PRC Ko To......

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: MARIBBAY, MARIPER PERALTA

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: JUNE 2006
Year Graduated (BSN Program): MARCH 2010
I. Major Operations
No. Date of Case Name of Diagnosis Operation Performed Type of Name of Name of Supervised by Qualified CI Signature of
Operation No. Patient Anesthesia Surgeon Hospital Qualified CI
Fatima
Nov. 0800000 Gonzaga, Posterior Subcapsular Phacoemulsification IV Sedation Dr. Vicente University Secinia I. Tallo,RM, RN, MAN
11,2008 120327 Rodolfo Cataract, Right eye withpoterior Chamber Santos Jr. Medical PRC#: 196915
Intraocular Lens, Right Center PNA#: 18696
eye
1. Fatima
Jan. 6,2009 0900001 Olivares, Marie Maxillary Sinusitis Bilateral Functional Endoscopic General Dr. Nixon University Secinia I. Tallo,RM, RN, MAN
2911 Cherylynn Nosetrils, Osteometal Region Sinus Surgery Maxillary Anesthesia See Medical PRC#: 196915
Anthrostomy Center PNA#: 18696
2. Fatima
Feb. 090000 Lumabas, Marginal Tumor Transverse Exploratory Laparotomy General Dr. James University Secinia I. Tallo,RM, RN, MAN
25,2010 127661 Jaime Colon Partial Obstruction Anesthesia Banez Medical PRC#: 196915
Section to Ruptured Cecum Center PNA#: 18696
3. Pregnancy Uterine 37-38 weeks Low Transverse Spinal Dr. Imelda Balagtas
Age of Gestation, Previous Willowena Angeles, RN,MAN
June 21, 01232 Manansala, Ria Ceasarian Section Anesthesia Carreon Doctor’s
Caesarean Section, second degree PRC#:304439
2008 Cephalopelvic Disproportion Hospital
PNA#:026818
4. Monitored Dr. Ronaldo Balagtas
June 22, 01234 Velasco, Loreta Cataract Senile Mature Left Cataract Extraction Anesthesia Fernando Doctor’s Willowena Angeles, RN,MAN
2008 Eye Care Hospital PRC#:304439
PNA#:026818
Valid Until: Lifetime Valid Until: December 2011
Prepared by:
Noted by: Concurred by:
MARIBBAY,MARIPER P. Concurred by:
Signature over printed Name of Student MARISOL GARCIA – MANIPOL, RN, MYLENE BERNADETTE O. SANTOS, Approved by:
MAN,LVN RN, MAN, MD LORNA P.DIANO, RN
Supervised by: Signature over printed name of Clinical Signature over printed name of Signature over printed name of NELIA R. CAPULONG, RN, RM, MAN
Coordinator Chief Nurse Chief Nurse Signature over printed name of Dean
SECINIA I. TALLO RM,RN,MAN Date Signed: __________ Date Signed: ___________ Date Signed: ___________ Date Signed: ____________
Signature over printed name of Faculty Degree: BSN, MAN Degree: BSN, MAN, MD Degree: BSN, Degree: BSN, MAN
Date Signed: ____________ a.) PRC NO: 0296870 a.) PRC NO: 0192913 a.) PRC NO: 0260345 a.) PRC NO: 0041904
Degree: BSN,RM, MAN Valid Until: September 2012 Valid Until: February 28, 2013 Valid Until: March 21, 2013 Valid Until: July 31, 2012
a.) PRC NO: 196915 b.) PNA NO: 025883 b.) PNA NO: 004987 b.) PNA NO: 026825 b.) PNA NO: 18698
Valid Until:November 29, 2011 Valid Until: October 31, 2010 Valid Until: October 31, 2010 Valid Until: October 31, 2010 Valid Until: Lifetime
b.) PNA NO: 18696 c.) ANSAP NO: 090890 c.) ADPCN NO: 0627
Valid Until: December 2010
Name of Student: MARIBBAY,MARIPER PERALTA

