COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

I. MAJOR OPERATIONS

NO. DATE OFOPERATION CASE NO. NAME OF

PATIENTS DIAGNOSIS OPERATIONPERFORMED

TYPES OFANESTHESIA NAME OF SURGEON NAME OF

HOSPITALS

Supervised by: Name and Signature of Qualified

Clinical Instructors

1 03-16-2010 10-03-92 Delia Catalan Abad Myoma Uterine

Total Abdominal Bilateral Hysterectomy

and SalpingoOophorectom

y

Sub-arachnoid Block

Dr. Maria Salome Romero

Cuison Hospital Incorporated Miss Sheila Soriano

Concurred by:

MR. CONRAD JULIUS CUISONChief Nurse

CUISON HOSPITAL INCORPORATED

Date Signed:Degree: RN, MAN in progress

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN,EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0538912 Valid Until: April 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.:061515 Valid Until: March 4, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 10-0147 Valid Until: December 31, 2012

c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA. ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400

Accredited Level (If any): Not Applicable Year Granted: Not Applicable

Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006

First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not Applicable

Year of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

I. MAJOR OPERATIONS

NO. DATE OFOPERATION CASE NO. NAME OF

PATIENTS DIAGNOSIS OPERATIONPERFORMED

TYPES OFANESTHE

SIANAME OF SURGEON NAME OF HOSPITALS

Supervised by: Name and Signature of Qualified Clinical

Instructors

1 08-08-2010 1851 Ernesto FrinGarduque

Generalized Peritonitis Secondary to Blunt Abdominal

Injury

Exploratory Laparotomy Evacuation of Hemo-peritoneum.Spleenectomy

Lavage

Sub-arachnoid

BlockDr. Maria Camila Rosario Region 1 Medical Center

Mr. Alain Jason Generale

2 08-13-2010 92637 Jennifer PerezBasa

Pregnancy Uterine 37 5/7 Weeks Age of Gestation Breech

Gravida: 3 Para:3

Low Transverse Caesarean Section Delivered to a Live Baby Girl,

Bilateral Tubal Ligation

Sub-arachnoid

BlockDr. Mary Kahreen Ramos Region 1 Medical Center Mr. Alain Jason Generale

3 08-20-2010 94320 Jocelyn TorenoApacis

Pregnancy Uterine 39 6/7 Weeks Age of Gestation,

Prolonged 2nd Stage of LaborLow Transverse Caesarean Section

Sub-arachnoid

BlockDr. Sheryl Aquino Region 1 Medical Center

Mr. Alain Jason Generale

4 08-25-2010 95617 Simon Dela CruzJr.

Stab Wound 2cm Supraumbilical Area Penetrating; Perforating

Exploratory Laparotomy with Myorraphy

Sub-arachnoid

BlockDr. Mayeen Fernandez Region 1 Medical Center

Mr. Alain Jason Generale

Concurred by:

Mr. Rosauro P. CatabayChief Nurse

REGION 1 MEDICAL CENTER

Date Signed:Degree: RN, MAN

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by:

________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

NO. DATE OFOPERATION CASE NO. NAME OF

PATIENTS DIAGNOSIS OPERATIONPERFORMED

TYPES OFANESTHESIA NAME OF SURGEON NAME OF

HOSPITALS

Supervised by: Name and Signature of Qualified

Clinical Instructors

1 03-17-2010 098 Anacleto Peralta Mamaril

Lacerated Wound at Right Foot; 4cm Suturing Local

Anesthesia Dr. ConradoCuison Cuison Hospital Incorporated Miss Sheila Soriano

2 03-19-2010 10-04-18 Doreen Dumagas Cuison

PregnancyUterine 38 Weeks Age of Gestation

Previous Caesarean Section, Family

Planning Acceptor

Bilateral Tubal Ligation

Sub-arachnoid Block

Dr. Maria Salome Rosario

Cuison Hospital Incorporated Miss Sheila Soriano

Concurred by:

MR. CONRAD JULIUS CUISONChief Nurse

CUISON HOSPITAL INCORPORATED

Date Signed:Degree: RN, MAN in progress

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0538912 Valid Until: April 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012

a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.:061515 Valid Until: March 4, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 10-0147 Valid Until: December 31, 2012

c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Medina, Allan Lester V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

