NORTH CENTRAL MINDANAO COLLEGES

Maranding, Lala, Lanao del Norte

Tel. No. (063) 388-7213

Name of Student :
Name and Address of School : North Central Mindanao Colleges Formerly: Central Mindanao Technical Institute
Accreditation Level (if any) : Government Recognition
Date School / Program was Recognized : April 22, 2002 Number: 0016 Year : 2002 Year: 1986
First Course (if Any) : Year:
Year of Admission in the BSN Program : 2002
Year Graduated ( BSN Program ) : APRIL 8, 2009

I. MAJOR OPERATIONS

NAME OF OR.
DATE OF CASE NAME OF PATIENT DIAGNOSIS OPERATION PERFORMED TYPE OF NAME OF SURGEON NAME OF HOSPITAL SCRUB NURSE SIGNATURE of
NO OPERATION NO. ANESTHESIA OR Scrub Nures

1 June 26, 2008 00-01-97 Vosotros, Marissa Pregnancy Uterine Full Term, 2nd Stage 2°Cephalo- Caesarian Section Spinal Anesthesia Dr. Mary Joy Yañez Lanao del Norte Provincial Betty Bihag, RN
Pelvic Disproportion Hospital PRC # 0095705

2 September 21, 2008 13-74-46 Avancenia, Nerizel Post Partum, Multiparity Bilateral Salphingectomy Spinal Anesthesia Dr. Marohom Lanao del Norte Provincial Betty Bihag, RN
Hospital PRC # 0095705

3 November 4, 2008 16-30-11 Sayson, Daisy Pregnancy Uterine Full term Low Transverse Caesarian Section Spinal Anesthesia Dr. L Tumada Mayor Hilarion A. Ramiro Sharon Lipatan, RN
Cephalo-Pelvic Disproportion Sr. Regional Teaching and PRC # 023541
Training Hospital

4 January 6, 2009 00-243-09 Sultan, Raishid Periappendicial Abscess Appendictomy Laparotomy General Dr. Elbert Ybañez Mayor Hilarion A. Ramiro Vicsil Virtudez, RN
Ruptured Appendicitis Lavage & Drainage Anesthesia I Sr. Regional Teaching and PRC # 013543
Training Hospital

5 February 11, 2009 04-213-71 Alimento, Mardie Endometritis, Septicemia, Hysterectomy & Left Salphingo- General Dr. Elbert Ybañez Mayor Hilarion A. Ramiro Vicsil Virtudez, RN
Hydatidiform Mole oopherectomy Anesthesia I Sr. Regional Teaching and PRC # 013543
Training Hospital

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

Name of Student MR. BENJIBER R. SILVA MRS. VANESSA JONALYN V. BANCALE MRS. GERLIE S. ALIMA, RN, MAN MRS. TRANSFIGURACION LEE, RN, MAN MRS. KHAIREIA U. GALLETO
Faculty Clinical Instructor Chief Nurse Chief Nurse OIC Dean-North Central Mindanao Colleges
Degree: BSN, RN,MN, Degree: BSN, RN, MN Mayor Hilarion A. Ramiro Sr. Regional Teaching Lanao del Norte Provincial Hospital Degree: RN, MN
and Training Hospital Degree: BSN, RN, MAN Date Signed: ___________________
Date Signed: _________________ Date Signed: __________________ Degree: BSN, RN, MAN,CGM, MPA a. PRC#: 0147768
a. PRC#: 0382065 a. PRC#: 0313873 Date Signed: ________________ Valid Until: September 20, 2010
Valid Until: October 10, 2011 Valid Until: October 15, 2009 Date Signed: ________________ a. PRC#: 0059574 b. PNA#: 41901
b. PNA#: 019433 b. PNA#: 20076 a. PRC#: 0143516 Valid Until: August 6, 2011 Valid Until: December 31, 2008
Valid Until: December 31, 2009 Valid Until: December 31, 2008 Valid Until: March 29, 2009 b. PNA#: 13337 c. ADPCN#: 0753
b. PNA#: 13337 Valid Until: Lifetime Member Valid Until: December 31, 2008
Valid Until: Lifetime Member c. ANSAP#: 021
c. ANSAP#: 00530 Valid Until: December 31, 2008
Valid Until: December 31, 2008

I declare under oath that these cases had been accompanied by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines.

