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OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student:
GARCIA, JAMIE LYNN CARTAGENA
Name and Address of School: Our Lady Of Fatima University; #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACU COA 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: 2004
Year Graduated (BSN Program): ______________________________________________________________________________________________________________________________________

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I. Major Operations
Name of
Patient

Diagnosis

Operation Performed

Type of
Anesthesia

Name of
Surgeon

Name of
Hospital

Name of Qualified
CI

09000012280

Bautista, Clara
Pedrosa

Mature Senile Cataract Left
Eye

Phacoemulsification with Posterior
Chamber Intraocular Lens Left Eye

Monitored
Anesthesia Care

Dr. Jonathan
Dominic Feliciano

Fatima
University
Medical Center

Secinia I. Tallo RN,
RM, MAN

March 19, 2009

090000123038

Gabito, Reynante

Ruptured Appendix

Appendectomy

Spinal
Anesthesia

Dr. James Taclin
Bañez

Fatima
University
Medical Center

Secinia I. Tallo RN,
RM, MAN

3.

June 11, 2009

06080968

Imperial, Hilaria
Ponce

Mature Senile Cataract Right
Eye

Phacoemulsification with Posterior
Chamber Intraocular Lens Right
Eye

Monitored
Anesthesia Care

Dr. Guillermo Loja

Fatima Eye And
Rehabilitation
Center

Arvin A. Aculana RN,
MAN

4.

October 27, 2009

01021

Dionela, Annabel
Non

Gravida 2 Para 1 Pregnancy
Uterine Full Term 37 Weeks
And 5 Days Age of Gestation
Not In Labor

Low Transverse Cesarian Section

Spinal
Anesthesia

Dr. Emily
Fernando

Balagtas Doctors
Hospital

Wilowena Angeles RN,
MAN

5.

October 27, 2009

01024

Pepito, Asuncion
Dagohoy

Mature Senile Cataract Right
Eye

Cataract Extraction Right Eye

Monitored
Anesthesia Care

Dr. Ronaldo
Fernando

Balagtas
Doctors Hospital

Wilowena Angeles RN,
MAN

Date of
Operation

Case No.

1.

March 12, 2009

2.

No.

Prepared by:

Noted by:

GARCIA, JAMIE LYNN C__________.
Signature over printed Name of Student

MARISOL GARCIA – MANIPOL RN, MAN

Supervised by:
_______________
Signature over printed name of Faculty
Date Signed: ____________
Degree: ________________
a.) PRC NO: __________
Valid Until: ________
b.) PNA NO: _________
Valid Until: ___________

Signature over printed name of
Clinical Coordinator
Date Signed: _____________________
Degree: BSN, MAN
PRC NO: 0296870
Valid Until: September 2012__
b.) PNA NO: ___________
Valid Until:_________
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Concurred by:
MYLENE BERNADETTE O. SANTOS RN, MAN, MD

Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree: _BSN, MD, MAN_____
PRC NO: _0192913____
Valid Until: _February 28, 2013_
b.) PNA NO: ___________
Valid Until: _________

Signature of
Qualified CI

Approved by:

Concurred by:
LORNA PUNONGBAYAN DIANO RN

Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree: _RN______________
PRC NO:0260345
Valid Until: _March 21, 2013
b.) PNA NO: ___________
Valid Until: _________
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NELIA R. CAPULONG RN, RM, MAN
Signature over printed Name of Dean
Date Signed: ____________
Degree: BSN, RM, MAN____
a.) PRC NO: _0041904____
Valid Until: _July 31, 2012__
b.) PNA NO: _18698_____
Valid Until: _LIFETIME____
ADPCN NO: _0627___
Valid Until: __________

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student:
GARCIA, JAMIE LYNN CARTAGENA
_
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Name and Address of School: Our Lady Of Fatima University; #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACU COA 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: 2004
Year Graduated (BSN Program): ____________________________________________________________________________________________________________________________________________
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I. Minor Operations
No.
Date of
Operation

Case No.

Name of Patient

Diagnosis

Operation Performed

Type of
Anesthesia

Name of Surgeon

Name of Hospital

Name of Qualified CI

1.

April 8, 2009

011245

Haban, Rondolf

Phemosis

Circumcision

Local
Anesthesia

Dr. Jose Antonio

Novaliches District
Hospital

Rosanie C. Moro RN,
PhD

2.

April 16, 2009

1775519

De Lava, Hansley

Abscess Left Frontal
Area

Incision And Drainage

Dr. Libunao

Novaliches District
Hospital

Rosanie C. Moro RN,
PhD

3.

4.

5.

