__ Name of Student
___MRS. IVY R. GO_ __ Clinical Instructor Date Signed: _________________________________ __ Degree:BSN, RN, MAN . a.) PRC No.: 0222293 . Valid Until: April 21, 2010 . b.) PNA No.: 066616 . Valid Until: December 31, 2009 .
MRS.CHRISTY G. DABLO . Clinical Coordinator Date Signed:
DR. DOROTHEA N. ROQUE . Chief Nurse Northern Mindanao Medical Center Date Signed:
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 . Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by:
.
MRS. JULIANA L. JAVIER
Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN . a. ) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
Approved by: DR. RAMONA HEIDI C. PALAD . Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: . Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722 . Valid Until: August 31, 2012 . b.) PNA No.: 11836 . Valid Until: Lifetime . c.) ADPCN No.: 0063 . Valid Until: October 31, 2010 .
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation level: (If any) None Date School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
II. MINOR OPERATIONS Num ber
Date of Operati on
Case Numbe r
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Name of Operating Room Scrub Nurse
1
Decembe r 19, 2007
480457
Hazel Jane Malinay
Sacrococcygeal Mass
Excision of Sacrococcygeal Teratoma
General Anesthesia
Dr. Dures Fe Tagayuna
Northern Mindanao Medical Center
Joesphine U. Cabeguin, BSN, RN
Mother’s House, Xavier University – Community Health Care Center Mother’s House, Xavier University – Community Health Care Center
2
February 8, 2008
2008601
Nilda Adoremos
Multiparity
Bilateral Tubal Ligation
Local Anesthesia
Dr. Maria Corazon Cuaycong
3
March 19, 2008
2008615
Judith Baterna
Multiparity
Bilateral Tubal Ligation
Local Anesthesia
Dr. Maria Corazon Cuaycong
4
April 17, 2008
259
Howard Wyne Llesis
Phimosis
Circumcision
Local Anesthesia
Dr. Melodee Zamora
City Health Office -Tablon Health Center
Iryn L. Salcedo, BSN, RN
5
April 17, 2008
260
Howard Miles Llesis
Phimosis
Circumcision
Local Anesthesia
Dr. Melodee Zamora
City Health Office -Tablon Health Center
Iryn L. Salcedo, BSN, RN
Grace L. Llevares, BSN, RN
Grace L. Llevares, BSN, RN
Signature of Operating Room Scrub Nurse
Prepared by:
Supervised by:
Noted by:
PAULA HELENA ROJAS ABA____ Name of Student
MRS. IVY R. GO ___ Clinical Instructor Date Signed:
___ MRS.CHRISTY G. DABLO_____ Clinical Coordinator Date Signed:
. Degree: BSN, RN, MAN . a.) PRC No.: 0222293 . Valid Until: April 21, 2010 . b.) PNA No.:066616 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
Concurred by: _
__DR. DOROTHEA N. ROQUE_____ Chief Nurse Northern Mindanao Medical Center Date Signed: . Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 . Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by:
Concurred by:
Approved by:
__ MRS. EVA R. LLENO________ Chief Nurse Xavier University – Community Health Care Center Date Signed:
______MS. IRYN L. SALCEDO______ Public Health Nurse III City Health Office Date Signed:
____DR. RAMONA HEIDI C. PALAD___ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed:
. Degree: BSN, RN, MHA . a. ) PRC No.: 0091662 . Valid Until: August 9, 2012 . b.) PNA No.: 18586 . Valid Until: Lifetime . c.) ANSAP No.: 090011 . Valid Until: Lifetime .
. Degree: BSN, RN, MPH . a.) PRC No.: 0148109 . Valid Until: January 11, 2012 . b.) PNA No.: 79897 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722 . Valid Until: August 31, 2012 . b.) PNA No.: 11836 . Valid Until: Lifetime . c.) ADPCN No.: 0063 . Valid Until: October 31, 2010 .
Number
Case Number
1
248374
2
3
4
5
224755 248554
245826
241938
Prepared by: ___PAULA HELENA ROJAS ABA___ Name of Student
Diagnosis Delivery Term Spontaneous to an alive baby girl 2.8 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 1 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 2 Parity 1 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 0 Delivery Term Spontaneous to an alive baby boy 3.0 kilograms with APGAR Score of 9 cephalic Gravida 3 Parity 3 Delivery Term Spontaneous to an alive baby girl 3.0 kilograms with APGAR Score of 9 cephalic Gravida 4 Parity 3
Name of Patient
Age
Lady June Balacuit
21
April 21, 2009
5:25pm
Marilyn Fernandez
25
April 24, 2009
Jonalyn Balatero
23
Eusebia Ragot
Riza Pagaran
Type of Delivery
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
10:20p m
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
April 26, 2009
1:30pm
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
27
May 2, 2009
12:43a m
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
30
May 3, 2009
10:00p m
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
.
