Arellano University

College of Nursing
2600 Legarda St. Sampaloc, Manila

NAME OF STUDENT: TIMAJO, CERES JILL P._ First Course (if any): _NOT APPLICABLE_______________
Name of School: _____Arellano University____ School Graduated: _ NOT APPLICABLE_______________
Address of School: ____2600 Legarda St. Sampaloc, Manila Year of Admission in the BSN Program: ___2007______________
Recognition and Accreditation Level: __PACUCOA Level I Formal (September Year Graduated from the BSN Program: ___2009______________
2006)_
Date When School Was Recognized: July 7, 1969_Number: R.O. 184 Year 1969

I. MAJOR OPERATION

Date of Type of Supervised by:

Name of Name of Name of Name of O.R.
No. Operatio Case # Diagnosis Operation Performed Anesthe Name and Signature of
n
Patient Surgeon Hospital Scrub Nurse Qualified Clinical
sia Instructor
Spinal Ma. Consuelo I.
July 01, 6-2008 Josephine G. Margarita M. San Miguel
1 Oligohydramnios Cesarian Section Anesthesi Rosalem
2008 8733 Pangilinan Ramos M.D District Hospital
a RM, RN, MAN
Local Mandaluyong Joana Eloisa A.
Septembe Loreta De Cataract Mature, Right Extra Capsular Cataract Extraction with Felipe C. Lily Ann L. Bayaua
2 051541 Anesthesi City Medical Sigue
r 23, 2008 Mesa Eye Intra Occular Lens Martinez M.D RN, MAN
a Center RN
General Mandaluyong
Septembe Invasive Ductil Mass, Mario C. Lato Marian T. Biona Lily Ann L. Bayaua
3 531060 Elisa Lindo Modified Radical Mastectomy Anesthesi City Medical
r 25, 2008 Left Breast M.D RN RN, MAN
a Center
Total Abdominal Hysterectomy and Sub-
November Fritzie O. Lipa Medix Zenaida S. Pasion
4 29684 Nora Hidalgo Myoma Uteri Bilateral Salpingo-Oophorectomy with arachnoid
17, 2008 Tenorio M.D Medical Center MD, RN, MAN
Adhesiolysis Block
Sub-
November Renato B. Fritzie O. Lipa Medix Zenaida S. Pasion
5 29689 Acute Appendicitis Appendectomy arachnoid
17, 2008 Riviera Tenorio M.D Medical Center MD, RN, MAN
Block
Concurred by: Concurred by: Concurred by: Concurred by: Concurred by:

VIRGINIA V. CRUZ, RN, MSN TERESITA J. DIMAYACYAC,RN, NANCY S. MALABANAN, RN, MAN ________________________________ ________________________________
(Chief Nurse, San Miguel District MAN (Chief Nurse, Lipa Medix Medical Center) (Chief Nurse’s Signature Over (Chief Nurse’s Signature Over Printed
Hospital) (Chief Nurse, Mandaluyong City Medical Degree: BSN, MAN Printed Name) Name)
Degree: BSN, MSN Center) PRC No. 0220617 Valid Until APR 31, Degree: _________________________ Degree: _________________________
PRC No. 0042371 Valid Until NOV 7, Degree: BSN, MAN 2011 PRC No. ________ Valid Until _______ PRC No. ________ Valid Until _______
2010 PRC No. 0127552 Valid Until OCT 2, PNA No. ________ Valid Until _______ PNA No. ________ Valid Until _______
PNA No. 06676 Valid Until
PNA No. 02361 Valid Until DEC 2010
2009 PNA No. 17873 Valid Until
LIFETIME
Noted by: Approved by Legend: Prepared by:

ESTER S. CLIMACO RN ROBERTO C. SOMBILLO RN, RM

Clinical Coordinator Dean
Degree: BSN, MAN Degree: BSN, MAN Timajo, Ceres Jill Pasia
PRC No. 042052 Valid Unitl: 10-16- PRC No. 0172832 Valid Unitl: 08-02-
2011 2010
PNA No. 4275 Valid Unitl: Lifetime ADPCN No. 0779 Valid Unitl: 2009
PNA No. 17268 Valid Until:
Lifetime
 Arellano Univesrity
College of Nursing
2600 Legarda St, Sampaloc, Manila

