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DEE HWA LIONG COLLEGE FOUNDATION

Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac,Duquit, Mabalacat, Pampanga___________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition – March 21__________ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

I. Major Operations
Signature
Name of
Date of Case Name of Type of Name of of O.R.
No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
Operation No. Patient Anesthesia Surgeon Scrub
Nurse
Nurse
Colloidal Adenomatous Total Lobectomy Left General Dr. Allan M. Jose B. Lingad Memorial Elizabeth L.
1.
Goiter Left Thyroid Gland Anesthesia Magday Regional Hospital Lazatin, RN
Diabetes Milletus Foot Spinal Dr. Julius C. Jose B. Lingad Memorial Marissa C.
2. Above Knee Amputation
Gangrene Left Anesthesia Bumadilla Regional Hospital Fronda, RN

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student _ __________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

I. Major Operations
Signature
Name of
Date of Case Name of Type of Name of of O.R.
No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
Operation No. Patient Anesthesia Surgeon Scrub
Nurse
Nurse
Gravida 4, Para 4,
Pregnancy Uterine 38
5/7 weeks Age of
Emergency, Classical Spinal Dra. Daisy May Jose B. Lingad Memorial Mark Louie
3. Gestation, Previous
Cessarean Section III Anesthesia L. Santos Regional Hospital S. Puyat, RN
Cessarean Section 3x2˚
Hydrocephalus in
beginning labor

Prepared by: Noted by: Concurred by: Approved by:

__________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 7368_____________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: __________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition - March 21___________ Number: HER-023 ___________Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

I. Major Operations
Signature
Name of
Date of Case Name of Type of Name of of O.R.
No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
Operation No. Patient Anesthesia Surgeon Scrub
Nurse
Nurse
Gravida 2, Para 2,
Status post Low Low Segment Cessarean Spinal Dr. Reynaldo S. Escolastica Romero Elvira A,
4.
Segment Cessarean Section II Anesthesia Alipio District Hospital Morales, RN
Section
Spinal and
Dr. Jaime P. Escolastica Romero Elvira A.
5. Gallbladder Stone Cholecystectomy intravenous
Flores District Hospital Morales, RN
Anesthesia

Prepared by: Noted by: Concurred by: Approved by:

__________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: July 2008_____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 11901_______________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008______ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: __________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition_- March 21_________ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

II. Minor Operation


Signature of
Date of Case Operation Type of Name of Name of O.R.
No. Name of Patient Diagnosis Name of Hospital O.R. Scrub
Operation No. Performed Anesthesia Surgeon Scrub Nurse
Nurse
Jose B. Lingad
Post Partum Gravida 3, Bilateral Tubal Local Dra. Jaimie Ma. Josefina S.
1. Memorial Regional
Para 3, Ligation Anesthesia A. Ocampo Basilio, RN
Hospital
Jose B. Lingad
Prolapsed Submucus Spinal Dra. Imelda Marissa C.
2. Fructional Curretage Memorial Regional
Myoma Anesthesia S. Calonzo Fronda, RN
Hospital
Jose B. Lingad
Acute Appendicitis Emergency Spinal Dr. Julius C. Marissa C.
3. Memorial Regional
Suppurative Appendix Appendectomy Anesthesia Bumadilla Fronda, RN
Hospital

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN__ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

II. Minor Operation


Signature of
Date of Case Operation Type of Name of Name of O.R.
No. Name of Patient Diagnosis Name of Hospital O.R. Scrub
Operation No. Performed Anesthesia Surgeon Scrub Nurse
Nurse
Gravida 1, Para 1, Pregnancy Right
Uterine Full term, Delivered Mediolateral Local Dr.Zennon V. Escolastica Romero Cristina S.
4.
spontaneously to a live baby episiotomy + Anesthesia Ponce District Hospital Lagman, RN
boy repair
Local Dra. Carlota Escolastica Romero Jane L. Barrera
5. Uncircumcised Penis Circumcision
Anesthesia M. Gutierres District Hospital RN, MAN

Prepared by: Noted by: Concurred by: Approved by:

_________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No.: 0254235________________ a.) PRC No.: 57881_____________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. :1901________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008_____ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition - March 21__ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

V. Cord Dressing
Case Date Gender of Supervised by:
No. Name of Baby Name of Mother Age Name of Hospital
No. Performed Baby Name & Signature of Qualified C.I.
1. Baby Boy Peralta Male 37 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN
Baby Boy
2. Male 41 y/o Escolastica Romero District Hospital
Duinagracia Agnes N.Alipio RN, MAN
3. Baby Boy Pagusan Male 26 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No.: 0254235_______________ a.) PRC No.: 57881______________ a.) PRC No. 0054482______________
Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________
b.) PNA No.: 43057_________________ b.) PNA No.: 11901________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008___ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition - March 21____ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