Accreditation Level (if any) :PACUCOA LEVEL II Year Granted: April 10,2002
II. Minor Operations

No. Date of Case No. Name of Diagnosis Operation Type of Name of Name of Supervised by Qualified CI Signature of
Operation Patient Performed Anesthesia Surgeon Hospital Qualified CI
1. ‘
Aug. 58762 Herrera, Pablo Ptyridium Removal Monitored Dr. Ronaldo Balagtas Doctor’s Willowena Angeles, RN,MAN
5,2008 anesthesia Fernando Hospital PRC#:304439
care PNA#:026818
2.
June 30, 01246 Fajardo, Obstructive Cystoretrograde Spinal Dr. Cesar Balagtas Doctor’s Willowena Angeles, RN,MAN
2008 Rosalinda uropathy Pyelography Anesthesia Ballesteros Hospital PRC#:304439
PNA#:026818
3. Depositor’s
Feb.23, 65004 Luigi, Christian Mass Scalp Excision Biopsy Local Dr. George Fatima University Secinia I. Tallo,RM, RN, MAN
2009 Lipoma 0.5 cm of Scalp Anesthesia Fermalino Medical Center PRC#: 196915
Occiput PNA#: 19696
4. Thermal Burn
May 30, 18151 Dela Cruz, Superficial Wound Local Dr. Juan Fatima University Secinia I. Tallo,RM, RN, MAN
2009 Artemio Partial, 35% Debridement Anesthesia Francisco Medical Center PRC#: 196915
BSA, second Beltran PNA#: 19696
Degree
5. Lacerated
May 28, 187773 Quevedo, Wound, Right Suturing Local Dr. Ramon Novaliches Rosemarie Moro, RN, PhD
2009 Raymund Foot Anesthesia Teodoro District Hospital PRC#: 664911
PNA#:002436
Prepared by: Noted by: Concurred by:
Concurred by:
MARIBBAY, MARIPER P. MARISOL GARCIA – MANIPOL, RN, Concurred by:
Signature over printed Name of Student MAN,LVN MYLENE BERNADETTE O. SANTOS, Approved by:
Signature over printed name of Clinical RN, MAN, MD LORNA P.DIANO, RN
Supervised by: Coordinator Signature over printed name of Chief Signature over printed name of Chief LANIE MANGALINDAN,RN,MAN NELIA R. CAPULONG, RN, RM, MAN
Date Signed: __________ Nurse Nurse Signature over printed name of Chief Signature over printed name of Dean
SECINIA I. TALLO, RM, RN, MAN Degree: BSN, MAN Date Signed: ___________ Date Signed: ___________ Nurse Date Signed: ____________
Signature over printed name of Faculty a.) PRC NO: 0296870 Degree:BSN,MAN,MD Degree: BSN, Date Signed: ___________ Degree: BSN, MAN
Date Signed: ____________ Valid Until: September 2012 a.) PRC NO: 0192913 a.) PRC NO: 0260345 Degree: BSN, MAN a.) PRC NO: 0041904
Degree: BSN, RM,MAN b.) PNA NO: 025883 Valid Until: February 28, 2013 Valid Until: March 21 2013 a.) PRC NO: 0212126 Valid Until: July 31, 2012
a.) PRC NO: 196915 Valid Until: October 31, 2010 b.) PNA NO: 004987 b.) PNA NO: 026825 Valid Until:Decmber 11 2013 b.) PNA NO: 18698
Valid Until:November 29 2011 Valid Until: October 31, 2010 Valid Until: October 31, 2010 b.) PNA NO: 066851 Valid Until: Lifetime
b.) PNA NO:18696 b.) ANSAP NO: 090890 Valid Until: October 31 2010 c.) ADPCN NO: 0627
Valid Until: Lifetime Valid Until: December 2011 Valid Until: December 2010
Name of Student: MARIBBAY,MARIPER PERALTA