NAME OF STUDENT: TIMAJO, CERES JILL P._ NOT APPLICABLE

First Course (if any):
Name of School: ______Arellano University____ School Graduated: NOT APPLICABLE
Address of School: ____2600 Legarda St. Sampaloc, Manila Year of Admission in the BSN Program: ___ 2007______________
Recognition and Accreditation Level: __PACUCOA Level I Formal (September Year Graduated from the BSN Program: ___2009______________
2006)_
Date When School Was Recognized: July 7, 1969_Number: R.O. 184 Year 1969

II. MINOR OPERATION

Date of Supervised by:

Name of Type of Name of Name of Name of O.R.
No. Operatio Case # Diagnosis Operation Performed Name and Signature
n
Patient Anesthesia Surgeon Hospital Scrub Nurse of Qualified Clinical
Instructor
Ospital ng Earl Don B. De
May 10, Lacerated wound, Palmar Robelle Joan Starsky G.
1 1833859 Allen Ty Bello Wound suturing Local Anesthesia Maynila Medical Castro MD, RN,
2008 area, Left hand A. Peralta M.D Yadan
Center MAN
Lucila C. Ma. Consuelo I.
July 01, Christina San Miguel
2 6-2008 8278 Post Cesarian Section Bilateral Tubal Ligation Spinal Anesthesia Gatchallian Rosalem RM, RN,
2008 Baylon District Hospital
MD MAN
Mandaluyong
Septembe Aurora Adolfo R. Marian T. Biona Lily Ann L. Bayaua
3 512984 External Hemorrhoids Hemorrhoidectomy Local Anesthesia City Medical
r 22, 2008 Calpotura Baviera MD RN RN, MAN
Center
Jose Joey H. Mandaluyong
Septembe Kyle Angela Joana Eloisa A. Lily Ann L. Bayaua
4 511700 Scald Burn Re-debridement Local Anesthesia Bienvinida City Medical
r 23, 2008 Reyes Sigue RN RN, MAN
MD Center
Mandaluyong
Septembe Juanito Felipe C. Mark Willard C. Lily Ann L. Bayaua
5 061182 Pterygium Excision Spinal Anesthesia City Medical
r 23, 2008 Clarido Martinez Wong RN RN, MAN
Center
Concurred by: Concurred by: Concurred by: Concurred by: Concurred by:

ASUNCION C. BALISADO, RN, MAN
(Chief Nurse, Ospital ng Maynila Medical
Center)
Degree: BSN , MAN
PRC No. 0116547 Valid Until AUG 15,
2009
PNA No. 014782 Valid Until LIFETIME
VIRGINIA V. CRUZ, RN, MSN
(Chief Nurse, San Miguel District
Hospital)
Degree: BSN, MSN
PRC No. 0042371 Valid Until NOV 7,
2010
PNA No. 02361 Valid Until DEC 2009
TERESITA J. DIMAYACYAC,RN, ________________________________ ________________________________
MAN (Chief Nurse’s Signature Over (Chief Nurse’s Signature Over
(Chief Nurse, Mandaluyong City Medical Printed Name) Printed Name)
Center) Degree: _________________________ Degree: _________________________
PRC No. ________ Valid Until _______ PRC No. ________ Valid Until _______
Degree: BSN, MAN
PNA No. ________ Valid Until _______ PNA No. ________ Valid Until _______
PRC No. 0127552 Valid Until OCT 2,
2010
PNA No. 17873 Valid Until
LIFETIME
Noted by: Approved by Legend: Prepared by:

ESTER S. CLIMACO RN ROBERTO C. SOMBILLO RN, RM

Clinical Coordinator Dean
Degree: BSN, MAN Degree: BSN, MAN Timajo, Ceres Jill Pasia
PRC No. 042052 Valid Unitl: 10-16- PRC No. 0172832 Valid Unitl: 08-02-
2011 2010
PNA No. 4275 Valid Unitl: Lifetime ADPCN No. 0779 Valid Unitl: 2009
PNA No. 17268 Valid Until:
Lifetime
 Arellano University
College of Nursing
2600 Legarda St., Sampaloc, Manila

