Name of Student: ALIBASHER D.

MACALNAS _________________________ ________

Name and Address of School: JAMIATU MARAWI AL-ISLAMIA FOUNDATION, MONCADO KADINGILAN, MARAWI CITY_____ School Code: _12021_____________
Accreditation Level, if any: N/A ____________ Year Granted: N/A ________
Date School/Program was Recognize: JUNE Number: 0045______ Year: 1996 ________
First course (if any): N/A School Graduated from: N/A __ _______ Year: _________N/A________
Year of Admission in the Bachelor of Science in Nursing Program: 2007 ________________
Year Graduated (BSN Program): 2011 ________________

I. MAJOR OPERATIONS
Date of Type of Name of Name of O.R. Signature of O.R.
No. Case No. Name of Patient Diagnosis Operational Performed Name of Surgeon
Operation Anesthesia Hospital Scrub Nurse Scrub Nurse

Pregnancy Uterine Full Lanao Norte Josefina F. Apat

1 01-04-10 00-79-11 Plariza, Nenita Term in Active Labor r/o Caesarian Section Spinal Dr. Esther Aida O. Provincial RN
CPD Belarmino Hospital PRC. # 0087469

Lanao Norte Josefina F. Apat

Pelvic Laparotomy with Right
2 07-28-10 00-80-70 Marumaya, Soraida Right Ovarian Cyst
Ovarian Oopherectomy
Spinal Dr. Enrico P. Maruhom Provincial RN
Hospital PRC. # 0087469

Lanao Norte Josefina F. Apat

Extra Capsular Cataract Lens Local Dr. Demetrio U.
3 11-23-10 00-81-30 Palagtine, Basilio Catarat Senile Mature O. S.
Eye with PC IOL O.S. Anesthesia Opamen
Provincial RN
Hospital PRC. # 0087469

Pregnancy Uterine Full Lanao Norte Josefina F. Apat

Dr. Esther Aida O.
4 11-25-10 00-81-32 Laborte, Emmabel Term, Pre-eclampsia Elderly Caesarean Section Spinal
Belarmino
Provincial RN
Prime Hospital PRC. # 0087469

Lanao Norte Josefina F. Apat

Dr. Esther Aida O.
5 08-25-10 00-80-90 Acosta, Christy Right Ovarian Cyst Right Salphingophirectomy Spinal
Belarmino
Provincial RN
Hospital PRC. # 0087469
Prepared by: Supervised by: Noted by: Concurred by: Approved by:

ALIBASHER D. MACALNAS MR. RANDY IAN F. GALLEGO, RN, MN MRS. RACHELLE U. VALENCIA, RN, MN TRANSFIGURACION C. LEE, RN, MN CHONA G. LIMBARING.RN, MAN (CAR) MN
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Student Clinical instructor Clinical Coordinator Chief Nurse Dean

Date Signed : Date Signed : Date Signed : ________________ Date Signed : __ Date Signed : _________
a. PRC No. : 0590564 a. PRC No. : 0257368 _ a. PRC No. : 0059574 ____ a. PRC No : _0216682________
Valid Until : 08-24-2011 Valid Until : _06-16-2010_____ Valid Until : 08-06-2011__ Valid Until : 08-18-2012______
b. PNA No. : 019948 b. PNA No. : 09973 b. PNA No. : 13935 ______ b. PNA No. : _034____________
Valid Until : 10-31-2011 Valid Until : Lifetime Valid Until : _Lifetime_____ Valid Until : 12-2010________
c. ANSAP No. : _021________ c. ADPCN No. : _0656___________
Valid Until : _Lifetime_____ Valid Until : _12-2010________
Name of Student: ALIBASHER D. MACALNAS _________________________ ________
Name and Address of School: JAMIATU MARAWI AL-ISLAMIA FOUNDATION, MONCADO KADINGILAN, MARAWI CITY_____ School Code: _12021_____________
Accreditation Level, if any: N/A ____________ Year Granted: N/A ________
Date School/Program was Recognize: JUNE Number: 0045______ Year: _1996 ________
First course (if any): N/A School Graduated from: N/A __ _______ Year: ____N/A ________
Year of Admission in the Bachelor of Science in Nursing Program: 2007 ________________
Year Graduated (BSN Program): 2011 ________________

II. MINOR OPERATIONS

Date of Type of Name of Name of O.R. Signature of O.R.
No. Case No. Name of Patient Diagnosis Operational Performed Name of Surgeon
Operation Anesthesia Hospital Scrub Nurse Scrub Nurse

Lanao Norte Rosenda S. Tolopia

Local RN
1 04-28-10 00-00-49 Matas, Daryl John Uncircumcised Penis Circumcision
Anesthesia
Dr. Anthony P. Embate Provincial
Hospital PRC. # 135940

Lacerated Wounds at Lanao Norte Kristoffer Alexius F.

