Documenti di Didattica
Documenti di Professioni
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Prepared by:
Noted by: Concurred by: Concurred by: Approved by:
CAPLIS, ERWIN REFUERZO__
Mr s. MA RIS OL G AR CIA -MAN IP OL , AMOR CALAYAN, RN,RM,MAN,PH.D.__ MINERVA N. ESPINO, RN, ____ __ NELIA R. CAPULONG,_RN,RM,MAN____
Signature over printed Name of Student
RN, MAN Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean
Supervised by:
,
Signature over printed name of Clinical Date Signed: ______________________ Date Signed: _______________________ Date Signed: ______________________
MARCELLUS C. BELISARIO, RN,MAN Coordinator
Signature over printed name of Faculty Degree:_BSN,RM,MAN,RN, PhD_______ Degree:_RN,BSN___________________ Degree:_BSN,RN, RM, MAN_________
Date Signed: ____________________ Date Signed: ______________________ a.) PRC NO: _151514 ______
Degree:__BSN, MAN________________ Valid Until: August 2010__________
a.) PRC NO: 0090530_________________ a.) PRC NO: 0041904______________
Degree: RN,MAN________ _ Valid Until: October 10, 2009_________
b.) PNA NO: _038801____ _________ Valid Until: July 31, 2012______ __
PRC No: 0349993___________ ___ a.) PRC NO: _0296870_____________ b.) ANSAP NO: ______________________
Valid Until: December 2009_______ b.) PNA NO: 18698__________________
Valid Until: September 12, 2012__ Valid Until: September 2012______ Valid Until: _______________________ Valid Until: Lifetime______________
PNA No: 19636 ______________ b.) PNA NO: __025883 _____________ c.) PNA NO: _19638 ________________
Valid Until:_Liifetime ____ b.) ADPCN NO:_0627______________
Valid Until:_December 2009 ______ Valid Until: Lifetime _______
Valid Until: December 2009_______
OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFEURZO __________________________________________________________________________________-__________________
Name and Address of School: OUR LADY OF FATIMA UNIVERSITY #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY___________________
Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________
Date School/Program was Recognized: April 25, 2001________________Number: 033 Year: 2001_____________________________________________
First Course (if any) :_NOT APPLICABLE____ ___________________ School Graduated From: NOT APPLICABLE____Year: NOT APPLICABLE_______________________
Year of Admission in the Bachelor of Science in Nursing Program: 2003___________________________________________________________________________________
Year Graduated (BSN Program): 2009______________________________________________________________________________________________________________
I. Major Operations
Date of Operation Type of Name of Signature of
No. Case No. Name of Patient Diagnosis Name of Hospital Name of Qualified CI
Operation Performed Anesthesia Surgeon Qualified CI
Marcellus C. Belisario
Pregnancy Uterine 37 Dra. Ma. Bulacan Maternity
Caesarian Spinal RN,MAN
1. December 132732 Basillo Ruth weeks gestation Cephalic Grace Agnes and Childrens
Section Anesthesia PRC No: 0349993
13, 2007 in Labor Para6 Bautista Hospital
PNA No: 19636
Marcellus C. Belisario
Pregnancy Uterine Full Bulacan Maternity
December Ma. Thersa Caesarian Spinal Dra. Pricilla RN,MAN
2. 088171 Term, cephalic in Labor and Childrens
19, 2007 Castro Section Anesthesia Quiambao PRC No: 0349993
Gravida3 Para1 Hospital
PNA No: 19636
Jonel Ramirez RN,MAN
August 27, Ruptured Appendix Exploratory Subarachnoid Dr. Aristotle Batangas Regional
3. 381315 Rodel Dayte PRC No;450849
2008 Laparotomy Anesthesia Arellano Hospital
PNA No: 2256
Combined
Jonel Ramirez RN,MAN
August 29, Spinal and Dr. Jose Batangas Regional
4. 373456 Jose Benemer Cholelithiasis Cholecystectomy PRC No: 450849
2008 Epedural Tenorio Hospital
PNA No: 2256
Anesthesia
Jonel Ramirez RN,MAN
August 29, Exploratory Laparotomy Closure of Subarachnoid Dr. Aristotle Batangas Regional
5. 364339 Edgardo Paner PRC No: 450848
2008 colostomy colostomy Anesthesia Arellano Hospital
PNA NO: 2256
Approved by:
Prepared by: Noted by: Concurred by: Concurred by: NELIA R. CAPULONG, RN,RM,MAN__
CAPLIS, ERWIN REFUERZO___ MRS. MARISOL GARCIA-MANIPOL, _MINERVA ESPINO, RN ____ AMOR CALAYAN RN,RM,MAN,PH.D. Signature over printed name of Dean
Signature over printed Name of Student RN,MAN Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse
Supervised by: Signature over printed name of Clinical Date Signed: ______________________
JONEL RAMIREZ, RN,MAN ______ Date Signed: ______________________ Date Signed: _______________________ Degree:_BSN RN,RM, MANMAN______
