PRC Form PJ

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: Fredrick M. Paderanga
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 2____________________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: 2008
Year Graduated (BSN Program): October 2011
I. Major Operations
Date of Case Type of Name of Name of Supervised by Signature of
No. Name of Patient Diagnosis Operation Performed
Operation No. Anesthesia Surgeon Hospital Qualified CI Qualified CI
Fatima
Phacoenulsification with Secinia I.
Dec. 8 090000 Pre Senile Cataract, Local Dr. R. University
1. Bautista, Editha Posterior Chamber intra Tallio
2009 127858 Left Eye Anesthesia Nepomuceno Medical
Occular Lens RM, RN, MAN
Center
Gregorio
Total Abdominal Ingrid R.
March 3, General Dr. Irene Del Pillar
2. 054025 Raymundo, Criselda Uterine Myoma Hysterectomy Bilateral Competente
2010 Anesthesia Tampolada District
Salphingo Oophorectomy RN, MAN
Hospital
Gregorio
Ingrid R.
March 27, General Dr. Angelito Del Pillar
3. 082952 Mangalindan, Gloria Parotid Tumor Thyroidectomy Competente
2010 Anesthesia Trinidad District
RN, MAN
Hospital
Gregorio
Ingrid R.
July 27, General Dr. Angelito Del Pillar
4. 379784 Marcelo, Raquel Cholelithiasis Cholecystectomy Competente
2010 Anesthesia Trinidad District
RN, MAN
Hospital
Gregorio
Ingrid R.
Nov, 23 Basaysay, Mary General Dr. Angelito Del Pillar
5. 384398 Cholelithiasis Cholecystectomy Competente
2010 Anne Anesthesia Trinidad District
RN, MAN
Hospital
Prepared by: Noted by: Concurred by: Approved by:
Fredrick M. Paderanga
Signature over printed Name of Student _____________________ _________________________ Nelia R. Capulong, RN, MAN
Signature over printed name of Clinical Signature over printed name of Signature over printed name of Dean
Supervised by: Coordinator Chief Nurse Date Signed: ____________
_______________ Date Signed: __________ Date Signed: ___________ Degree:________________
Signature over printed name of Faculty Degree:_______________ Degree:_______________ a.) PRC NO: ___________
Date Signed: ____________ b.) PRC NO: __________ a.) PRC NO: __________ Valid Until: __________
Degree: ________________ Valid Until: ________ Valid Until: ____________ b.) PNA NO: ____________
a.) PRC NO: __________ b.) PNA NO: ___________ b.) PNA NO: ___________ Valid Until: __________
Valid Until: ________ Valid Until:_________ Valid Until: _________ c.) ADPCN NO:_________
b.) PNA NO: ___________ Valid Until: __________
Valid Until:_________