NAME OF STUDENT: TIMAJO, CERES JILL P._ NOT APPLICABLE

First Course (if any):
Name of School:______Arellano University____ School Graduated: NOT APPLICABLE
Address of School: ____2600 Legarda St. Sampaloc, Manila Year of Admission in the BSN Program: ___ 2007______________
Recognition and Accreditation Level: __PACUCOA Level I Formal (September Year Graduated from the BSN Program: ___2009______________
2006)_
Date When School Was Recognized: July 7, 1969_Number: R.O. 184 Year 1969

III. ACTUAL DELIVERIES

Time of
Case Date of Gender Supervised by:
No. Diagnosis Name of Mother Age Deliver Name of Hospital Type of Delivery
# Delivery of Baby Name and Signature of Qualified CI
y
Pregancy Uterine 39 weeks
6-2008 Age of Gestation, Cephalic July 03, San Miguel District Normal Spontaneous Ma. Consuelo I. Rosalem RM, RN,
1 Celestina S. Libunao 27 11:40 am Male
3638 in Presentation, Gravida 3, 2008 Hospital Delivery MAN
Para 3
Pregancy Uterine 40 1/7
Armed Forces of the
80578 weeks Age of Gestation, July 28, Normal Spontaneous
2 Rowena A. Lopez 30 12:50 pm Female Philippines Medical Yolanda A. Quetua RN, MAN
5 Cephalic in Presentation, 2008 Delivery
Center
Gravida 4, Para 4
Pregancy Uterine 38 6/7
80600 weeks Age of Gestation, August 05, Armed Forces of the Normal Spontaneous
3 Noreen Calaoagan 31 01:16 pm Female Yolanda A. Quetua RN, MAN
4 Cephalic in Presentation, 2008 Philippines Delivery
Gravida 3, Para 3
Pregancy Uterine 39 weeks
Age of Gestation, Cephalic November Lipa Medix Medical Normal Spontaneous
4 29736 Myrna L. Ubeda 33 05:01 am Female Zenaida S. Pasion MD, RN, MAN
in Presentation, Gravida 2, 19, 2008 Center Delivery
Para 2
Pregancy Uterine 38 weeks
Age of Gestation, Cephalic Ma. Allena M. November Lipa Medix Medical Normal Spontaneous
5 29770 43 03:46 am Female Zenaida S. Pasion MD, RN, MAN
in Presentation, Gravida 3, Apduhan 20, 2008 Center Delivery
Para 3

Concurred by: Concurred by: Concurred by: Concurred by: Concurred by:

VIRGINIA V. CRUZ, RN, MSN
(Chief Nurse, San Miguel District
Hospital)
Degree: BSN, MSN
PRC No. 0042371 Valid Until NOV 7,
2010
PNA No. 02361 Valid Until DEC 2009
COL. EVELYN C. BALISADO, RN, NANCY S. MALABANAN, RN, MAN ________________________________ ________________________________
MAN (Chief Nurse, Lipa Medix Medical Center) (Chief Nurse’s Signature Over Printed (Chief Nurse’s Signature Over Printed
Degree: BSN, MAN Name) Name)
(Command Nurse, Armed Forces of the Degree: _________________________ Degree: _________________________
Philippines Medical Center) PRC No. 0220617 Valid Until APR 31,
2011 PRC No. ________ Valid Until _______ PRC No. ________ Valid Until _______
Degree: BSN , MAN PNA No. ________ Valid Until _______ PNA No. ________ Valid Until _______
PRC No. 0059003 Valid Until JAN PNA No. 06676 Valid Until
04,2012
PNA No. 010516 Valid Until
LIFETIME
Noted by: Approved by Legend: Prepared by:

