LICEO DE CAGAYAN UNIVERSITY

College of Nursing
Paseo Del Rio Campus, Macasandig, Cagayan De Oro City
858-4093 to 95 local 115, 658-3123, www.liceo.edu.ph
PACUCOA LEVEL IV
February 2021 – 2026
SURGICAL SCRUB in NORTHERN MINDANAO MEDICAL CENTER, CAPITOL COMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL___
Prepared by: Hospital, Street Number, Barangay, City, Province
OR Form 1A
___ MANCAO, SEAN LESTER OBIDOS____
OR Scrub Form
Printed Name and Signature of the Student
Major
(Last Name, First Name, Middle Name)
Date & Time Patient’s Initial OR Nurse on Duty Supervised by
Procedure Performed Signature Signature
Performed Case no. (Name) (Name)
November 13,2021
S.K.M.P Raul D. Valenzuela
Appendectomy Laarne O. Devilla, RN
01304504 MN,RN
2:55 PM
November 27,
2021 D.R Primary Low Segment Transverse Arlyn B. Celestial
Amina Busara, RN
58300 Cesarean Section MAN,RN
5:50 AM

March 19, 2022 B.C.C Removal of Implant, Deep, Intra- Raul D. Valenzuela
Jeson Jay A. Tizon, RN
01465110 Medullary Nail, Tibia, Right MN,RN
4:25 AM

Noted by: Approved by:

EMMA M. DEJARME,MAN, RN GLORIA M. CUNANAN, PhD, RN
RLE Chairperson Dean, College of Nursing
PRC ID: 0171897 PRC ID: 0077729
Valid Until: July 07,2023 Valid Until: May 07,2024
Date Signed: _______________ Date Signed: _______________
 LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Paseo Del Rio Campus, Macasandig, Cagayan De Oro City
858-4093 to 95 local 115, 658-3123, www.liceo.edu.ph
PACUCOA LEVEL IV
February 2021 – 2026
SURGICAL CIRCULATING in NORTHERN MINDANAO MEDICAL CENTER, CAPITOL COMPOUND, CAGAYAN DE ORO CITY, MISAMIS ORIENTA L
Hospital, Street Number, Barangay, City, Province
Prepared by:
OR Form 1B
_ MANCAO, SEAN LESTER OBIDOS_____
OR Circulating Form
Printed Name and Signature of the Student
Major
(Last Name, First Name, Middle Name)
Date & Time Patient’s Initial OR Nurse on Duty Supervised by
Procedure Performed Signature Signature
Performed Case no. (Name) (Name)
Suture of One Nerve, Median Left
November 27,2021
Repair, Flexor Tendons, 1) Flexor
M.C Arlyn B. Celestial
Digitorum Profundus 2-5) Flexor Amina M. Busara, RN
01452561 MAN,RN
12:10 PM Digitorum Superficialis (Index,
Middle, Ring, Little)
March 18, 2022
M.E.G Raul D. Valenzuela
Radical Nephrectomy, Left Jared C. Sabornido, RN
01465308 MN,RN
2:00 PM

June 04, 2022 O.L.O Merry Cris Villota-de la Raul D. Valenzuela

Tracheostomy
714323 Riarte, RN MN,RN
3:50 PM

Noted by: Approved by:

EMMA M. DEJARME,MAN, RN GLORIA M. CUNANAN, PhD, RN
RLE Chairperson Dean, College of Nursing
PRC ID: 0171897 PRC ID: 0077729
Valid Until: July 07,2023 Valid Until: May 07,2024
Date Signed: _______________ Date Signed: _______________
 LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Paseo Del Rio Campus, Macasandig, Cagayan De Oro City
858-4093 to 95 local 115, 658-3123, www.liceo.edu.ph
PACUCOA LEVEL IV
February 2021 – 2026
DELIVERY HANDLE in J.R BORJA GENERAL HOSPITAL, J.V. SERIÑA STREET, CARMEN, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL
Prepared by: Hospital, Street Number, Barangay, City, Province

__MANCAO, SEAN LESTER OBIDOS_____ DR Form 2A

Printed Name and Signature of the Student DELIVERY HANDLE
(Last Name, First Name, Middle Name)
Date & Time Patient’s Initial DR Nurse on Duty Supervised by
Procedure Performed Signature Signature
Performed Case no. (Name) (Name)
September 04,
2019 C.I Normal Spontaneous Vaginal Sylvia Garcia RN,
Jescyn G. Tan, RN
532486 Delivery MAN
5:31 AM