II. Minor Operations

No. Date of Case No. Name of Diagnosis Operation Type of Name of Surgeon Name of Hospital Supervised by Signature of
Operation Patient Performed Anesthesia Qualified CI Qualified CI
Gastrascopy, Secinia I.
Dec 8, 0900001 Local Fatima University
1. Tadina, Rodolfo Mild Antral Gastritis Colonoscopy Dr. Roberto Lopez Tallio
2009 27596 Anesthesia Medical Center
with Biopsy RM, RN, MAN
Multiple Physical Injuries
Dec. 18, San Miguel, Dr. Crisante De Fatima University Elirey Alabado
2. 4305 secondary to Motor
2009 Fortunato Guzman Medical Center Dadula RN
Vehicle Accident
Philippine Thelma C.
May 11, Latumbo, Local
3. 066856 Redundant Prepuce Circumsision Dr. Fuentes National Police Adzuara
2010 Cedrick Anesthesia
General Hospital RN
Gregorio Del Diosa G.
Nov 3, Recurrent Tendon Cyst Local
4. 107444 Alejo, Ricardo Excision Dr. Angelito Trinidad Pillar District Ocampo
2010 Ulnar, Left Anesthesia
Hospital RN, MAN
Gregorio Del Ingrid R.
Nov. 23,
5. 107225 Valisno, Nenita Mass Left Breast Excision Biopsy I.V. Sedation Dr. Angelito Trinidad Pillar District Competente
2010
Hospital RN, MAN
Prepared by: Valid Until:_________
Noted by: Concurred by: Approved by:
Fredrick M. Paderanga
Signature over printed Name of Student _____________________ _________________________ Nelia R. Capulong, RN, MAN
Supervised by: Signature over printed name of Clinical Signature over printed name of Signature over printed name of Dean
Coordinator Chief Nurse Date Signed: ____________
_______________ Date Signed: __________ Date Signed: ___________ Degree:________________
Signature over printed name of Faculty Degree:_______________ Degree:_______________ b.) PRC NO: ___________
Date Signed: ____________ d.) PRC NO: __________ b.) PRC NO: __________ Valid Until: __________
Degree: ________________ Valid Until: ________ Valid Until: ____________ b.) PNA NO: ____________
c.) PRC NO: __________ b.) PNA NO: ___________ b.) PNA NO: ___________ Valid Until: __________
Valid Until: ________ Valid Until:_________ Valid Until: _________ c.) ADPCN NO:_________
b.) PNA NO: ___________ Valid Until: ___________

III. Actual Deliveries

Supervised by:
Case Name of Date of Time of Gender Name of
No. Diagnosis Age Type of Delivery Signature of Qualified
No. Mother Delivery Delivery of Baby Hospital
C.I.
Philippine
Peña, Ana Aug. 15, National Victoria Rizalina K.
1. 039864 G9, P8, PU 36 weeks AOG 37 5:00pm Girl NSD
Marie 2009 Police General Concepcion RN
Hospital
Gregorio Del
Tacorda, Feb. 5 Ingrid R. Competente
2. 374930 G3, P2, PU, 38 weeks AOG 24 6:40am Girl Pillar District NSD
Rowena 2010 RN, MAN
Hospital
Gregorio Del
Caronigo, Mar. 3, Ingrid R. Competente
3. 375744 G1, P0, PU 38 weeks AOG 20 1:46pm Girl Pillar District NSD
Jonah 2010 RN, MAN
Hospital
Gregorio Del
Apr. 13, Ingrid R. Competente
4. 376989 G3, P2, PU, 39-40 weeks AOG Orave, Evelyn 36 9:05am Boy Pillar District NSD
2010 RN, MAN
Hospital
United
G1,P1, PU 39 weeks AOG Beltran, Sheila Oct. 17, Balagtas
5. 00-624 19 11:34pm Boy NSD Wilowena Angeles RN
LBB Marie T. 2010 Doctor’s
Hospital Corp.
Fredrick M. Paderanga Noted by: Concurred by: Approved by:
Signature over printed Name of Student
_____________________ _________________________ Nelia R. Capulong, RN, MAN
_______________ Coordinator Chief Nurse Date Signed: ____________
Signature over printed name of Faculty Date Signed: __________ Date Signed: ___________ Degree:________________
Date Signed: ____________ Degree:_______________ Degree:_______________ c.) PRC NO: ___________
Degree: ________________ f.) PRC NO: __________ c.) PRC NO: __________ Valid Until: __________
e.) PRC NO: __________ Valid Until: ________ Valid Until: ____________ b.) PNA NO: ____________
Valid Until: ________ b.) PNA NO: ___________ b.) PNA NO: ___________ Valid Until: __________
b.) PNA NO: ___________ Valid Until:_________ Valid Until: _________ c.) ADPCN NO:_________
Valid Until: ___________