Valid Until: November 22, 2010
b.)
_________MRS. CHRISTY G. DABLO________ Clinical Coordinator Date Signed: . Degree: BSN, RN, MN, MAN .
PNA No.: 066620 . Valid Until: December 31, 2009 .
Concurred by:
PRC No.: 0222342 .
Not Applicable
Name of Hospital
Noted by:
a.)
III. HANDLED DELIVERIES Time Gende Date of of r of Delivery Delive Baby ry
Year Granted:
___________MRS. JULIANA L. JAVIER___________
Supervised by: Name & Signature of Qualified C.I.
Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN . a.) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
Approved by: ________DR. RAMONA HEIDI C. PALAD________ Dean College of Nursing Xavier University- Ateneo de Cagayan Date Signed: Degree: BSN, RN, MAN, MAed, PhD .
a.)
PRC No.: 0053722 . Valid Until: August 31, 2012 .
b.)
PNA No.: 11836 . Valid Until: Lifetime .
c.) .
ADPCN No.: 0063 . Valid Until: October 31, 2010
.
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation Level (if any): None Date of School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Number
1
Case Number
508349
2
229708
3
226758
4
1891
5
226258
Diagnosis
Name of Patient
Age
Inevitable Abortion, G4P3 (3003)
Marivic Aguiton
27
Delivery Term Spontaneous to an alive baby girl 3.0 kilograms with APGAR Score of 9 cephalic Gravida 4 Parity 3 Delivery Term Spontaneous to an alive baby boy 2.6 kilograms with APGAR score of 9 cephalic Gravida 1 Para 1 (1001) Delivery Term Spontaneous to an alive baby girl 3.4 kilograms with APGAR Score of 9 cephalic Gravida 1 Parity 0 Delivery Term Spontaneous to an alive baby girl 3 kilograms with APGAR Score of 9 cephalic Gravida 2 Parity 1
Prepared by:
IV. DELIVERIES ASSISTED Time Gende Date of of r of Delivery Deliver Baby y May 8, 2008
Male
___MRS.CHRISTY G. DABLO_______ Clinical Coordinator
Type of Delivery
Northern Mindanao Medical Center
Normal Spontaneous Vaginal Delivery
42
April 23, 2009
9:45am
Female
Gingoog District Hospital
Maria Bernadette Oncada
19
April 25, 2009
7:43am
Male
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
Jodeza Peligro
25
April 27, 2009
5:23pm
Female
Gingoog City Women & Puericulture Center
Normal Spontaneous Vaginal Delivery
Delma Faith Aviancio
24
May 3, 2009
6:00pm
Female
Gingoog District Hospital
Normal Spontaneous Vaginal Delivery
Valid Until: December 31, 2009 .
a.) _
Name of Hospital
Angelita Sabuga
. Degree: BSN, RN, MN, MAN . Noted by:
Not Applicable
Normal Spontaneous Vaginal Delivery
Date Signed:
___ PAULA HELENA ROJAS ABA____ Name of Student
1:26pm
Year Granted:
PRC No.: 0222342 . Valid Until: November 22, 2010 .
b.)
PNA No.: 066620 .
Concurred by:
Supervised by: Name & Signature of Qualified Clinical Instructor
Mrs. Jessica D. Bunao, BSN, RN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
__ DR. DOROTHEA N. ROQUE_____ Chief Nurse Northern Mindanao Medical Center Date Signed: . Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 .
Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by: _______MRS. JULIANA L. JAVIER______ Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN .
____DR. RAMONA HEIDI C. PALAD_____ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: . Degree: BSN, RN, MAN, MAEd, PhD .
a.)
. Valid Until: August 31, 2012 .
a.)
PRC No.: 0077182 . Valid Until: December 10, 2010 .
b.)
PNA No.: 11836 . Valid Until: Lifetime .
b.)
PNA No.: 80212 . Valid Until: December 31, 2009 .
c.) . .
Concurred by: _________MS. RIZA C. DAJAO_________ Nurse Gingoog City Women & Puericulture Center Date Signed: . Degree: RM, RN . a.) PRC No.: 0349503 . Valid Until: August 25, 2012 . b.) PNA No.: 066466 . Valid Until: December 4, 2010 .