V. Cord Dressing
Case Date Gender of Supervised by:
No. Name of Baby Name of Mother Age Name of Hospital
No. Performed Baby Name & Signature of Qualified C.I.
4. Baby Boy Asures Male 35 y/o Jose B. Lingad Memorial Regional Hospital Nerissa A. Mercado, RN, MAN
5. Baby Boy Sulano Male 28 y/o Jose B. Lingad Memorial Regional Hospital
Nerissa A. Mercado, RN, MAN

Prepared by: Noted by: Concurred by: Approved by:

___________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 7368_______________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until:Lifetime_______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga___________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

III. Actual Deliveries


No. Supervised by:
Name of Date of Time of Gender
Case No. Diagnosis Age Name of Hospital Type of Delivery Name & Signature of
Mother Delivery Delivery of Baby
Qualified C.I.
Gravida 3, Para 3, Pregnancy
Jose B. Lingad Normal
Uterine delivered spontaneously September
1. 2:17 pm Male Memorial Regional Spontaneous
to a live baby boy, 39 weeks 18, 2006 Hospital Anna Jane B. Lozano RN,
Delivery
Age of Gestation, cephalic MAN
Gravida 7, Para 6, Pregnancy
Jose B. Lingad Normal
Uterine delivered spontaneously November
2.
1: 50 pm Male Memorial Regional Spontaneous
to a live baby boy, 40 weeks 15, 2007 Hospital Anna Jane B. Lozano RN,
Delivery
Age of Gestation, cephalic MAN

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328________________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang_Maisac, Duquit, Mabalacat, Pampanga __________________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition- March 21__ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

III. Actual Deliveries


No. Supervised by:
Name of Date of Time of Gender Type of
Case No. Diagnosis Age Name of Hospital Name & Signature of
Mother Delivery Delivery of Baby Delivery
Qualified C.I.
Gravida 3, Para 3, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
3. Male Spontaneous
to a live baby boy 38 – 39 weeks District Hospital RN, MAN
Delivery
Age of Gestation, cephalic
Gravida 1, Para 1, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
4.
Male Spontaneous
to a live baby boy 40 weeks Age District Hospital RN, MAN
Delivery
of Gestation, cephalic
Gravida 1, Para 1, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
5.
Female Spontaneous
to a live baby girl 40 weeks Age District Hospital RN, MAN
Delivery
of Gestation, cephalic

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008__ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized: Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

IV. Deliveries Assisted


No. Supervised by:
Name of Date of Time of Gender
Case No. Diagnosis Age Name of Hospital Type of Delivery Name & Signature of
Mother Delivery Delivery of Baby
Qualified C.I.
Gravida 3, Para 3, Pregnancy Jose B. Lingad Normal
1. Uterine delivered spontaneously Female Memorial Regional Spontaneous Anna Jane B. Lozano RN,
to a live baby girl Hospital Delivery MAN

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 0041328_______________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 6378________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: _Lifetime______________ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

IV. Deliveries Assisted


No. Supervised by:
Name of Date of Time of Gender Type of
Case No. Diagnosis Age Name of Hospital Name & Signature of
Mother Delivery Delivery of Baby Delivery
Qualified C.I.
Gravida 2, Para 2, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero
2. Male District Hospital
Spontaneous
to a live baby boy 40 weeks Age Cynthia F. Deogracias,
Delivery
of Gestation, cephalic RN, MAN
Gravida 1, Para 1, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
3. Male District Hospital
Spontaneous
to a live baby boy 39 - 40 weeks RN, MAN
Delivery
Age of Gestation, cephalic

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008____ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________
DEE HWA LIONG COLLEGE FOUNDATION
Sapang Maisac, Duquit, Mabalacat, Pampanga

Name of Student: ___________________________________________________________________________________________________


Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _______________________________
Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
Date School/ Program was Recognized:Government Recognition- March 21__ _ Number: HER-023 ___________ Year: 2007_____________________
First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

IV. Deliveries Assisted


No. Supervised by:
Name of Date of Time of Gender Type of
Case No. Diagnosis Age Name of Hospital Name & Signature of
Mother Delivery Delivery of Baby Delivery
Qualified C.I.
Gravida 1, Para 1, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero
4. Female Spontaneous
to a live baby girl 38-39 weeks District Hospital Cynthia F. Deogracias,
Delivery
Age of Gestation, cephalic RN, MAN
Gravida 1, Para 1, Pregnancy
Normal
Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
5.
Female Spontaneous
to a live baby girl 39 - 40 weeks District Hospital RN, MAN
Delivery
Age of Gestation, cephalic

Prepared by: Noted by: Concurred by: Approved by:

____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
Coordinator Nurse
Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
Valid Until: December 2008__________ Valid Until: December 2008 ___ Valid Until: Lifetime ____________
c.) ADPCN No. 0397 _______________
Valid Until: 2008 _________________