Signature of
Qualified CI

Prepared by:

Noted by:

GARCIA, JAMIE LYNN C__________.
Signature over printed Name of Student

MARISOL GARCIA – MANIPOL RN, MAN

Supervised by:

Signature over printed name of
Clinical Coordinator
Date Signed: _____________________
Degree: BSN, MAN
PRC NO: 0296870
Valid Until: September 2012__
b.) PNA NO: ___________
Valid Until:_________
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_______________
Signature over printed name of Faculty
Date Signed: ____________
Degree: ________________
a.) PRC NO: __________
Valid Until: ________
b.) PNA NO: _________
Valid Until: ___________

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Concurred by:

Concurred by:

Approved by:

JOSEPHINE B. LEONARDO RN, PhD
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_BSN, MAN, PhD___
PRC NO: _0081174___
Valid Until: _April 3, 2013___
b.) PNA NO: _15614___
Valid Until: _LIFETIME____

___________________________
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_______________
PRC NO: __________
Valid Until: ____________
b.) PNA NO: ___________
Valid Until: _________

NELIA R. CAPULONG RN, RM, MAN
Signature over printed Name of Dean
Date Signed: ____________
Degree: BSN, RM, MAN____
a.) PRC NO: _0041904____
Valid Until: _July 31, 2012__
b.) PNA NO: _18698_____
Valid Until: _LIFETIME____
ADPCN NO: _0627___
Valid Until: __________

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student:
GARCIA, JAMIE LYNN CARTAGENA
Name and Address of School: Our Lady Of Fatima University; #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACU COA 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: 2004

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I. Actual Deliveries
No.

Supervised by: Signature of
Qualified CI

Case No.

Diagnosis

Name of Mother

Age

Date of Delivery

Time of
Delivery

Gender of
Baby

Name of Hospital

Type of Delivery

1.

09-8329

Gravida 1 Para 0 Pregnancy Uterine
Full Term Cephalic In Labor

Rosales, Jermanie
Masangkay

22

August 3, 2009

2:28 AM

Girl

San Jose District Hospital

Forcep Delivery

Rosalinda L. Flores RN, MAN
PRC NO: 0082223
PNA NO:

2.

421850

Gravida 1 Para 0 Pregnancy Uterine
Full Term 39 Weeks and 4 Days Age Of
Gestation Cephalic In Labor

Sangalong, Jocelyn

20

September 16,
2009

8:44 PM

Girl

Batangas Regional
Hospital

Normal Spontaneous
Delivery

Gonzala De Mesa RN, MAN

3.

421936

Gravida 4 Para 3 Pregnancy Uterine
Full Term 41 Weeks and 1 Day Age Of
Gestation Cephalic In Labor

Magpantay, Maria
Carmina

34

September 18,
2009

9:16 PM

Boy

Batangas Regional
Hospital

Normal Spontaneous
Delivery

Gonzala De Mesa RN, MAN

4.

422188

Colis, Rodelyn

32

September 19,
2009

12:38 AM

Boy

Batangas Regional
Hospital

Normal Spontaneous
Delivery

Gonzala De Mesa RN, MAN

5.

Gravida 3 Para 2 Pregnancy Uterine
Full Term 38 Weeks and 1 Day Age Of
Gestation Cephalic In Labor

Year Graduated (BSN Program): _______________________________________________________________________________________
Prepared by:

Noted by:

GARCIA, JAMIE LYNN C__________.
Signature over printed Name of Student

MARISOL GARCIA – MANIPOL RN, MAN

Supervised by:

Signature over printed name of
Clinical Coordinator
Date Signed: _____________________
Degree: BSN, MAN
PRC NO: 0296870
Valid Until: September 2012__
b.) PNA NO: ___________
Valid Until:_________
.

_______________
Signature over printed name of Faculty
Date Signed: ____________
Degree: ________________
a.) PRC NO: __________
Valid Until: ________
b.) PNA NO: _________
Valid Until: ___________

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________________

__________

Concurred by:
Concurred by:
ROSALINDA L. FLORES RN, MAN
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_BSN, MAN______
PRC NO: _0082223_____
Valid Until: _November 25, 2011
b.) PNA NO: ___________
Valid Until: _________

AMOR CALAYAN RN, RM, MAN,PhD
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_ BSN, RM, MAN,PhD ___
PRC NO: _151514___
Valid Until: _August 2013____
b.) PNA NO: ___________
Valid Until: _________
c.) ANSAP NO: ______________
Valid Until:_______________

Approved by:
NELIA R. CAPULONG RN, RM, MAN
Signature over printed Name of Dean
Date Signed: ____________
Degree: BSN, RM, MAN____
a.) PRC NO: _0041904____
Valid Until: _July 31, 2012__
b.) PNA NO: _18698_____
Valid Until: _LIFETIME____
ADPCN NO: _0627___
Valid Until: __________

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student:
GARCIA, JAMIE LYNN CARTAGENA
Name and Address of School: Our Lady Of Fatima University; #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACU COA 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: 2004
Year Graduated (BSN Program): ___________________________________________________________

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IV. Deliveries Assisted
No.

Case No.

Diagnosis

Name of
Mother

Age

Date of Delivery

Time of
Delivery

Gender of
Baby

Name of Hospital

Type of Delivery

Supervised by: Signature of
Qualified C.I.