III. Actual Deliveries

No. Case Diagnosis Name of Age Date of Time of Gender Name of Type of Delivery Supervised by: Qualified C.I. Signature of
No. Mother Delivery Delivery of Baby Hospital Qualified C.I.
1. 08-11869 Pregnancy Uterine 36 weeks 21y/o April 30, 2:50pm Baby Gregorio del Normal Spontaneous
Ageof Gestation,Cephalic in Pondol, Archie 2009 Girl Pilar District Delivery to Cecile F. Guevarra, RN MAN
Labor, Gavida1,Para 0 Hospital Lymphoblastogenesis PRC#: 29377
PNA#:18471
2. 394250 Pregnancy Uterine 37 3/7 21y/o Dec.11 2:53 am Baby Batangas Normal Spontaneous
weeks Age of Gestation, Lumod, Bunny 2009 Girl Regional Delivery Gonzala B. De Mesa,RN,MAN
Cephalic in Labor Gravida 2, Hospital PRC#:0127007
Para 0 PNA#:17119
3. 373560 Pregmancy Uterine 36 3/7 27y/o Dec. 5, 8:41 pm Baby Batangas Normal Spontaneous
weeks Age of Gestation, Diaz, Lorena 2009 Girl Regional Delivery Gonzala B. De Mesa,RN,MAN
Cephalic in Labor, Gravida Hospital PRC#:0127007
2,Para 1 PNA#:17119
4. 388698 Pregnancy Uterine 42 2/7 23y/ Dec. 3:21pm Baby Batangas Normal Spontaneous
weeks Age of Gestation, De Chavez, o 6,2009 Girl Regional Delivey Gonzala B. De Mesa,RN,MAN
Cephalic in Labor, Gravida 2, Maryjane Hospital PRC#:0127007
Para 1 PNA#:17119
5. 2010- Pregnancy Uterine 39 weeks 28y/ Feb. 6 2:30 am Baby Fatima Normal Spontaneous Daisy Y. Yadan, RN, MAN
020290 Age of Gestation,Cephalic in De Jesus, o 2010 Girl University Delivery PRC#: 0317896
Labor, Gravida 2 Para 1 Jenice Joie Medical Center PNA#: 012938

Concurred by:
MARIBBAY, MARIPER P. MARISOL GARCIA – MANIPOL, RN, Concurred by:
Signature over printed Name of Student MAN MYLENE BERNADETTE O. SANTOS,
Signature over printed name of Clinical RN, MAN, MD AMOR CALAYAN,RN,MAN,PHD Approved by:
Supervised by: Coordinator Signature over printed name of Chief Signature over printed name of Chief ARLENE GALANG-
Date Signed: __________ Nurse Nurse GENEROSA,RN,MAN NELIA R. CAPULONG, RN, RM, MAN
GONZALA B. DE MESA,RN,MAN Degree: BSN, MAN Date Signed: ___________ Date Signed: ___________ Signature over printed name of Chief Signature over printed name of Dean
Signature over printed name of Faculty a.) PRC NO: 0296870 Degree:BSN,MAN,MD Degree: BSN, MAN PhD Nurse Date Signed: ____________
Date Signed: ____________ Valid Until: September 2012 a.) PRC NO: 0192913 a.) PRC NO: 151514 Date Signed: ___________ Degree: BSN, MAN
Degree: BSN, MAN b.) PNA NO: 025883 Valid Until: February 28, 2013 Valid Until: August 2013 Degree: BSN, MAN a.) PRC NO: 0041904
a.) PRC NO: 0127007 Valid Until: October 31, 2010 b.) PNA NO: 004987 b.) PNA NO: 006601 a.) PRC NO: 152240 Valid Until: July 31, 2012
Valid Until: January10,2013 Valid Until: October 31, 2010 Valid Until: October 31,2010 Valid Until: October 19,2011 b.) PNA NO: 18698
b.) PNA NO: 17119 c.) ANSAP NO: 090890 c.) ANSAP NO: 00505 b.) PNA NO: 18248 Valid Until: Lifetime
Valid Until: Lifetime Valid Until: December 2011 Valid Until: December 2010 Valid Until: Lifetime c.) ADPCN NO: 0627