IV. Deliveries Assisted

Supervised by:
Name of Date of Time of Gender of
No. Case No. Diagnosis Age Name of Hospital Type of Delivery Signature of
Mother Delivery Delivery Baby
Qualified C.I.
Philippine National Victoria
Angles, Aug. 14,
1. 060522 G2, P1, PU 37 weeks AOG 31 2:00pm Boy Police General NSD Rizalina K.
Celeste 2009
Hospital Concepcion RN
Ingrid R.
Salazar, Feb. 15, Gregorio Del Pillar
2. 375213 G3, P2, PU 38 weeks AOG 28 11:59am Girl NSD Competente
Rose Marie 2010 District Hospital
RN, MAN
Ingrid R.
Dimas, Mar. 8 Gregorio Del Pillar
3. 368417 G3, P2, PU 38 weeks AOG 23 1:22pm Boy NSD Competente
Jocelyn 2010 District Hospital
RN, MAN
Ingrid R.
2008 Bundeclaro, Mar. 8 Gregorio Del Pillar
4. G3, P2, PU 38 weeks AOG 27 4:48pm Boy NSD Competente
9472 Junila 2010 District Hospital
RN, MAN
United Balagtas
G3, P3, PU 39-40 weeks Ruiz Oct. 27, Wilowena
5. 00627 32 2:28pm Boy Doctor’s Hospital NSD
AOG Veronica 2010 Angeles RN
Corp.
Prepared by:
Date Signed: ____________ Degree:_______________ Degree:_______________ d.) PRC NO: ___________
Degree: ________________ h.) PRC NO: __________ d.) PRC NO: __________ Valid Until: __________
g.) PRC NO: __________ Valid Until: ________ Valid Until: ____________ b.) PNA NO: ____________
Valid Until:_________ Valid Until: _________

First Course (if any) NOT APPLICABLE School Graduated From: NOT APPLICABLE Year: NOT APPLICABLE____
V. Cord Dressing
Date Gender of Supervised by: Signature of
No. Case No. Name of Baby Name of Mother Age Name of Hospital
Performed Baby Qualified C.I.
Aug. 13, Philippine National Police Victoria Rizalina K.

1. 026447 Baby Boy Chuidian Boy Chuidian, Bernieda 33
2009 General Hospital Concepcion RN
Mar. 3, Gregorio Del Pillar District Ingrid R. Competente RN,

2. 304891 Baby Boy Ronquillo Boy Ronquillo, Rosabelle 23
2010 Hospital MAN
Gregorio Del Pillar District Ingrid R. Competente RN,

3. 376484 Mar. 26, 2010 Baby Girl Melasco Girl Melasco, Maica 15
Hospital MAN
Gregorio Del Pillar District Ingrid R. Competente RN,

4. 376500 Mar. 27, 2010 Baby Girl Santos Girl Santos, Marilyn 17
Hospital MAN
Oct. 30, United Balagtas Doctor’s

5. 00629 Baby Boy Gongob Boy Gonob Jasmine 31 Wilowena Angeles RN
2010 Hospital Corp.

Date Signed: ____________ Degree:_______________ Degree:_______________ e.) PRC NO: ___________
Degree: ________________ j.) PRC NO: __________ e.) PRC NO: __________ Valid Until: __________
i.) PRC NO: __________ Valid Until: ________ Valid Until: ____________ b.) PNA NO: ____________
Valid Until: ___________

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OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: Fredrick M. Paderanga

II. Minor Operations

Name of Student: Fredrick M. Paderanga

III. Actual Deliveries

Name of Student: Fredrick M. Paderanga

IV. Deliveries Assisted

Name of Student: Fredrick M. Paderanga

Aug. 13, Philippine National Police Victoria Rizalina K.

Mar. 3, Gregorio Del Pillar District Ingrid R. Competente RN,

Gregorio Del Pillar District Ingrid R. Competente RN,

Gregorio Del Pillar District Ingrid R. Competente RN,

Oct. 30, United Balagtas Doctor’s

Prepared by: Valid Until:_________

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