08-3249

Gravida 1 Para 0 39 Weeks Age of
Gestation Cephalic In Labor

Remo,
Rochelle

31

August 1, 2009

2:14 PM

Boy

San Jose District Hospital

Normal Spontaneous
Delivery

Rosalinda L. Flores RN, MAN
PRC NO: 0082223
PNA NO:

08-1610

Gravida 1, Para 0 Pregnancy Uterine
37-38 Weeks Age Of Gestation
Cephalic In Labor

Cuasay,
Rose Ann

21

July 30, 2009

6:58 PM

Boy

San Jose District Hospital

Normal Spontaneous
Delivery

Rosalinda L. Flores RN, MAN
PRC NO: 0082223
PNA NO:

Lacdang,
April

18

September 16,
2009

8:05 AM

Boy

Batangas Regional
Hospital

Normal Spontaneous
Delivery

Gonzala De Mesa RN, MAN

1.

2.

3.
420394
4.

Gravida 1, Para 0 Pregnancy Uterine
38 Weeks and 2 Days Age Of
Gestation Cephalic In Labor

5.

Prepared by:

Noted by:

GARCIA, JAMIE LYNN C__________.
Signature over printed Name of Student

MARISOL GARCIA – MANIPOL RN, MAN

Supervised by:

Concurred by:
Concurred by:

Signature over printed name of
Clinical Coordinator
Date Signed: _____________________
Degree: BSN, MAN
PRC NO: 0296870
Valid Until: September 2012__
b.) PNA NO: ___________
Valid Until:_________

ROSALINDA L. FLORES RN, MAN
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_BSN, MAN______
PRC NO: _0082223_____
Valid Until: _November 25, 2011
b.) PNA NO: ___________
Valid Until: _________

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_______________
Signature over printed name of Faculty
Date Signed: ____________
Degree: ________________
a.) PRC NO: __________
Valid Until: ________
b.) PNA NO: _________
Valid Until: ___________

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AMOR CALAYAN RN, RM, MAN,PhD
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_ BSN, RM, MAN,PhD ___
PRC NO: _151514___
Valid Until: _August 2013____
b.) PNA NO: ___________
Valid Until: _________
c.) ANSAP NO: ______________
Valid Until:_______________

Approved by:
NELIA R. CAPULONG RN, RM, MAN
Signature over printed Name of Dean
Date Signed: ____________
Degree: BSN, RM, MAN____
a.) PRC NO: _0041904____
Valid Until: _July 31, 2012__
b.) PNA NO: _18698_____
Valid Until: _LIFETIME____
ADPCN NO: _0627___
Valid Until: __________

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student:
GARCIA, JAMIE LYNN CARTAGENA
Name and Address of School: Our Lady Of Fatima University; #1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Accreditation Level (if any): PACU COA 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: 2004
Year Graduated (BSN Program): ______________________________

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V. Cord Dressing
No.

Case No.

Date Performed

Name of Baby

Gender of
Baby

Name of
Mother

Age

Name of Hospital

Supervised by: Signature of Qualified C.I.

1.

09-10-466

July 31, 2009

Baby Boy Ocampo

Boy

Ocampo, Maricel

25

San Jose District Hospital

Rosalinda L. Flores RN, MAN
PRC NO: 0082223
PNA NO:

2.

09-10-433

July 31, 2009

Baby Boy Liwanag

Boy

Liwanag, Maylin

20

San Jose District Hospital

3.

4.

Rosalinda L. Flores RN, MAN
PRC NO: 0082223
PNA NO:

5.

Prepared by:

Noted by:

Concurred by:

Concurred by:

Approved by:

GARCIA, JAMIE LYNN C__________.
Signature over printed Name of Student

MARISOL GARCIA – MANIPOL RN, MAN

ROSALINDA L. FLORES RN, MAN
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_BSN, MAN______
b.) PRC NO: _0082223_____
Valid Until: _November 25, 2011
b.) PNA NO: ___________
Valid Until: _________

______________________________
Signature over printed name of
Chief Nurse
Date Signed: ___________
Degree:_______________
a.) PRC NO: __________
Valid Until: ____________
b.) PNA NO: ___________
Valid Until: _________

NELIA R. CAPULONG RN, RM, MAN
Signature over printed Name of Dean
Date Signed: ____________
Degree: BSN, RM, MAN____
a.) PRC NO: _0041904____
Valid Until: _July 31, 2012__
b.) PNA NO: _18698_____
Valid Until: _LIFETIME____
b.)ADPCN NO: _0627___
Valid Until: __________

Supervised by:
_______________
Signature over printed name of Faculty
Date Signed: ____________
Degree: ________________
a.) PRC NO: __________
Valid Until: ________
b.) PNA NO: _________
Valid Until: ___________

Signature over printed name of
Clinical Coordinator
Date Signed: _____________________
Degree: BSN, MAN
a.)_PRC NO: 0296870
Valid Until: September 2012__
b.) PNA NO: ___________
Valid Until:_________
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