Approved by:
PRC No.: 0053722
ADPCN No.: 0063 Valid Until: October 31, 2010
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation Level (if any): None Date of School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
V. CORD DRESSING Number
Case Number
Date Performed
1
2081295
April 21, 2008
Name of Baby
Gender of Baby
Name of Mother
Age
Name of Hospital
Baby Boy Bernadez
Male
Fe Bernadez
35
Madonna and Child Hospital
2
248386
April 21, 2009
Baby Girl Ragot
Female
Marshaliza Ragot
32
Gingoog District Hospital
3
248385
April 21, 2009
Baby Boy Castil
Male
Renie Macaranas
35
Gingoog District Hospital
4
248388
April 21, 2009
Baby Boy Salugsugan
Male
Elcita Salugsugan
31
Gingoog District Hospital
5
248731
May 5, 2009
Baby Girl Pagapong
Female
Evelyn Pagapong
31
Gingoog District Hospital
Supervised by: Name & Signature of Qualified C.I.
Mrs. Rosalie A. Uriarte, BSN, RN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN Mrs. Christy G. Dablo, BSN, RN, MN, MAN
Prepared by:
Noted by:
Concurred by:
Concurred by:
PAULA HELENA ROJAS ABA_____ Name of Student
________MRS.CHRISTY G. DABLO__________ Clinical Coordinator Date Signed:
_ MS. FRANCES ROSARY C. MARFORI____ Chief Nurse Madonna and Child Hospital Date Signed:
_ MRS. JULIANA L. JAVIER____ _______ Chief Nurse Gingoog District Hospital Date Signed:
. Degree: BSN, RN, MN . a.) PRC No.: 0164585 . Valid Until: October 31, 2011 . b.) PNA No.: 19685 . Valid Until: Lifetime . c.) ANSAP No.: 02507 . Valid Until: December 31, 2009 .
. Degree: BSN, RN . a. ) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
Approved by: __ DR. RAMONA HEIDI C. PALAD________ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: .
Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722
. . . . . .
Valid Until: August 31, 2012 b.) PNA No.: 11836 Valid Until: Lifetime c.) ADPCN No.: 0063 Valid Until: October 31, 2010
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation level: (If any) None Date School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
I. MAJOR OPERATIONS Num ber
Date of Operati on
Case Numbe r
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Name of Operating Room Scrub Nurse
1
Decembe r 19, 2007
480465
Gina Dagunot
Cholelithiasis with cholecystolithiasis, gangrenous gallbladder with adhesion
Cholecystectomy Lavage and Drainage
Spinal Anesthesia – Epidural Anesthesia
Dr. Elmer Zalsos
Northern Mindanao Medical Center
Pilarlita Mae S. Pagaray, BSN, RN
2
Decembe r 20, 2007
352552
Francisco Canaya
Nodular Non-toxic goiter with neck metastasis probably malignant
Total Thyroidectomy with Radical Neck Dissection, Right
General Anesthesia
Dr. Bernabe Mendoza
Northern Mindanao Medical Center
Pilarlita Mae S. Pagaray, BSN, RN
Signature of Operating Room Scrub Nurse
Eddie Yap
Healed Fracture Radius Middle Third, Right; Refracture Medial Third Ulna, Right
Removal of Implant Radius, Right; Replating of the medial third ulna, Right
General Anesthesia
Dr. Justiniano Aquilino Cyril Pimentel
Northern Mindanao Medical Center
Leni I. Gestuveo, BSN, RN
507732
Leonila Villaruel
Phylloides Tumor, Left
Simple Mastectomy, Left
General Anesthesia
Dr. Riman Ricardo
Northern Mindanao Medical Center
Almer Jan L. Zalsos, BSN, RN
006679
Clemente Salarda
Incarcerated Inguinal Hernia
Herniorrhapy, Right
Local Anesthesia
Dr. Joel Babanto
Gingoog District Hospital
Fe T. Teope, BSN, RN
3
April 24, 2008
507532
4
April 24, 2008
5
April 23, 2009
Prepared by:
Supervised by:
Noted by:
Concurred by:
PAULA HELENA ROJAS ABA__ Name of Student
___MRS. IVY R. GO_ __ Clinical Instructor Date Signed: _________________________________ __ Degree:BSN, RN, MAN . a.) PRC No.: 0222293 . Valid Until: April 21, 2010 . b.) PNA No.: 066616 . Valid Until: December 31, 2009 .
MRS.CHRISTY G. DABLO . Clinical Coordinator Date Signed:
DR. DOROTHEA N. ROQUE . Chief Nurse Northern Mindanao Medical Center Date Signed:
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 . Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by:
.
MRS. JULIANA L. JAVIER
Chief Nurse Gingoog District Hospital Date Signed: . Degree: BSN, RN . a. ) PRC No.: 0077182 . Valid Until: December 10, 2010 . b.) PNA No.: 80212 . Valid Until: December 31, 2009 .