Local Dra. Anisa S.
2 04-30-10 01-42-70 Dolotollas, Eduardo Forehead secondary to Wound Suturing
Anesthesia Pacasum
Provincial Birondo, RN
Motorcycle Accident Hospital PRC. # 0424553

Lanao Norte Josefina F. Apat

Intravenous Dra. Anisa S.
3 12-27-10 00-81-55 Colo, Sinab Incomplete Abortion Dilatation and Curettage
Sedation Pacasum
Provincial RN
Hospital PRC. # 0087469

Lanao Norte Josefina F. Apat

Status Post Partum for Local Dr. Grace Joy P.
4 03-11-11 00-82-00 Canopin, Leve
Bilateral Tubal Ligation
Bilateral Tubal Ligation
Anesthesia Yanez
Provincial RN
Hospital PRC. # 0087469
Rosenda S. Tolopia
Lanao Norte
Local Dr. Anthony P. RN
5 03-21-11 05-12-36 Pansoy, Khent Carlo Abcess Wound at the Back Incision and Drainage Provincial
Anesthesia Embate PRC. # 135940
Hospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by:

ALIBASHER D. MACALNAS MR. RANDY IAN F. GALLEGO, RN, MN MRS. RACHELLE U. VALENCIA, RN, MN TRANSFIGURACION C. LEE, RN, MN CHONA G. LIMBARING.RN, MAN (CAR) MN
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Student Clinical instructor Clinical Coordinator Chief Nurse Dean

Date Signed : Date Signed : Date Signed : ________________ Date Signed : __ Date Signed : _________
a. PRC No. : 0590564 a. PRC No. : 0257368 _ a. PRC No. : 0059574 ____ a. PRC No : _0216682________
Valid Until : 08-24-2011 Valid Until : _06-16-2010_____ Valid Until : 08-06-2011__ Valid Until : 08-18-2012______
b. PNA No. : 019948 b. PNA No. : 09973 b. PNA No. : 13935 ______ b. PNA No. : _034____________
Valid Until : 10-31-2011 Valid Until : Lifetime Valid Until : _Lifetime_____ Valid Until : 12-2010________
c. ANSAP No. : _021________ c. ADPCN No. : _0656___________
Valid Until : _Lifetime_____ Valid Until : _12-2010________
Name of Student: ALIBASHER D. MACALNAS _________________________ ________
Name and Address of School: JAMIATU MARAWI AL-ISLAMIA FOUNDATION, MONCADO KADINGILAN, MARAWI CITY_____ School Code: ___12021___________
Accreditation Level, if any: N/A ____________ Year Granted: N/A ________
Date School/Program was Recognize: JUNE Number: 0045______ Year: 1996 ________
First course (if any): N/A School Graduated from: N/A __ _______ Year: _________N/A________
Year of Admission in the Bachelor of Science in Nursing Program: 2007 ________________
Year Graduated (BSN Program): 2011 ________________

III. Actual Deliveries

Supervised by:
Case Date of Time of Gender of Name of
No. DIAGNOSIS Name of Mother Age Type of Delivery Name and signature of
No. Delivery Delivery Baby Hospital
qualified C.I
Pregnancy Uterine Full Term Lanao Norte
Delivery Spontaneously to an alive Normal Spontaneous
1 00-35-40 Biating, Gloria C. 40 y/o 04-02-10 10:05 am Male Provincial Vaginal Delivery Randy Ian F. Gallego RN, MN
baby boy Cephalic Weight 2.8 Hospital PRC. # 0590564
Kilograms G3 P3 Apgar score 7-10
Pregnancy Uterine Full Term Lanao Norte Normal Spontaneous
2 00-40-69 Delivery Spontaneously to an alive Madrona, Judith G. 22 y/o 11-20-10 6:55 pm Male Provincial Vaginal Delivery with Randy Ian F. Gallego RN, MN
baby boy Breech Footling Weight Hospital Episiotomy PRC. # 0590564
2.1 Kilograms G1 P1 Apgar score
7-9
Pregnancy Uterine Full Term Lanao Norte Normal Spontaneous
3 00-40-77 Delivery Spontaneously to an alive Sumalipao, Hapsa I. 23 y/o 11-23-10 12:05 pm Female Provincial Vaginal Delivery with Randy Ian F. Gallego RN, MN
baby girl Cephalic Weight 2.6 Hospital Episiotomy PRC. # 0590564
Kilograms G1 P1 Apgar score 7-10
Pregnancy Uterine Full Term Lanao Norte Normal Spontaneous
4 00-42-35 Delivery Spontaneously to an alive Macabawe, Normidah B. 39 y/o 12-26-10 1:47 am Female Provincial Vaginal Delivery with Randy Ian F. Gallego RN, MN
baby girl Cephalic Weight 3.1 Hospital Episiotomy PRC. # 0590564
Kilograms G3 P3 Apgar score 8-10
Pregnancy Uterine Full Term Lanao Norte Normal Spontaneous
5 00-40-76 Delivery Spontaneously to an alive Patarlas, Roselyn J. 37 y/o 11-23-10 8:16 am Female Provincial Vaginal Delivery with Randy Ian F. Gallego RN, MN
baby girl Cephalic Weight 2.65 Hospital Episiotomy PRC. # 0590564
Kilograms G4 P3 Apgar score 7-10
Prepared by: Supervised by: Noted by: Concurred by: Approved by:

ALIBASHER D. MACALNAS MR. RANDY IAN F. GALLEGO, RN, MN MRS. RACHELLE U. VALENCIA, RN, MN TRANSFIGURACION C. LEE, RN, MN CHONA G. LIMBARING.RN, MAN (CAR) MN
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Student Clinical instructor Clinical Coordinator Chief Nurse Dean

Date Signed : Date Signed : Date Signed : ________________ Date Signed : __ Date Signed : _________
a. PRC No. : 0590564 a. PRC No. : 0257368 _ a. PRC No. : 0059574 ____ a. PRC No : _0216682________
Valid Until : 08-24-2011 Valid Until : _06-16-2010_____ Valid Until : 08-06-2011__ Valid Until : 08-18-2012______
b. PNA No. : 019948 b. PNA No. : 09973 b. PNA No. : 13935 ______ b. PNA No. : _034____________
Valid Until : 10-31-2011 Valid Until : Lifetime Valid Until : _Lifetime_____ Valid Until : 12-2010________
c. ANSAP No. : _021________ c. ADPCN No. : _0656___________
Valid Until : _Lifetime_____ Valid Until : _12-2010________
Name of Student: ALIBASHER D. MACALNAS _________________________ ________
Name and Address of School: JAMIATU MARAWI AL-ISLAMIA FOUNDATION, MONCADO KADINGILAN, MARAWI CITY_____ School Code: __12021____________
Accreditation Level, if any: N/A ____________ Year Granted: N/A ________
Date School/Program was Recognize: JUNE Number: 0045______ Year: 1996 ________
First course (if any): N/A School Graduated from: N/A __ _______ Year: _________N/A________
Year of Admission in the Bachelor of Science in Nursing Program: 2007 ________________
Year Graduated (BSN Program): 2011 ________________

IV. Deliveries Assisted

Supervised by:
No. Case DIAGNOSIS Name of Mother Age Date of Time of Gender Name of Type of Delivery Name and signature of
No. Delivery Delivery Of Baby Hospital qualified C.I
Pregnancy Uterine Full Term Delivery Lanao Norte Normal Spontaneous
Ovillo, Evelyn 34 y/o 05-04-10 12:23 am Female Provincial Vaginal Delivery Randy Ian F. Gallego RN, MN
1 00-35-50 Spontaneously to an alive baby girl Cephalic
Hospital PRC. # 0590564
Weight 2.6 Kilograms G5 P5 Apgar score 8-10
Pregnancy Uterine Full Term Delivery Lanao Norte
Normal Spontaneous Randy Ian F. Gallego RN, MN
2 00-40-55 Spontaneously to an alive baby boy Cephalic Lantaca, Jeanny 31 y/o 11-18-10 12:16 pm Male Provincial
Vaginal Delivery with PRC. # 0590564
Weight 3.0 Kilograms G5 P4 Apgar score 8-10 Hospital
Laceration

Pregnancy Uterine Full Term Delivery Lanao Norte Normal Spontaneous

3 00-40-58 Aballe, Jealyn 20 y/o 11-18-10 11:11 am Male Provincial Vaginal Delivery with Randy Ian F. Gallego RN, MN
Spontaneously to an alive baby boy Cephalic
Hospital Episiotomy PRC. # 0590564
Weight 3.2 Kilograms G1 P1 Apgar score 8-10

Pregnancy Uterine Full Term Delivery Lanao Norte Normal Spontaneous

Randy Ian F. Gallego RN, MN
4 00-40-71 Spontaneously to an alive baby boy Cephalic Montebron, Zamera 26 y/o 11-22-10 2:22 am Male Provincial Vaginal Delivery with
PRC. # 0590564
Weight 2.3 Kilograms G1 P1 Apgar score 8-10 Hospital Episiotomy