IV. Deliveries Assisted

No. Case No. Diagnosis Name of Age Date of Time of Gender of Name of Hospital Type of Delivery Supervised by: Signature
Mother Delivery Deliver Baby Qualified C.I. of
y Qualified
C.I.
1. 368148 Pregnancy Uterine 40 weeks 2 Gregorio del Pilar Normal Spontaneous
Cecile F. Guevarra, RN MAN
Age of Gestation, Gravida Somera, 18 y/o May 2, 2:40 pm Baby Boy District Hospital Delivery to PRC#: 29377
1,Para 0 Lorena 2009 Lymphoblastogenesis PNA#:18471
2. 429973 Pregnancy Uterine 38 weeks Batangas Normal Spontaneous
Gonzala B. DeMesa,RN,MAN
Age of Gestation, Cephalic in Atienza, Arlene 31y/o Dec.6, 8:23 pm Baby Girl Regional Hospital Delivery PRC#:0127007
Labor, Gravida 3, Para 2 2009 PNA#:17119
3. 429626 Pregnancy Uterine 37 3/7 Batangas Normal Spontaneous
Gonzala B. DeMesa,RN,MAN
weeks Age of Gestation, Cuasay, 16y/o Dec.5, 9:52 pm Baby Boy Regional Hospital Delivery PRC#:0127007
Cephalic in Labor, Gravida 2, Patricia 2009 PNA#:17119
Para 0
4. 2010- Pregnancy Uterine 38 weeks, Fatima Univesity Normal Spontaneous
Daisy Y. Yadan, RN, MAN
021229 Age of Gestation, Cephalic in Policar, Jhoan 25y/o Feb. 6:31pm Baby Boy Medical Center delivery PRC#: 0317896
Labor Gravida 1 Para 0 8,2010 PNA#: 012938
5. 2010- Pregnancy Uterine 37 weeks Calamayan, Fatima University Normal Spontaneous
Daisy Y. Yadan, RN, MAN
022051 Age of Gestation, Cephalic in Jofely 25y/o Feb.10, 4:58am Baby Girl Medical Center Delivery PRC#: 0317896
Labor,Gravida 2 Para1 2010 PNA#: 012938
Prepared by: Noted by: Concurred by: Concurred by: Concurred by: Approved by:
MARIBBAY, MARIPER P. MARISOL GARCIA – MANIPOL, NELIA R. CAPULONG, RN, RM,

MYLENE BERNADETTE O. AMOR CALAYAN,RN,MAN,PHD ARLENE GALANG-
Signature over printed Name of RN, MAN MAN
SANTOS, RN, MAN, MD Signature over printed name of GENEROSA,RN,MAN
Student Signature over printed name of Signature over printed name of
Signature over printed name of Chief Nurse Signature over printed name of
Clinical Coordinator Dean
Chief Nurse Date Signed: ___________ Chief Nurse
Supervised by: Date Signed: __________ Date Signed: ____________
Date Signed: ___________ Degree: BSN, MAN PhD Date Signed: ___________
Degree: BSN, MAN Degree: BSN, MAN
Degree:BSN,MAN,MD a.) PRC NO: 151514 Degree: BSN, MAN
GONZALA B. DE MESA,RN,MAN a.) PRC NO: 0296870 a.) PRC NO: 0041904
a.) PRC NO: 0192913 Valid Until: August 2013 a.) PRC NO: 152240
Signature over printed name of Valid Until: September 2012 Valid Until: July 31, 2012
Valid Until: February 28, 2013 b.) PNA NO: 006601 Valid Until: October 19,2011
Faculty b.) PNA NO: 025883 b.) PNA NO: 18698
b.) PNA NO: 004987 Valid Until: October 31,2010 b.) PNA NO: 18248
Date Signed: ____________ Valid Until: October 31, 2010 Valid Until: Lifetime
Valid Until: October 31, 2010 c.) ANSAP NO: 00505 Valid Until: Lifetime
Degree: BSN, MAN c.) ADPCN NO: 0627
c.) ANSAP NO: 090890 Valid Until: December 2010
a) PRC NO: 0127007 Valid Until: December 2010
Valid Until: January10,2013
b) PNA NO: 17119
Valid Until: Lifetime

