ARELLANO UNIVERSITY COLLEGE of NURSING 2600 Legarda St., Sampaloc, Manila 7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.

ph PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)

SURGICAL SCRUB in _______ARELLANO UNIVERSITY MEDICAL CENTER, Manila, Metro Manila_______________ Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student _ JUAN A. DELA CRUZ____________________

Date Performed and Time Started March 05, 2007 9:00 AM February 24, 2007 2:00 PM January 26, 2007 8:00 AM

Patients INITIAL Only Case Number K. B. P. 11436 C. A. G. 0407000447 L. D. C. 0407000416

SURGICAL PROCEDURE PERFORMED

O.R. Nurse On Duty (Name and Signature)

SUPERVISED BY Clinical instructor Name and Signature

Herniotomy Bilateral Phacoemulsification with Intra Ocular Lens left Craniotomy Reopen, Evacuation of Blood Clots, Ligation of Bleeders

Tetchie Alvarez R.N. Alex Abanggan R.N. Tetchie Alvarez R.N

Jonil P. Dalisay R.N., MAN Rachelle Ann Ligan R.N., MAN Jonil P. Dalisay R.N., MAN

Noted by: LEONARDO M. NUESTRO JR., MAN, RN Clinical Coordinator: PRC I.D. No. 190198 Valid Until March 25, 2013 October 16, 2013 Date document is signed: ________________ Time: ______________ Highest Nursing Degree Earned: BSN, MAN

Approved by: NOLI V. PAGDANGANAN, MAN, MPA, RN Dean: PRC I.D. No. 25555 Valid Until Date document is signed: ________________ Time: _____________ Highest Nursing Degree Earned: BSN, MPA, MAN

ARELLANO UNIVERSITY COLLEGE of NURSING 2600 Legarda St., Sampaloc, Manila 7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph PACUCOA Level II Re-Accredited Status (February 2010 to February 2015) SURGICAL CIRCULATING in ____________SAN LEONARDO HOSPITAL , Pasig City, Metro Manila Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student _ JUAN A. DELA CRUZ__________________________ ________

Date Performed and Time Started March 06, 2007 9:00 AM February 25, 2007 2:00 PM January 27, 2007 8:00 AM

Patients INITIAL Only Case Number J. M.M. 19768 D. L. P. 0407000466 F. S. D. 3498

SURGICAL PROCEDURE PERFORMED

O.R. Nurse On Duty (Name and Signature)

SUPERVISED BY Clinical instructor Name and Signature

Suturing Excision of Pterygium Proctosigmoidoscopy, Wound Debridement, Fistulotomy

Jonil Dalisay R.N. Jonil Dalisay R.N. Jonil Dalisay R.N.

Jhong Diego R.N., MAN Kim Uichangco R.N., MAN Andrew Hidalgo R.N., MAN

Noted by: LEONARDO M. NUESTRO JR., MAN, RN Clinical Coordinator: PRC I.D. No. 190198 Valid Until March 25, 2013 October 16, 2013 Date document is signed: ________________ Time: ______________ Highest Nursing Degree Earned: BSN, MAN

Approved by: Approved by: NOLI V. PAGDANGANAN, MAN, MPA, RN Dean: PRC I.D. No. Dean: PRC I.D. No. 25555 Valid Until Date document is signed: ________________ Time: _____________ Highest Nursing Degree Earned: BSN,MPA , MAN

ARELLANO UNIVERSITY COLLEGE of NURSING 2600 Legarda St., Sampaloc, Manila 7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)

ACTUAL DELIVERY in ___________OAKWOOD GENERAL HOSPITAL , Antipolo City, Rizal Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student _ JUAN A. DELA CRUZ______________________

____________

Date Performed and Time Started

Patients INITIAL Only Case Number

(not applicable for Birthing/Lyingin Clinic/Home)

PROCEDURE PERFORMED

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical instructor Name and Signature

March 06, 2008 9:00 AM February 25, 2008 2:00 PM January 27, 2008 8:00 AM

A.F.A. 4408 J.G.D. 317847 S.C.C. 517748

Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

Andrew Hidalgo R.N. Tetchie Alvarez R.N. Rachelle Ann Ligan R.N.

Iris Isidro R.N., MAN Iris Isidro R.N., MAN Iris Isidro R.N., MAN

Noted by: LEONARDO M. NUESTRO JR., MAN, RN Clinical Coordinator: PRC I.D. No. 190198 Valid Until March 25, 2013 October 16, 2013 Date document is signed: ________________ Time: ______________

Approved by: Approved by: NOLI V. PAGDANGANAN, MAN, MPA, RN Dean: PRC I.D. No. Dean: PRC I.D. No. 25555 Valid Until Date document is signed: ________________ Time: _____________

Highest Nursing Degree Earned: BSN, MAN

Highest Nursing Degree Earned: BSN,MPA , MAN

ARELLANO UNIVERSITY COLLEGE of NURSING 2600 Legarda St., Sampaloc, Manila 7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph PACUCOA Level II Re-Accredited Status (February 2010 to February 2015) IMMEDIATE NEWBORN CARE in ____________SAN MARCELINO HOSPITAL, Lipa City, Batangas Hospital/Home/Lying-in Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student _ JUAN A. DELA CRUZ_______________________ __________

Date Performed and Time Started

Patients INITIAL Only Case Number

(not applicable for Birthing/Lyingin Clinic/Home)

Immediate Newborn Cord Care PERFORMED

Indicate where performed e.g. D.R., Nursery, NICU, or Home

D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical instructor Name and Signature

March 26, 2008 9:00 AM February 10, 2008 2:00 PM January 10, 2008 8:00 AM

Baby Girl A. 4400 Baby Boy B. 4405 Baby Boy R. 431127

Delivery Room Delivery Room Delivery Room

Iris Isidro, R.N. Iris Isidro, R.N. Iris Isidro, R.N.

Jhong Diego R.N., MAN Jhong Diego R.N., MAN Jhong diego R.N., MAN

Noted by: LEONARDO M. NUESTRO JR., MAN, RN Clinical Coordinator: PRC I.D. No. 190198 Valid Until March 25, 2013 October 16, 2013

Approved by: Approved by: NOLI V. PAGDANGANAN, MAN, MPA, RN Dean: PRC I.D. No. Dean: PRC I.D. No. 25555 Valid Until

Date document is signed: ________________ Time: ______________ Highest Nursing Degree Earned: BSN, MAN

Date document is signed: ________________ Time: _____________ Highest Nursing Degree Earned: BSN,MPA , MAN