Pregnancy Uterine Full Term Delivery Lanao Norte Normal Spontaneous Randy Ian F. Gallego RN, MN
5 00-42-39 Spontaneously to an alive baby Girl Cephalic Eneales, Analyn Nerf 20 y/o 12-26-10 2:20 pm Female Provincial Vaginal Delivery with PRC. # 0590564
Weight 3.2 Kilograms G2 P2 Apgar score 8-10 Hospital Episiotomy
Prepared by: Supervised by: Noted by: Concurred by: Approved by:

ALIBASHER D. MACALNAS MR. RANDY IAN F. GALLEGO, RN, MN MRS. RACHELLE U. VALENCIA, RN, MN TRANSFIGURACION C. LEE, RN, MN CHONA G. LIMBARING.RN, MAN (CAR) MN
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Student Clinical instructor Clinical Coordinator Chief Nurse Dean

Date Signed : Date Signed : Date Signed : ________________ Date Signed : __ Date Signed : _________
a. PRC No. : 0590564 a. PRC No. : 0257368 _ a. PRC No. : 0059574 ____ a. PRC No : _0216682________
Valid Until : 08-24-2011 Valid Until : _06-16-2010_____ Valid Until : 08-06-2011__ Valid Until : 08-18-2012______
b. PNA No. : 019948 b. PNA No. : 09973 b. PNA No. : 13935 ______ b. PNA No. : _034____________
Valid Until : 10-31-2011 Valid Until : Lifetime Valid Until : _Lifetime_____ Valid Until : 12-2010________
c. ANSAP No. : _021________ c. ADPCN No. : _0656___________
Valid Until : _Lifetime_____ Valid Until : _12-2010________
Name of Student: ALIBASHER D. MACALNAS _________________________ ________
Name and Address of School: JAMIATU MARAWI AL-ISLAMIA FOUNDATION, MONCADO KADINGILAN, MARAWI CITY_____ School Code: __12021____________
Accreditation Level, if any: N/A ____________ Year Granted: N/A ________
Date School/Program was Recognize: JUNE Number: 0045______ Year: 1996 ________
First course (if any): N/A School Graduated from: N/A __ _______ Year: _________N/A________
Year of Admission in the Bachelor of Science in Nursing Program: 2007 ________________
Year Graduated (BSN Program): 2011 ________________

V. Cord Dressing
Supervised by:
No. Case Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Name and signature of
No. Of mother qualified C.I
Lanao Norte Provincial Randy Ian F. Gallego RN, MN
1 02-05-54 11-18-10 Baby Girl Rebucas Female Rebucas, Rosie 24 y/o
Hospital PRC. # 0590564

Lanao Norte Provincial Randy Ian F. Gallego RN, MN

2 02-05-63 11-20-10 Baby Boy Gallo Male Gallo, Mercy 24 y/o Hospital PRC. # 0590564

Lanao Norte Provincial Randy Ian F. Gallego RN, MN

3 02-06-37 11-23-10 Baby Boy Bongcales Male Bongcales, Ivy. 20 y/o Hospital PRC. # 0590564

Lanao Norte Provincial Randy Ian F. Gallego RN, MN

4 02-17-55 01-01-11 Baby Boy Pansoy Male Pansoy, Jovielyn 29 y/o Hospital PRC. # 0590564

Baby Girl Baes Lanao Norte Provincial Randy Ian F. Gallego RN, MN
5 02-17-97 01-02-11 Female Baes, Josephine 19 y/o Hospital PRC. # 0590564
Prepared by: Supervised by: Noted by: Concurred by: Approved by:

ALIBASHER D. MACALNAS MR. RANDY IAN F. GALLEGO, RN, MN MRS. RACHELLE U. VALENCIA, RN, MN TRANSFIGURACION C. LEE, RN, MN CHONA G. LIMBARING.RN, MAN (CAR) MN
Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name Signature over Printed Name
Student Clinical instructor Clinical Coordinator Chief Nurse Dean

Date Signed : Date Signed : Date Signed : ________________ Date Signed : __ Date Signed : _________
a. PRC No. : 0590564 a. PRC No. : 0257368 _ a. PRC No. : 0059574 ____ a. PRC No : _0216682________
Valid Until : 08-24-2011 Valid Until : _06-16-2010_____ Valid Until : 08-06-2011__ Valid Until : 08-18-2012______
b. PNA No. : 019948 b. PNA No. : 09973 b. PNA No. : 13935 ______ b. PNA No. : _034____________
Valid Until : 10-31-2011 Valid Until : Lifetime Valid Until : _Lifetime_____ Valid Until : 12-2010________
c. ANSAP No. : _021________ c. ADPCN No. : _0656___________
Valid Until : _Lifetime_____ Valid Until : _12-2010________