NO. DATE OFOPERATION CASE NO. NAME OF

PATIENTS DIAGNOSIS OPERATIONPERFORMED

TYPES OFANESTHESIA NAME OF SURGEON NAME OF

HOSPITALS

Supervised by: Name and Signature of Qualified

Clinical Instructors

1 03-23-2010 6175 Karylle NicoleCorpuz

Multiple Lacerated Wound at Right Hand

with Presence of Abscess

Incision and Drainage

Local Anesthesia

Dr. Marie Jen BenignoUy

Manaoag Community Hospital

Mrs. Jessica Reyes

2 03-24-2010 6048 FloydCabingasDiabetic Right Foot with Gangreenenous sores at

sole aspectDebridement Dr. V. Petrola Manaoag Community

Hospital Mrs. Jessica Reyes

Concurred by:

MR. DENNIS N. CALIMLIMChief Nurse

MANAOAG COMMUNITY HOSPITAL

Date Signed:Degree: RN, MAN in progress

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012

a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.:09-0055 Valid Until: December 31, 2012

c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year:Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

II. MINOR OPERATIONS

NO. DATE OFOPERATION CASE NO. NAME OF

PATIENTS DIAGNOSIS OPERATIONPERFORMED

TYPES OFANESTHESIA NAME OF SURGEON NAME OF

HOSPITALS

Supervised by: Name and Signature of Qualified

Clinical Instructors

1 03-23-2011 136757 Mercedita Javier

Post Menstrual Bleeding

Secondary Endocervical Polyp

Rule Out Endometrial Pathology

Polypectomy, Curettage

Intravenous Sedation

Dr. Caryl Queen Bugaoan

Region 1 Medical Hospital

Miss Lizette B. Ching

Concurred by:

MR. ROSAURO P. CATABAYChief Nurse

REGION 1 MEDICAL CENTER

Date Signed:Degree: RN, MAN

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN,EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.: 0157085 Valid Until: October 28, 2012

a. PRC No.: 0301235 Valid Until: August 8, 2012

a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

III. DELIVERIES HANDLED

NO. CASE NO. DIAGNOSIS NAME OF MOTHER AGE DATE OFDELIVERY

TIME OFDELIVER

Y

GENDEROF

BABYNAME OF HOSPITALS TYPE OF

DELIVERY

Supervised by: Name and Signature of

QualifiedClinical Instructors

1. 6814

Pregnancy Uterine Full Term Cephalic,

Delivered to an Alive Baby Boy

Wilma G. Velasco 19 03-21-2010

9:21am Male Manaoag Community Hospital

Normal Spontaneous

DeliveryMrs. Jessica Reyes

Concurred by:

MR. DENNIS N. CALIMLIMChief Nurse

MANAOAG COMMUNITY HOSPITAL

Date Signed:Degree: RN, MAN in progress

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 09-0055 Valid Until: December 31, 2012

c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________

MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

III. DELIVERIES HANDLED

NO. CASE NO. DIAGNOSIS NAME OF

MOTHERAGE

DATE OFDELIVERY

TIME OFDELIVER

Y

GENDER

OF BABY

NAME OF HOSPITALS TYPE OFDELIVERY

Supervised by: Name and Signature of

QualifiedClinical Instructors

1. 128596 Pregnancy Uterine Full Term Cephalic, Delivered to an Alive Baby Boy Jennifer Ortiz 37 02-10-2011 2:52am Male Region 1 Medical Center Normal Spontaneous

DeliveryMiss Rosanta Ellasus

2. 136678Pregnancy Uterine Full Term Cephalic,

Delivered to an Alive Baby Boy Gretchen Turao 27 03-22-2011 8:27pm Male Region 1 Medical Center Normal Spontaneous

DeliveryMiss Lizette B. Ching

3. 136694Pregnancy Uterine Full Term Cephalic,

Delivered to an Alive Baby Boy Elizabeth Bangal 31 03-23-2011 4:20pm Male Region 1 Medical Center Normal Spontaneous

DeliveryMiss Lizette B. Ching

4 136867Pregnancy Uterine Full Term Cephalic,

Delivered to an Alive Baby Boy Myra Baniqued 29 03-23-2011 11:04pm Male Region 1 Medical Center Normal Spontaneous

Delivery Miss Lizette B. Ching

Concurred by:

MR. ROSAURO P. CATABAYChief Nurse

REGION 1 MEDICAL CENTERDate Signed:Degree: RN, MAN

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSINGDate Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSINGDate Signed:Degree: RN, RM, MAN

a. PRC No.: 0157085 Valid Until: October 28, 2012

a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

IV. DELIVERIES ASSISTED

CASE NO. DIAGNOSIS NAME OF MOTHER AGE DATE OF

DELIVERYTIME OF

DELIVERYGENDEROF BABY NAME OF HOSPITALS TYPE OF

DELIVERY

Supervised by: Name and Signature of Qualified

Clinical Instructors

1 127655Pregnancy Uterine Preterm Delivered

Cephalic,to a Stillbirth Baby Boy

Rachelle Iglesia 18 02-04-2011 2:16pm Male Region 1 Medical Center Normal Spontaneous Delivery MrsRosanta Ellasus