Coordinator Degree:_BSN,RN___________________ Degree:_BSN, RN_RM,MAN, PH.D._____
Signature over printed name of Faculty Date Signed: ______________________ c.) PRC NO: 0041904______________
Date Signed: ____________________ a.) PRC NO:_0090530________________ a.) PRC NO: _151514 _____________
Degree:__BSN, MAN________________ Valid Until: October 10, 2009________ Valid Until: _August 2010____________ Valid Until: July 31, 2012 _______
Degree: RN,MAN________________
PRC No: 450849_________________ b.) PRC NO: _0296870_____________ b.) ANSAP NO: _____________________ b.) PNA NO: _038801 ______________ b.) PNA NO: 18698__________________
Valid Until: September 2012______ Valid Until: ______________________ Valid Until: _December 2009_______ Valid Until: Lifetime______________
Valid Until: September 2010_____
b.) PNA NO: __025883______________ c.) PNA NO: 19638 _______________ c.) ADPCN NO:_0627________________
PNA No: 2256 _____________ Valid Until:_December 2009______ Valid Until: _Lifetime _______ Valid Until: December 2009_________
Valid Until: December 2009
OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CALIS ERWIN REFUERZO _______________________________________________________________________________ __________________
Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY____________________
Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002___________________________________________________________
Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________
First Course (if any) :NOT APPLICABLE_________________ School Graduated From: NOT APPLICABLE__Year:__NOT APPLICABLE________________________________
Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________
Year Graduated (BSN Program): _2009_____________________________________________________________________________________________________________
Prepared by:
CAPLIS, ERWIN REFUERZO___ Noted by: Concurred by: JO SE PH INE B . LE ON ARD O_ Concurred by: Approved by:
Mrs. MAR ISO L GAR CI A- M AN IPO L, RN, MAN RN, MAN, Ph. D . ESTELITA B. LORENZO RN,RM,MAN NELIA R. CAPULONG RN,RM,MAN
Supervised by: Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean
Signature over printed name of Clinical Coordinator
ROSANIEover
Signature C. MORO
printed,_RN,
NamePH.D._____
of Student Date Signed: ______________________ Date Signed: __________________
Date Signed: ___________________ Date Signed: ____________________ Degree:_RN, RM, MAN___________
Signature over printed name of Faculty
_______________________________
Degree:_BSN, RN, MAN__________ Degree:__BSN.,RN,MAN,PH.D_______ Degree:_RN, RM, MAN______________
Date Signed: ____________________
Degree: BSN, RN,PH.D ______ a.) PRC NO: __0081174____________ a.) PRC NO: _0111348_______________
e.) PRC NO: 0041904__________
d.) PRC NO: _0296870__________ Valid Until: _April 3, 2011________ Valid Until: July 31, 2012_____
PRC No: 66491 _________ Valid Until: September 2012__
Valid Until: _September 3, 2011_____
b.) PNA NO: 18698______________
b.) PNA NO: _1078 __________
Valid Until; November 8, 2009 b.) PNA NO: __025883___________ b.) PNA NO: __15614______________
Valid Until: ___December 2009 ___ Valid Until: Lifetime_________
Valid Until:__December 2009__ Valid Until: _Lifetime___________
PNA No: 25665 ___________ c.) ADPCN NO:_0627__ ________
Valid Until: December 2009___
Valid Until: December 2009____
OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: CAPLIS, ERWIN REFUERZO_________________________________________________________________________________________
Name and Address of School: OUR LADY OF FATIMA UNEVRSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY_____________________
Accreditation Level (if any): PACUCOA LEVEL II_____________________Year Granted: April 10, 2002____________________________________________________________
Date School/Program was Recognized: April 25, 2001________________Number: 033________________________Year: 2001_______________________________________
First Course (if any) :_NOT APPLICABLE____ ____________________ School Graduated From: _NOT APPLICABLE_____Year: NOT APPLICABLE____________________
Year of Admission in the Bachelor of Science in Nursing Program: _2003__________________________________________________________________________________
Year Graduated (BSN Program): __2009___________________________________________________________________________________________________________-
V. Cord Dressing
Date Gender of Supervised by: Signature of Qualified
No. Case No. Name of Baby Name of Mother Age Name of Hospital
Performed Baby C.I.