ESTER S. CLIMACO, RN ROBERTO C. SOMBILLO RN, RM

Clinical Coordinator Dean
Degree: BSN, MAN Degree: BSN, MAN Timajo, Ceres Jill Pasia
PRC No. 042052 Valid Unitl: 10-16- PRC No. 0172832 Valid Unitl: 08-02-
2011 2010
PNA No. 4275 Valid Unitl: ADPCN No. 0779 Valid Unitl: 2009
Lifetime PNA No. 17268 Valid Until:
Lifetime

Arellano University
College of Nursing
2600 Legarda St., Sampaloc, Manila

NAME OF STUDENT: TIMAJO, CERES JILL P._ NOT APPLICABLE

First Course (if any):
Name of School:______Arellano University____ School Graduated: NOT APPLICABLE
Address of School: ____2600 Legarda St. Sampaloc, Manila Year of Admission in the BSN Program: ___ 2007______________
Recognition and Accreditation Level: __PACUCOA Level I Formal (September Year Graduated from the BSN Program: ___2009______________
2006)_
Date When School Was Recognized: July 7, 1969_Number: R.O. 184 Year 1969

IV. DELIVERIES ASSISTED

Date of Time of Gende
Case Supervised by:
No. Diagnosis Name of Mother Age Deliver Deliver r of Name of Hospital Type of Delivery
# Name and Signature of Qualified CI
y y Baby
Pregancy Uterine 38- 39
SB=08 weeks Age of Gestation, April 13, St. Blasé Maternity
1 Margie Ponce 25 01:30 am Female Normal Spontaneous Delivery Maricel Jose MD, RN
152 Cephalic in Presentation, 2008 and Medical hospital
Gravida 1 Para 1
Pregancy Uterine 30 weeks
63958 Age of Gestation, Cephalic in Naila Abdhul Kadir May 06, Ospital ng Maynila Earl Don B. De Castro MD, RN,
2 38 04:15 am Female Normal Spontaneous Delivery
8 Presentation, Gravida 6, Para Dalinogen 2008 Medical Center MAN
6
Pregancy Uterine 39 weeks
6-2008 Age of Gestation, Cephalic in Maria Conception C. July 01, San Miguel District Ma. Consuelo I. Rosalem RM,
3 24 10:40 am Male Normal Spontaneous Delivery
6274 Presentation, Gravida 2, Para Maliwanag 2008 Hospital RN, MAN
2
Pregancy Uterine 39 weeks
6-2008 Age of Gestation, Cephalic in Mariflor P. July 02, San Miguel District Ma. Consuelo I. Rosalem RM,
4 37 09:40 am Male Normal Spontaneous Delivery
5110 Presentation, Gravida 3, Para Constantino 2008 Hospital RN, MAN
3
Pregancy Uterine 40 weeks
6-2008 Age of Gestation, Cephalic in July 03, San Miguel District Ma. Consuelo I. Rosalem RM,
5 Roselyn B. Dela Cruz 35 8:25 am Female Normal Spontaneous Delivery
5160 Presentation, Gravida 3, Para 2008 Hospital RN, MAN
3
Concurred by: Concurred by: Concurred by: Concurred by: Concurred by:

ROBERTO F. GALANG MD ASUNCION C. BALISADO, RN, VIRGINIA V. CRUZ, RN, MSN ________________________________ ________________________________
Chief Nurse’s Signature Over Printed MAN (Chief Nurse, San Miguel District (Chief Nurse’s Signature Over Printed (Chief Nurse’s Signature Over Printed
Name) (Chief Nurse, Ospital ng Maynila Medical Hospital) Name) Name)
Degree: MD Center) Degree: BSN, MSN Degree: _________________________ Degree: _________________________
PRC No. 0088026 Valid Until FEB Degree: BSN , MAN PRC No. 0042371 Valid Until NOV 7, PRC No. ________ Valid Until _______ PRC No. ________ Valid Until _______
20, 2010 PRC No. 0116547 Valid Until AUG 15, 2010 PNA No. ________ Valid Until _______ PNA No. ________ Valid Until _______
PNA No. ________ Valid Until _______ 2009 PNA No. 02361 Valid Until DEC
PNA No. 014782 Valid Until 2009
LIFETIME
Noted by: Approved by Legend: Prepared by:

ESTER S. CLIMACO, RN ROBERTO C. SOMBILLO, RN RM

Clinical Coordinator Dean
Degree: BSN, MAN Degree: BSN, MAN Timajo, Ceres Jill Pasia
PRC No. 042052 Valid Unitl: 10-16- PRC No. 0172832 Valid Unitl: 08-02-
2011 2010
PNA No. 4275 Valid Unitl: Lifetime ADPCN No. 0779 Valid Unitl: 2009
PNA No. 17268 Valid Until:
Lifetime
 Arellano University
College of Nursing
2600 Legarda St., Sampaloc,
Manila
NAME OF STUDENT: TIMAJO, CERES JILL P._ NOT APPLICABLE
First Course (if any):
Name of School:______Arellano University____ School Graduated: NOT APPLICABLE
Address of School: ____2600 Legarda St. Sampaloc, Manila Year of Admission in the BSN Program: ___ 2007______________
Recognition and Accreditation Level: __PACUCOA Level I Formal (September Year Graduated from the BSN Program: ___2009______________
2006)_
Date When School Was Recognized: July 7, 1969_Number: R.O. 184 Year 1969

V. CORD DRESSING
Gende Supervised by:
Date
No. Case # Name of Baby r of Name of Mother Age Name of Hospital Name and Signature of Qualified
Performed CI
Baby
SB=08
1 April 17, 2008 Baby Boy Torres Male Grace Torres 29 St. Blasé Maternity and Medical hospital Maricel Jose MD, RN
154
Earl Don B. De Castro MD,
2 639588 May 06, 2008 Baby Girl Dalinogen Female Naila Abdhul Kadir Dalinogen 38 Ospital ng Maynila Medical Center
RN, MAN
6-2008 Ma. Consuelo I. Rosalem RM,
3 July 01, 2008 Baby Girl Sanchez Female Jean A. Sanchez 34 San Miguel District Hospital
1735 RN, MAN
6-2008 Ma. Consuelo I. Rosalem RM,
4 July 02, 2008 Baby Boy De Jesus Male May C. De Jesus 37 San Miguel District Hospital
7189 RN, MAN
6-2008 Ma. Consuelo I. Rosalem RM,
5 July 03, 2008 Baby Boy Leviste Male Christine C. Leviste 35 San Miguel District Hospital
8620 RN, MAN
Concurred by: Concurred by: Concurred by: Concurred by: Concurred by:

ROBERTO F. GALANG MD
Chief Nurse’s Signature Over
Printed Name)
Degree: MD
PRC No. 0088026 Valid Until FEB
20, 2010
PNA No. ________ Valid Until _______
ASUNCION C. BALISADO, RN, VIRGINIA V. CRUZ, RN, MSN ________________________________ ________________________________
MAN (Chief Nurse, San Miguel District (Chief Nurse’s Signature Over Printed (Chief Nurse’s Signature Over Printed
(Chief Nurse, Ospital ng Maynila Medical Hospital) Name) Name)
Center) Degree: BSN, MSN Degree: _________________________ Degree: _________________________
Degree: BSN , MAN PRC No. 0042371 Valid Until NOV 7, PRC No. ________ Valid Until _______ PRC No. ________ Valid Until _______
PRC No. 0116547 Valid Until AUG 15, 2010 PNA No. ________ Valid Until _______ PNA No. ________ Valid Until _______
2009 PNA No. 02361 Valid Until DEC
PNA No. 014782 Valid Until LIFETIME 2009

Noted by: Approved by Legend: Prepared by:

ESTER S. CLIMACO, RN ROBERTO C. SOMBILLO, RN, RM

Clinical Coordinator Dean
Degree: BSN, MAN Degree: BSN, MAN Timajo, Ceres Jill Pasia
PRC No. 042052 Valid Unitl: 10-16- PRC No. 0172832 Valid Unitl: 08-02-
2011 2010
PNA No. 4275 Valid Unitl: ADPCN No. 0779 Valid Unitl: 2009
Lifetime PNA No. 17268 Valid Until:
Lifetime