V. Cord Dressing
No. Case No. Date Name of Baby Gender of Name of Mother Age Name of Hospital Supervised by: Qualified C.I. Signature of Qualified
Performed Baby C.I.
1. Daisy Y. Yadan, RN, MAN
PE090000 Dec.12,2009 Baby Girl Pabustan Girl Pia Joy Pabustan 23y/o Fatima University PRC#: 0317896
127485 Medical Center PNA#: 012938
2. 23y/o Daisy Y. Yadan, RN, MAN
PE0900001 Dec.13,2009 Baby Boy Banagua Boy Cynthia Banagua Fatima University PRC#: 0317896
3. Marichu Yalung Daisy Y. Yadan, RN, MAN
2010- Jan.3,2010 Baby Girl Yalung Girl 28y/o Fatima University PRC#: 0317896
4. Gennaly Dela Fuente Daisy Y. Yadan, RN, MAN
2010- Jan.6 2010 Baby Girl Dela Fuente Girl 21y/o Fatima University PRC#: 0317896
5. Cecile F. Guevarra, RN MAN
381534 Oct.30,2009 Baby Girl Flores Girl Geraldine Flores 20 y/o Gregorio Del Pilar PRC#: 29377
District Hospital PNA#:18471

Concurred by:
MARIBBAY,MARIPER P. MARISOL GARCIA – MANIPOL, RN, MYLENE BERNADETTE O. SANTOS, Approved by:
Signature over printed Name of Student MAN,LVN RN, MAN, MD ARLENE GALANG-
Signature over printed name of Clinical Signature over printed name of GENEROSA,RN,MAN NELIA R. CAPULONG, RN, RM, MAN
Supervised by: Coordinator Chief Nurse Signature over printed name of Chief Signature over printed name of Dean
Date Signed: __________ Date Signed: ___________ Nurse Date Signed: ____________
SECINIA I. TALLO RM,RN,MAN Degree: BSN, MAN Degree: BSN, MAN, MD Date Signed: __________ Degree: BSN, MAN
Signature over printed name of Faculty a.) PRC NO: 0296870 a.) PRC NO: 0192913 Degree: BSN, MAN a.) PRC NO: 0041904
Date Signed: ____________ Valid Until: September 2012 Valid Until: February 28, 2013 a.) PRC NO: 152240 Valid Until: July 31, 2012
Degree: BSN,RM, MAN b.) PNA NO: 025883 b.) PNA NO: 004987 Valid Until: October 19,2011 b.) PNA NO: 18698
a.) PRC NO: 196915 Valid Until: October 31, 2010 Valid Until: October 31, 2010 b.) PNA NO: 18248 Valid Until: Lifetime
Valid Until:November 29, 2011 c.) ANSAP NO: 090890 Valid Until: Lifetime c.) ADPCN NO: 0627
b.) PNA NO: 18696 Valid Until: December 2011 Valid Until: December
Valid Until: Lifetime

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OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: MARIBBAY, MARIPER PERALTA

Name of Student: MARIBBAY,MARIPER PERALTA

II. Minor Operations

Name of Student: MARIBBAY,MARIPER PERALTA

III. Actual Deliveries

Prepared by: Noted by: Concurred by:

Name of Student: MARIBBAY, MARIPER PERALTA

IV. Deliveries Assisted

MARIBBAY, MARIPER P. MARISOL GARCIA – MANIPOL, NELIA R. CAPULONG, RN, RM,

Name of Student: MARIBBAY, MARIPER PERALTA

Prepared by: Noted by: Concurred by:

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