____________________
Signature of Applicant
Subscribe and sworn to before me this _____ day of _________ 20____, _____________________________________________, Philippines. NOTARY PUBLIC
 NORTH CENTRAL MINDANAO COLLEGES
Maranding, Lala, Lanao del Norte
Tel. No. (063) 388-7213

Name of Student :
Name and Address of School : North Central Mindanao Colleges Formerly: Central Mindanao Technical Institute
Accreditation Level (if any) : Government Recognition
Date School / Program was Recognized : April 22, 2002 Number: 0016 Year : 2002 Year: 1986
First Course (if Any) : Year:
Year of Admission in the BSN Program : 2002
Year Graduated ( BSN Program ) : April 8, 2009

II. MINOR OPERATIONS

NAME OF OR.
DATE OF CASE NO. NAME OF DIAGNOSIS OPERATION PERFORMED TYPE OF NAME OF SURGEON NAME OF HOSPITAL SCRUB NURSE SIGNATURE
N OPERATION PATIENT ANESTHESIA
O

1 December 12, 2008 3398 Lanao del Norte Provincial Ms. Edna Dayao, RN, Man
Miliano, Alia Foreign Body Right Foot Debridement Local Anesthesia Dr. E. Embate Hospital PRC # 0614950

Mrs. Josefina Apat, RN

2 December 13, 2008 02-04-23 Lanao del Norte Provincial
Bilateral Tubal Ligation Local Infiltration Dr. Maruhom Hospital
PRC # 0087469
Ligaria, Daria Multigravida

3 January 16, 2009 18-08-36 Lanao del Norte Provincial Mrs. Josefina Apat, RN
Lacerated Wound Suturing Local Anesthesia
Hibong, Melizabeth Dr. Asentista Hospital PRC # 0087469

4 February 23, 2009 32-86-91 Topical Lanao del Norte Provincial Ms. Edna Dayao, RN, Man
Tagaytay, Florentino Cataract Senile Mature Both Eyes Extracapsular Lens Extraction
Anesthesia Dr. Demetrio Opamen Hospital PRC # 0614950

Mrs. Josefina Apat, RN

5 March 2, 2009 01-02-98 Lanao del Norte Provincial
Gumba, Merril Joseph Lacerated Wound Suturing Local Anesthesia PRC # 0087469
Dr. Maruhom Hospital

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

MRS. LUZ O. MUNASQUE MRS. VANESSA JONALYN V. BANCALE MRS. TRANSFIGURACION N. LEE MRS. KHAIREIA U. GALLETO
Faculty Clinical Instructor Chief Nurse OIC Dean-North Central Mindanao Colleges
Name of Student Degree: BSN, RN,MN, MAN Degree: BSN, RN, MN Degree: RN, MN
Date Signed: __________________ Degree: BSN, RN, MAN, Date Signed: ___________________
Date Signed: _________________ a. PRC#: 0313873 Date Signed: ________________ a. PRC#: 0147768
a. PRC#: 55581 Valid Until: October 15, 2009 a. PRC#: 0059574 Valid Until: September 20, 2010
Valid Until: August 28, 2009 b. PNA#: 20076 Valid Until: August 8, 2011 b. PNA#: 41901
b. PNA#: 13752 Valid Until: December 31, 2008 b. PNA#: 13935 Valid Until: December 31, 2008
Valid Until: lifetime Member Valid Until: Lifetime Member c. ADPCN#: 0753
c. ANSAP#: 021 Valid Until: December 31, 2008
Valid Until: Lifetime Member
I declare under oath that these cases had been accompanied by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines.