October 26, 2019

B.H Normal Spontaneous Vaginal Sylvia Garcia
Glaiza A. Sunogan, RN
366297 Delivery RN,MAN
5:43 AM
November 11,
2019 M.S Partial Breech Extraction/ Normal Arlyn B. Celestial RN,
Glory Mae R. Yee, RN
544764 Spontaneous Vaginal Delivery MAN
10:19 AM

Noted by: Approved by:

EMMA M. DEJARME,MAN, RN GLORIA M. CUNANAN, PhD, RN
RLE Chairperson Dean, College of Nursing
PRC ID: 0171897 PRC ID: 0077729
Valid Until: July 07,2023 Valid Until: May 07,2024
Date Signed: _______________ Date Signed: _______________
 LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Paseo Del Rio Campus, Macasandig, Cagayan De Oro City
858-4093 to 95 local 115, 658-3123, www.liceo.edu.ph
PACUCOA LEVEL IV
February 2021 – 2026
DELIVERY ASSIST in J.R BORJA GENERAL HOSPITAL, J.V. SERIÑA ST, CARMEN, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL
Prepared by: Hospital, Street Number, Barangay, City, Province

___MANCAO, SEAN LESTER OBIDOs_____ DR Form 2B

Printed Name and Signature of the Student DELIVERY ASSIST
(Last Name, First Name, Middle Name)
Date & Time Patient’s Initial DR Nurse on Duty Supervised by
Procedure Performed Signature Signature
Performed Case no. (Name) (Name)
September 04,
2019 S.M.A.S Normal Spontaneous Vaginal Sylvia Garcia RN,
Jescyn G. Tan, RN
532497 Delivery MAN
2:07 AM
September 04,
2019 N.G.A Normal Spontaneous Vaginal Sylvia Garcia RN,
Jescyn G. Tan, RN
532512 Delivery MAN
6:25 AM

October 26, 2019 O.R.G Normal Spontaneous Vaginal Sylvia Garcia RN,
Glaiza A. Sunogan, RN
533815 Delivery MAN
1:46 AM

Noted by: Approved by:

EMMA M. DEJARME,MAN, RN GLORIA M. CUNANAN, PhD, RN
RLE Chairperson Dean, College of Nursing
PRC ID: 0171897 PRC ID: 0077729
Valid Until: July 07,2023 Valid Until: May 07,2024
Date Signed: _______________ Date Signed: _______________
 LICEO DE CAGAYAN UNIVERSITY
College of Nursing
Paseo Del Rio Campus, Macasandig, Cagayan De Oro City
858-4093 to 95 local 115, 658-3123, www.liceo.edu.ph
PACUCOA LEVEL IV
February 2021 – 2026
IMMEDIATE NEWBORN CORD CARE in J.R BORJA GENERAL HOSPITAL, J.V. SERIÑA ST, CARMEN, CAGAYAN DE ORO CITY, MISAMIS ORIENTAL
Prepared by: Hospital, Street Number, Barangay, City, Province

___MANCAO, SEAN LESTER OBIDOS_____ ICNB FORM

Printed Name and Signature of the Student CORD CARE
(Last Name, First Name, Middle Name)
Date & Time Patient’s Initial ICNB Performed DR Nurse on Duty Supervised by
Signature Signature
Performed Case no. (Indicate where e.g. DR, NICU) (Name) (Name)
October 26, 2019
S.Bb.G Sylvia Garcia RN,
Delivery Room Rhea Mariz Aganan, RN
542349 MAN
3:10 AM
November 10,
2019 M.Bb.G Arlyn B. Celestial RN,
Delivery Room Angela D. Panlasigue, RN
544769 MAN
7:38 AM

December 17,2019 S.Bb.G Sylvia Garcia RN,

Delivery Room Angela D. Panlasigue, RN
551206 MAN
8:10 AM

Noted by: Approved by:

EMMA M. DEJARME,MAN, RN GLORIA M. CUNANAN, PhD, RN
RLE Chairperson Dean, College of Nursing
PRC ID: 0171897 PRC ID: 0077729
Valid Until: July 07,2023 Valid Until: May 07,2024
Date Signed: _______________ Date Signed: _______________