ST.

MARY”S COLLEGE
Tagum City

Name of Student: Neil Ian E. Barco

Name & Address of School: St. Mary’s College , National Highway Tagum City
Accreditation Level (if any): Year Granted
Date School/Program was Recognized: Number Year
First Course (if any): School Graduated From Year
Year of Admission in the Bachelor of Science in Nursing Program:
Year Graduated (BSN Program):

IV. Deliveries Assisted

No. Case No. Diagnosis Name of Patient Age Date of Delivery Time of Gender Name of Type of Supervised
Delivery of Baby Hospital Delivery by: Name &
Signature of
Qualified C.I.
1. 250572 PU 29 6/7 wks. AOG cephalic Michelle P. Garalde 24 July 25, 2008 7:09pm Boy Davao NSVD
delivered spontaneous to a live Regional
Baby Boy AS 6,8 BW 3195 BL Hospital
51 CMS G1P1 (1001)
2 259195 PU 36-37 wks. AOG Cephalic Joylyn M. Sulapas 19 October 9, 2008 7:12 pm Boy Davao NSVD
delivered spontaneous to alive Regional
BB boy AS 8,9 BW 1852 BL Hospital
41 CMS G1P1 (1001) Mild Pre
clampsia
 ST. MARY”S COLLEGE
Tagum City

Name of Student: Neil Ian E. Barco

Name & Address of School: St. Mary’s College , National Highway Tagum City
Accreditation Level (if any): Year Granted
Date School/Program was Recognized: Number Year
First Course (if any): School Graduated From Year
Year of Admission in the Bachelor of Science in Nursing Program:
Year Graduated (BSN Program):
V. Cord Dressing

No. Case Date Performed Name of Baby Gender of Name of Mother Age Name of Hospital Supervised by: Name & Signature
No. Baby of Qualified C.I.

1 250485 July 24, 2008 Isaac Camamara Male Janeza Camamara Davao Regional
Hospital
2 250504 July 24, 2008 Male Ligaya Jamero Davao
Regional Hospital
 ST. MARY”S COLLEGE
Tagum City

Name of Student: Neil Ian E. Barco

Name & Address of School: St. Mary’s College , National Highway Tagum City
Accreditation Level (if any): Year Granted
Date School/Program was Recognized: Number Year
First Course (if any): School Graduated From Year
Year of Admission in the Bachelor of Science in Nursing Program:
Year Graduated (BSN Program):

IV. Deliveries Assisted

No. Case No. Diagnosis Name of Patient Age Date of Delivery Time of Gender Name of Type of Supervised
Delivery of Baby Hospital Delivery by: Name &
Signature of
Qualified C.I.
1. 250653 Pagay Julieta 33 July 26, 2008 7:40 pm Male Davao NSVD
Regional
Hospital
Prepared by:

Signature over printed name of Student

Noted by: Concurred by: Approved by:

Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:

a.) PRC NO: a.) PRC No. a.) PRC No.:

Valid Until: Valid Until: Valid Until:

b.) PNA No: b.) PNA No: b.) PNA No.:

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c.) ANSAP No: c.) ADPCN No.:

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Prepared by:

Signature over printed name of Student

Noted by: Concurred by: Approved by:

Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:

a.) PRC NO: a.) PRC No. a.) PRC No.:

Valid Until: Valid Until: Valid Until:

b.) PNA No: b.) PNA No: b.) PNA No.:

Valid Until: Valid Until: Valid Until:

c.) ANSAP No: c.) ADPCN No.:

Valid Until: Valid Until:
Prepared by:

Signature over printed name of Student

Noted by: Concurred by: Approved by:

Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:

a.) PRC NO: a.) PRC No. a.) PRC No.:

Valid Until: Valid Until: Valid Until:

b.) PNA No: b.) PNA No: b.) PNA No.:

Valid Until: Valid Until: Valid Until:

c.) ANSAP No: c.) ADPCN No.:

Valid Until: Valid Until: