Mindanao Sanitarium & Hospital College

Barangay San Miguel, Iligan City 9200

Name of the Student: Krisleen S. Caulawon ________ _

Name & Address of School: Mindanao Sanitarium and Hospital College, Barangay San Miguel, Iligan City School code: 1362_____________________________________________
Accreditation Level: Level 1 Year Granted: February 28, 2008 _______ _
Date School Program was Recognized: October 17, 2002 Number: 0043 Year: 2002 _
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: 2006 _
Year Graduated from the BSN Program: 2010 _

I. MAJOR OPERATIONS

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

Mindanao
Right Ovarian
1 April 29, 2009 170350 Sittie Assia P. Mamailao Bilateral Ovarian Cyst Spinal-Epidural Dr. Salamah Pandapatan Sanitarium and Jandy Lou M. Tagolgol, RN
Cystectomy
Hospital

Gregorio T. Lluch
Removal of Implant Left Removal of Implant Left General Anesthesia Dr. Ronnie Repollo Sarah Dane Quidlat, RN
2 September 3, 2009 049987 Liezl Fernandez Memorial Hospital
Radius Radius

Pregnancy Uterine Full

Term in Labor Previous Cesarean Section Dr. Esther Aida O. Belarmino Lanao del Norte Vilma M. Alivia, RN
007350 Floramay D. Acampado
3 September 27, 2009 Cesarean Section for Spinal-Epidural Provincial Hospital
Cephalopelvic
Disproportion

Tuberculosis arthritis Left Redebridement

Mindanao
November 2, 2009 Carlos Capilis Knee Status Post Arthrotomy Arthrodesis Spinal-Epidural Dr. Selwyn P. Embay Emmanuel C. Hechanova, RN
4 176435 Sanitarium and
Arthrotomy and (External Fixatator) +
Hospital
Debridement Bone Grafting Left Knee

Total Abdominal
Mindanao
January 21, 2010 178953 Norhaya Monte Abruptio Placenta Hysterectomy Right General Anesthesia Janrich Allen A. Sarmiento, RN
5 Dr. Teresita Amatonding Sanitarium and
Salpingo Oophorectomy Intubation
Hospital

Prepared by: Supervised by: Noted by: Concurred by: Approved by:

Krisleen S. Caulawon
Signature Over Printed Name
Student
Date Signed: __________
EVALYN M. LECCIONES, MN, RN PRIMITIVO G. SANTIAS, MN, RN_ NOEMI T. MORENTE, MAN, RN TRANSFIGURACION C. LEE, MN, RN MYRNA P. SUAN, MN, RN G’TER G. GAID, MAN, RN
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Clinical Instructor Clinical Coordinator Chief Nurse (MSH) Chief Nurse (LNPH) Chief Nurse (GTLMH) Dean
Date Signed: ______________ Date Signed: ______________ Date Signed: ______________ Date Signed: ______________ Date Signed: ___________ Date Signed: ____________
a.) PRC No.: 0245303 a.) PRC No.: 0284464 a.) PRC No: 0161458 a.) PRC No: 0059974 a.) PRC No: 78434 a.) PRC No.: 0302269
Valid Until: May 9, 2012 Valid Until: November 12, 2011 Valid Until: October 1, 2011 Valid Until: August 6, 2011_ Valid Until: April 8, 2012 Valid Until: September 13, 2012
b.) PNA No.: 024303_ b.) PNA No.: 15666 b.) PNA No: 15898_ b.) PNA No: 13935_ b.) PNA No: 4249_ b.)
PNA No: 16832__
Valid Until: October 31, 2010 Valid Until: Lifetime_ Valid Until: Lifetime_ Valid Until: Lifetime_ Valid Until: Lifetime_ Valid Until: Lifetime_
c.) ANSAP No: 05068_ c.) ANSAP No: 21_ c.) ANSAP No: __025_____ c.) ADPCN No.: 0768_
Valid Until: January 11, 2011 Valid Until: Lifetime_ Valid Until: _2011_____ Valid Until: 2011_
 Mindanao Sanitarium & Hospital College
Barangay San Miguel, Iligan City 9200

Name of the Student: Krisleen S. Caulawon _____

Name & Address of School: Mindanao Sanitarium and Hospital College, Barangay San Miguel, Iligan City School code: 1362________________________________________
Accreditation Level: Level 1 Year Granted: February 28, 2008 ______________
Date School Program was Recognized: October 17, 2002 Number: 0043 Year: 2002
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: 2006
Year Graduated from the BSN Program: 2010

II. MINOR OPERATIONS

Type of Signature of O.R.

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

To Considered
Guillian-Barre Mindanao
1 April 29, 2009 169485 Elma Tana Navarro Syndrome Related Tracheostomy Local Dr. Abner J. Dela Cruz Sanitarium and Guilly Glenn N. Sala, RN
to Tuberculosis Hospital
Meningitis

2 June 12, 2009
Lacerated Wound
Right Wrist with Wound Exploration Mindanao
170517 Jerome Lodriguito Multiple Tendons Control OF Bleeding and General Intubation Dr. Mario B. Genio Sanitarium and Jandy Lou M. Tagolgol, RN
and Massive Tendon Repair Hospital
Bleeding

Internal and
External Mindanao
July 13, 2009 165721 Hadji Yusoph Saripada Hemorrhoidecomy Spinal-Epidural Dr. Allan B. Achacoso Mirmalyn Rose D. Revelo, RN
3 Hemorrhoids Sanitarium and
Prolapse Hospital

Dr. Jasmine Punginaguina Mindanao

114689 Gilbert D. Rocamora Lacerated Wound Suturing Local Ernesto O. Tomenio, RN
4 September 24, 2009 Sanitarium and
Hospital

Lacerated Right Mindanao

5 January 1, 2010 404658 Harold C. Villanueva Eyebrow Suturing Local Dr. Abner J. Dela Cruz Sanitarium and Ernesto O. Tomenio, RN
Hospital

Prepared by: Supervised by: Noted by: Concurred by: Approved by:

Krisleen S. Caulawon
Signature Over Printed Name
Student
Date Signed: _____________
EVALYN M. LECCIONES, MN, RN PRIMITIVO G. SANTIAS, MN, RN NOEMI T. MORENTE, MAN, RN G’TER G. GAID, MAN, RN
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Clinical Instructor Clinical Coordinator Chief Nurse (MSH) Dean
Date Signed: ______________ Date Signed: ______________ Date Signed: ______________ Date Signed: ______________
a.) PRC No.: 0245303 a.) PRC No.: 0284464 a.) PRC No: 0161458 a.) PRC No.: 0302269
Valid Until: May 9, 2012_ Valid Until: November 12, 2011_ Valid Until: October 1, 2011_ Valid Until: September 13, 2012_
b.) PNA No.: 024303 b.) PNA No.: 15666 b.) PNA No: 15898 __ b.) PNA No: 16832
Valid Until: October 31, 2010 Valid Until: Lifetime Valid Until: Lifetime_ Valid Until: Lifetime
c.) ANSAP No: 05068_ c.) ADPCN No.: 0768
 Valid Until: January 11, 2011 Valid Until: 2011

Mindanao Sanitarium & Hospital College

Barangay San Miguel, Iligan City 9200

Name of the Student: Krisleen S. Caulawon __________

Name & Address of School: Mindanao Sanitarium and Hospital College, Barangay San Miguel, Iligan City School code: 1362_____________________________________________
Accreditation Level: Level 1 Year Granted: February 28, 2008 __________
Date School Program was Recognized: October 17, 2002 Number: 0043 Year: 2002 __________
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: 2006 _________
Year Graduated from the BSN Program: 2010 __________

III. ACTUAL DELIVERIES

Time of
NO. Case No. Diagnosis Name of Patient Age Date of Delivery Gender of Baby Name of Hospital Type of Delivery Supervised by:
Delivery