_____________________
Signature of Applicant

Subscribe and sworn to before me this _____ day of _________ 20____, _____________________________________________, Philippines. NOTARY PUBLIC
 NORTH CENTRAL MINDANAO COLLEGES
Maranding, Lala, Lanao del Norte
Tel. No. (063) 388-7213

Name of Student :
Name and Address of School : North Central Mindanao Colleges Formerly: Central Mindanao Technical Institute
Accreditation Level (if any) : Government Recognition
Date School / Program was Recognized : April 22, 2002 Number: 0016 Year : 2002 Year: 1986
First Course (if Any) : Year:
Year of Admission in the BSN Program : 2002
Year Graduated ( BSN Program ) : April 8, 2009
III.ACTUAL DELIVERIES
Supervised By:
NO CASE DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERY TIME OF GENDER OF NAME OF HOSPITAL TYPE OF DELIVERY Name & Signature of Qualified C.I.
NO. DELIVERY BABY
Pregnancy Uterine Full Term,
1 Delivered Spontaneous to alive baby boy, June 23, 2008 Normal
Lanao del Norte Provincial Hospital Philip Gene A. Malacas II,
12-44-09 Cephalic Presentation, 22 3:42pm Male Spontaneous
Gravida 1, Para 0, Abortion 0 Padica, Jennifer RN
Vaginal Delivery
PRC # 0400525
Pregnancy Uterine Full Term,
2 Delivered Spontaneous to alive baby boy, September 18, 2008 Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
22-54-00 Cephalic Presentation, Montoya, Hayde 28 12.15pm Male Spontaneous RN
Gravida 2, Para 1 , Abortion 0 Vaginal Delivery PRC # 0400525
Pregnancy Uterine Full Term,
3 Delivered Spontaneous to alive baby boy, November 15, 2008 Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
30-87-09 Cephalic Presentation, Macalabo, Sittie Anni 36 9:30pm Female Spontaneous RN
Gravida 4, Para 3 , Abortion 0 Vaginal Delivery PRC # 0400525
Pregnancy Uterine Full Term,
4 Delivered Spontaneous to alive baby boy, January 9, 2009 Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
00-09-84 Cephalic Presentation, Suntanan, Apipa 21 8:25am Female Spontaneous RN
Gravida 2, Para 1 , Abortion 0 Vaginal Delivery PRC # 0400525
Pregnancy Uterine Full Term,
5 Delivered Spontaneous to alive baby boy, February 25, 2009 Normal Philip Gene A. Malacas II,
Cephalic Presentation,
Lanao del Norte Provincial Hospital
02-84-72
Gravida 3, Para 2 , Abortion 0 Flores, Mercy 27 10:10am Male Spontaneous RN
Vaginal Delivery PRC # 0400525

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

MRS. PEARL MARIE L. CAPILITAN MRS. VANESSA JONALYN V. BANCALE MRS. GERLIE S. ALIMA MRS. KHAIREIA U. GALLETO
Faculty Clinical Instructor Chief Nurse OIC Dean-North Central Mindanao Colleges
Name of Student Degree: BSN, RN,MN, MAN Degree: BSN, RN, MN Mayor Hilarion A. Ramiro Sr. Regional Degree: RN, MN
Teaching and Training Hospital Date Signed: ___________________
Date Signed: _________________ Date Signed: __________________ Degree: BSN, RN, MAN,CGM, MPA a. PRC#: 0147768
a. PRC#: 0382076 a. PRC#: 0313873 Valid Until: September 20, 2010
Valid Until: June 10, 2011 Valid Until: October 15, 2009 Date Signed: ________________ b. PNA#: 41901
b. PNA#: 29087 b. PNA#: 20076 a. PRC#: 0143516 Valid Until: December 31, 2008
Valid Until: December 31, 2008 Valid Until: December 31, 2008 Valid Until: March 29, 2009 c. ADPCN#: 0753
b. PNA#: 13337 Valid Until: December 31, 2008
Valid Until: Lifetime Member
c. ANSAP#: 00530
Valid Until: December 31, 2008

I declare under oath that these cases had been accompanied by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines.

______________________
Signature of Applicant

Subscribe and sworn to before me this _____ day of _________ 20____, _____________________________________________, Philippines. NOTARY PUBLIC
 NORTH CENTRAL MINDANAO COLLEGES
Maranding, Lala, Lanao del Norte
Tel. No. (063) 388-7213

Name of Student :
Name and Address of School : North Central Mindanao Colleges Formerly: Central Mindanao Technical Institute
Accreditation Level (if any) : Government Recognition
Date School / Program was Recognized : April 22, 2002 Number: 0016 Year : 2002 Year: 1986
First Course (if Any) : Year:
Year of Admission in the BSN Program : 2002
Year Graduated ( BSN Program ) : April 8, 2009

IV. DELIVERIES ASSISTED

Supervised By:
NO CASE DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERY TIME OF GENDER OF NAME OF HOSPITAL TYPE OF DELIVERY Name & Signature of Qualified C.I.
NO. DELIVERY BABY
Pregnancy Uterine Full Term,
Delivered Spontaneous to alive baby boy, Normal
Lanao del Norte Provincial Hospital Philip Gene A. Malacas II,
1 134 -732 Cephalic Presentation, Agrabe, Honey 32 August 10, 2008 11:20 am Female Spontaneous
Gravida 3, Para 2 , Abortion 1 RN
Vaginal Delivery
PRC # 0400525
Pregnancy Uterine Full Term,
Delivered Spontaneous to alive baby boy, Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
2 156-092 Cephalic Presentation, Lomondot, Jane 18 September 11, 2008 2:34 pm Male Spontaneous RN
Gravida 1, Para 0 , Abortion 0 Vaginal Delivery PRC # 0400525
Pregnancy Uterine Full Term,
Delivered Spontaneous to alive baby boy, Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
3 231-789 Cephalic Presentation, Rosquete, Precy 24 December 6, 2008 9:45 pm Male Spontaneous RN
Gravida 2, Para 1 , Abortion 0 Vaginal Delivery PRC # 0400525
Pregnancy Uterine Full Term,
Delivered Spontaneous to alive baby boy, Normal Philip Gene A. Malacas II,
Lanao del Norte Provincial Hospital
4 231-793 Cephalic Presentation, Intong, Katherine 24 December 7, 2008 4:05 am Female Spontaneous RN
Gravida 1, Para 1 , Abortion 0 Vaginal Delivery PRC # 0400525

Pregnancy Uterine Full Term,

Delivered Spontaneous to alive baby boy, Lanao del Norte Provincial Hospital Normal Philip Gene A. Malacas II,
300- 212 Cephalic Presentation, Abamonga, Meizel 29 January 7, 2009 3:50 pm Male Spontaneous RN
5 Gravida 2, Para 1 , Abortion 0 Vaginal Delivery PRC # 0400525

Prepared by: Supervised by: Noted by: Concurred by: Approved by:
MRS. GERLIE S. ALIMA
MRS. PEARL MARIE L. CAPILITAN MRS. VANESSA JONALYN V. BANCALE Chief Nurse MRS. KHAIREIA U. GALLETO
Faculty Clinical Instructor Mayor Hilarion A. Ramiro Sr. Regional OIC Dean-North Central Mindanao Colleges
Name of Student Degree: BSN, RN,MN, MAN Degree: BSN, RN, MN Teaching and Training Hospital Degree: RN, MN
Degree: BSN, RN, MAN,CGM, MPA Date Signed: ___________________
Date Signed: _________________ Date Signed: __________________ a. PRC#: 0147768
a. PRC#: 0382076 a. PRC#: 0313873 Date Signed: ________________ Valid Until: September 20, 2010
Valid Until: June 10, 2011 Valid Until: October 15, 2009 a. PRC#: 0143516 b. PNA#: 41901
b. PNA#: 29087 b. PNA#: 20076 Valid Until: March 29, 2009 Valid Until: December 31, 2008
Valid Until: December 31, 2008 Valid Until: December 31, 2008 b. PNA#: 13337 c. ADPCN#: 0753
Valid Until: Lifetime Member Valid Until: December 31, 2008
c. ANSAP#: 00530
Valid Until: December 31, 2008
I declare under oath that these cases had been accompanied by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines.