2 136689 Pregnancy Uterine Full Term Cephalic, Delivered to an Alive Baby Girl

Merle Del Campo 42 03-21-2011 9:10 pm Female Region 1 Medical Center Normal Spontaneous

Delivery Miss Lizette Leah B. Ching

3 136381 Pregnancy Uterine Full Term Cephalic, Delivered to an Alive Baby Boy Sheryl Agustin 22 03-23-2011 9:48pm Boy Region 1 Medical Center Normal Spontaneous

Delivery Miss Lizette Leah B. Ching

4 52109 Pregnancy Uterine Preterm Cephalic, Delivered to a Stillbirth Baby Girl

Michele Meneses 28 03-26-2011 3:15 Girl Region 1 Medical Center Normal Spontaneous

Delivery Mrs Rosanta Ellasus

5 Region 1 Medical Center Normal Spontaneous Delivery

Concurred by:

MR. ROSAURO P. CATABAYChief Nurse

REGION 1 MEDICAL CENTERDate Signed:Degree: RN, MAN

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSINGDate Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSINGDate Signed:Degree: RN, RM, MAN

a. PRC No.: 0157085 Valid Until: October 28, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

V. CORD DRESSING

NO. CASE NO.

DATE OFPERFORMED NAME OF BABY GENDER OF

BABY NAME OF MOTHER AGE NAME OF HOSPITALS Supervised by: Name and Signature of Qualified Clinical Instructors

1 6804 03-25-2010 Baby Boy Aquino Male Assuncion Aquino 28 Manaoag Community Hospital Mrs. Jessica Reyes

Concurred by:

MR. DENNIS N. CALIMLIMChief Nurse

MANAOAG COMMUNITY HOSPITAL

Date Signed:Degree: RN, MAN in progress

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.:0095309 Valid Until: April 12, 2012 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.:037322 Valid Until: October 31, 2012 b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 09-0055 Valid Until: December 31, 2012

c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.

COLEGIO DE DAGUPANFormerly COMPUTRONIX COLLEGE

COLLEGE OF NURSINGArellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: MEDINA, ALLAN LESTER V.Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400Accredited Level (If any): Not Applicable Year Granted: Not ApplicableDate School/ Program was Recognized: May 19, 2006 Number: 004s. 2006First Course (If any): Not Applicable School Graduated from: Not Applicable Year: Not ApplicableYear of Admission in Bachelor Science in Nursing: 2007 Year Graduated in Bachelor Science Nursing Programs: 2011

V. CORD DRESSING

NO. CASE NO.

DATE OFPERFORMED NAME OF BABY GENDER OF

BABY NAME OF MOTHER AGE NAME OF HOSPITALS Supervised by: Name and Signature of Qualified Clinical Instructors

1 128935 02-11-2010 Baby Boy Balolong Male LiwayBalolong 20 Region 1 Medical Center Miss RosantaEllasus

2 609757 03-22-2011 Baby Boy Bacani Male Marjorie Bacani 26 Region 1 Medical CenterMiss Lizette Leah B. Ching

3 83647 03-24-2011 Baby Boy Romero Male Ivy RacelQuinto Romero 26 Region 1 Medical CenterMiss RosantaEllasus

4 128553 03-25-2011 Baby Boy Mangsat Male Wilma Mangsat 35 Region 1 Medical Center Miss RosantaEllasus

Concurred by:

MR. ROSAURO P. CATABAYChief Nurse

REGION 1 MEDICAL CENTER

Date Signed:Degree: RN, MAN

Approved by:

MRS. AIDA D. SORIANODean

COLLEGE OF NURSING

Date Signed:Degree: RN, MAN, EdD

Noted by:

MRS. MARIVIC C. VERGONIAClinical Coordinator, Level IV

COLLEGE OF NURSING

Date Signed:Degree: RN, RM, MAN

a. PRC No.: 0157085 Valid Until: October 28, 2012

a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2014

b. PNA No.: 12121 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:013755 Valid Until: December 31, 2011

c. ANSAP No.: 0498 Valid Until: Lifetime c. ADPCN No.: 6632 Valid Until: December 31, 2012

Prepared by: ________________________ MEDINA, ALLAN LESTER V.