Approved by: DR. RAMONA HEIDI C. PALAD . Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed: . Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722 . Valid Until: August 31, 2012 . b.) PNA No.: 11836 . Valid Until: Lifetime . c.) ADPCN No.: 0063 . Valid Until: October 31, 2010 .
XAVIER UNIVERSITY – ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines School Code: 0839 Name of Student: PAULA HELENA ROJAS ABA Name & Address of School: Xavier University – Ateneo de Cagayan, Corrales Avenue, Cagayan de Oro City Accreditation level: (If any) None Date School / Program was Recognized: June 9 Number: 008 Year: 1992 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: 2005 Year Graduated (BSN Program): 2009
Year Granted:
Not Applicable
II. MINOR OPERATIONS Num ber
Date of Operati on
Case Numbe r
Name of Patient
Diagnosis
Operation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Name of Operating Room Scrub Nurse
1
Decembe r 19, 2007
480457
Hazel Jane Malinay
Sacrococcygeal Mass
Excision of Sacrococcygeal Teratoma
General Anesthesia
Dr. Dures Fe Tagayuna
Northern Mindanao Medical Center
Joesphine U. Cabeguin, BSN, RN
Mother’s House, Xavier University – Community Health Care Center Mother’s House, Xavier University – Community Health Care Center
2
February 8, 2008
2008601
Nilda Adoremos
Multiparity
Bilateral Tubal Ligation
Local Anesthesia
Dr. Maria Corazon Cuaycong
3
March 19, 2008
2008615
Judith Baterna
Multiparity
Bilateral Tubal Ligation
Local Anesthesia
Dr. Maria Corazon Cuaycong
4
April 17, 2008
259
Howard Wyne Llesis
Phimosis
Circumcision
Local Anesthesia
Dr. Melodee Zamora
City Health Office -Tablon Health Center
Iryn L. Salcedo, BSN, RN
5
April 17, 2008
260
Howard Miles Llesis
Phimosis
Circumcision
Local Anesthesia
Dr. Melodee Zamora
City Health Office -Tablon Health Center
Iryn L. Salcedo, BSN, RN
Grace L. Llevares, BSN, RN
Grace L. Llevares, BSN, RN
Signature of Operating Room Scrub Nurse
Prepared by:
Supervised by:
Noted by:
PAULA HELENA ROJAS ABA____ Name of Student
MRS. IVY R. GO ___ Clinical Instructor Date Signed:
___ MRS.CHRISTY G. DABLO_____ Clinical Coordinator Date Signed:
. Degree: BSN, RN, MAN . a.) PRC No.: 0222293 . Valid Until: April 21, 2010 . b.) PNA No.:066616 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MN, MAN . a.) PRC No.: 0222342 . Valid Until: November 22, 2010 . b.) PNA No.: 066620 . Valid Until: December 31, 2009 .
Concurred by: _
__DR. DOROTHEA N. ROQUE_____ Chief Nurse Northern Mindanao Medical Center Date Signed: . Degree: BSN, RN, MAN, Ed D. . a.) PRC No.: 0041397 . Valid Until: February 6, 2010 . b.) PNA No.: 018604 . Valid Until: December 31, 2009 . c.) ANSAP No.: 05047 . Valid Until: December 31, 2009 .
Concurred by:
Concurred by:
Approved by:
__ MRS. EVA R. LLENO________ Chief Nurse Xavier University – Community Health Care Center Date Signed:
______MS. IRYN L. SALCEDO______ Public Health Nurse III City Health Office Date Signed:
____DR. RAMONA HEIDI C. PALAD___ Dean College of Nursing Xavier University-Ateneo de Cagayan Date Signed:
. Degree: BSN, RN, MHA . a. ) PRC No.: 0091662 . Valid Until: August 9, 2012 . b.) PNA No.: 18586 . Valid Until: Lifetime . c.) ANSAP No.: 090011 . Valid Until: Lifetime .
. Degree: BSN, RN, MPH . a.) PRC No.: 0148109 . Valid Until: January 11, 2012 . b.) PNA No.: 79897 . Valid Until: December 31, 2009 .
. Degree: BSN, RN, MAN, MAEd, PhD . a.) PRC No.: 0053722 . Valid Until: August 31, 2012 . b.) PNA No.: 11836 . Valid Until: Lifetime . c.) ADPCN No.: 0063 . Valid Until: October 31, 2010 .
Related Documents
Xavier University - Prc Form
May 2020 3
Xavier University Prc Dr
May 2020 2
Xavier University Prc Or
May 2020 0
Prc Form > 3
November 2019 12
Prc Form > 5
November 2019 11