Rosanie C. Moro RN,PhD
1. 142608 July 24, 2007 Baby Girl Ritchelle Female Rirchelle Gelbolingo 28 Novaliches District Hospital PRC No: 66491
PNA NO: 25665
Rosanie C. Moro RN,PhD
2. 161279 June 2, 2008 Baby Boy Mauricio Male Mauricio Leanie 22 Novaliches District Hospital PRC No: 66491
PNA No: 25665
Norberta C. Alcarion RN,RM,MAN
January 5, Ospital ng Lungsod ng San Jose Del
3. 398815 Baby Girl Joli Female Joli Gabalda San Juan 23 Monte Bulacan
PRC No: 170101
2009 PNA No: 1077
Norberta C. Alcarion RN,RM,MAN
January 5, Ospital ng Lungsod ng San Jose Del
4. 358616 Baby Boy Coredes Male Teresita Coredes 25 PRC No: 170101
2009 Monte Bulacan
PNA No: 1077
Norberta C. Alcarion RN,RM,MAN
January 5, Ospital ng Lungsod ng San Jose Del
5. 398603 Baby Boy Mangao Male Mery Joy Mangao 21 Monte Bulacan
PRC No: 170101
2009 PNA No: 1077Approved by:
NELIA R. CAPULONG RN,RM.MAN
Prepared by: Noted by: Concurred by: Concurred by: Signature over printed name of Dean
CAPLIS, ERWIN REFUERZO___ Mrs. MARISOL GARCIA- MANIPOL, ESTELITA B. LORENZO_RN,RM,MAN__ JOSEPHINE B. LEONARDO RN,MN,PH.D. Date Signed: __________________
Supervised by: RN,MAN Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse
Degree:_BSN,RN, RM, MAN______
NORBERTA C. ALCARION, RN,M,MAN Signature over printed name of Clinical Date Signed: ____________________ Date Signed: ________________________
Signature over printed name of Faculty Coordinator f.) PRC NO: 0041904__________
Degree:_BSN,RM, RN, MAN _______ Degree: RN,MAN,PH.D_______________
Date Signed: ____________________ Valid Until: July 31, 2012____
Date Signed: ___________________ a.) PRC NO: __0081174______________
Degree: BSN,RM,RN,MAN__________ a.) PRC NO: ___0111348__________ b.) PNA NO: 18698______________
Degree:_BSN,RN , MAN___________ Valid Until: _April 3, 2011 ______
PRC No: 170101___________ Valid Until: _September 3, 2011__ Valid Until: Lifetime__________
e.) PRC NO: _0296870___________ b.) PNA NO: ___15614 _____________
.) ADPCN NO:_0627_____________
Valid Until; June 6, 2012_____ Valid Until: September 2012___ b.) PNA NO: __1078_____________ Valid Until:___Lifetime ___________
Valid Until: December 2009____
PNA No: 1077_____________ b.) PNA NO: 025883 ____________ Valid Until: __December 2009_____
Valid Until:_December 2009_____
Valid Until: December 2009