____________________
Signature of Applicant
Subscribe and sworn to before me this _____ day of _________ 20____, _____________________________________________, Philippines. NOTARY PUBLIC
 NORTH CENTRAL MINDANAO COLLEGES
Maranding, Lala, Lanao del Norte
Tel. No. (063) 388-7213

Name of Student :
Name and Address of School : North Central Mindanao Colleges Formerly: Central Mindanao Technical Institute
Accreditation Level (if any) : Government Recognition
Date School / Program was Recognized : April 22, 2002 Number: 0016 Year : 2002 Year: 1986
First Course (if Any) : Year:
Year of Admission in the BSN Program : 2002
Year Graduated ( BSN Program ) : April 8, 2009
V. CORD DRESSING

NO CASE NO. DATE PERFORMED NAME OF BABY GENDER NAME OF MOTHER AGE NAME OF HOSPITAL Supervised By:
Name & Signature of Qualified C.I.

1
01-87-39 June 26, 2008 Baby Boy Inapan Male Jessica Inapan 30 Philip Gene A. Malacas II, RN
Lanao del Norte Provincial Hospital
PRC # 0400525
2 Philip Gene A. Malacas II, RN
09-23-03 September 4, 2008 Baby Boy Garay Male Luisa Garay 23 Lanao del Norte Provincial Hospital
PRC # 0400525

Philip Gene A. Malacas II, RN

3 08-73-654 October 5, 2008 Baby Girl Segovia Female Leslie Ann Segovia 26
Lanao del Norte Provincial Hospital PRC # 0400525
Philip Gene A. Malacas II, RN
4 00-98-84 February 5, 2009 Baby Girl Abantas Female Aminah Abantas 32
Lanao del Norte Provincial Hospital PRC # 0400525

5 Philip Gene A. Malacas II, RN

00-93-64 March 2, 2009 Baby Girl Jabutay Female Armaina Jabutay 27 Lanao del Norte Provincial Hospital
PRC # 0400525

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

MRS. PEARL MARIE L. CAPILITAN MRS. VANESSA JONALYN V. BANCALE MRS. GERLIE S. ALIMA MRS. KHAIREIA U. GALLETO
Faculty Clinical Instructor Chief Nurse OIC Dean-North Central Mindanao Colleges
Degree: BSN, RN,MN, MAN Degree: BSN, RN, MN Mayor Hilarion A. Ramiro Sr. Regional Degree: RN, MN
Teaching and Training Hospital Date Signed: ___________________
Name of Student Date Signed: _________________ Date Signed: __________________ Degree: BSN, RN, MAN,CGM, MPA a. PRC#: 0147768
a. PRC#: 0382076 a. PRC#: 0313873 Valid Until: September 20, 2010
Valid Until: June 10, 2011 Valid Until: October 15, 2009 Date Signed: ________________ b. PNA#: 41901
b. PNA#: 29087 b. PNA#: 20076 a. PRC#: 0143516 Valid Until: December 31, 2008
Valid Until: December 31, 2008 Valid Until: December 31, 2008 Valid Until: March 29, 2009 c. ADPCN#: 0753
b. PNA#: 13337 Valid Until: December 31, 2008
Valid Until: Lifetime Member
c. ANSAP#: 00530
Valid Until: December 31, 2008
I declare under oath that these cases had been accompanied by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete statement pursuant to the provision of pertinent laws, rules and regulations of the Republic of the Philippines.

____________________
Signature of Applicant

Subscribe and sworn to before me this _____ day of _________ 20____, _____________________________________________, Philippines. NOTARY PUBLIC