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____

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