Faculty with Master’s Degree/ Clinical Instructor Nurse/Midwife (On Duty)

Pregnancy Uterine Full Normal
Term Delivered Lanao del Norte Spontaneous
1 002098 Spontaneously Cephalic
Jurindah Bulaybulay 38 February 18, 2009 1:55 am Female
Provincial Hospital Vaginal Delivery
to Alive Baby Girl DAVERLY M. CAŇEDA, MN, RN
PRC No.: 0364265 PNA No.: 18841
Valid Until: April 18, 2013 Valid Until: Lifetime
Date Signed:__________

Pregnancy Uterine Full

Term Delivered Normal DARILYN G. LITERATUS, MN, RN
Gregorio T. Lluch
2 036208 Spontaneously Cephalic Charlyn Felizartas 17 February 25, 2009 6:57 am Female Spontaneous PRC No.: 0301632 PNA No.: 16829
to Alive Baby Girl Memorial Hospital Valid Until: November 25, 2012 Valid Until: Lifetime
Vaginal Delivery
Date Signed:__________

Pregnancy Uterine Full Normal DARILYN G. LITERATUS, MN, RN

Term Delivered Gregorio T. Lluch
3 052656 Spontaneously Cephalic
Rosie Zamoras 33 September 15, 2009 6:30 am Female Spontaneous PRC No.: 0301632 PNA No.: 16829
Memorial Hospital
to Alive Baby Girl Vaginal Delivery Valid Until: November 25, 2012 Valid Until: Lifetime
Date Signed:__________

Pregnancy Uterine Full Rural Health Unit Normal FLORA D. YAP, RM

Term Delivered LORELEI J. CABALUNA, MN, RN
4 4892 Spontaneously Cephalic
Rhea Caballes 30 November 10, 2009 1:45 pm Female Bagong Silang, Spontaneous PRC No.:0244767 PNA No.: 18838 PRC No.: 6032868_
to Alive Baby Girl Iligan City Vaginal Delivery Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: July 29, 2012
Date Signed:__________ Date Signed:__________

Pregnancy Uterine Full LORELEI J. CABALUNA, MN, RN

Term Delivered Rural Health Unit Normal FE S. CASAS, RM
PRC No.:0244767 PNA No.: 18838_
5 4305 Spontaneously Cephalic Liezel Benzon 33 December 22, 2009 8:30 pm Male Sta. Filomena, Spontaneous Valid Until: July 21, 2012 Valid Until: Lifetime
PRC No.: 0042480_
to Alive Baby Boy Iligan City Vaginal Delivery Valid Until: May 21, 2012
Date Signed:__________
Date Signed:__________

Prepared by: Noted by: Concurred by: Approved by:

Krisleen S. Caulawon PRIMITIVO G. SANTIAS, MN, RN
Signature Over Printed Name Signature Over Printed Name
Student Clinical Instructor
Date Signed: _____________ Date Signed: ______________
a.) PRC No.: 0284464
Valid Until: November 12, 2011
TRANSFIGURACION C. LEE, MN, RN MYRNA P. SUAN, MN, RN G’TER G. GAID, MAN, RN
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Chief Nurse (LNPH) Chief Nurse (GTLMH) Dean
Date Signed: ______________ Date Signed: ______________ Date Signed: ______________
a.) PRC No.: 0059974__ a.) PRC No: 78434_ a.) PRC No.: 0302269
Valid Until: August 6, 2011__ Valid Until: April 8, 2012 Valid Until: September 13, 2012
 b.) PNA No.: 15666 b.) PNA No.: 13935___ b.) PNA No: 4249__ b.) PNA No: 16832__
Valid Until: Lifetime Valid Until: Lifetime__ Valid Until: Lifetime_ Valid Until: Lifetime_
c.) ANSAP No: 21__ c.) ANSAP No: _025____ c.) ADPCN No.: 0768_
Valid Until: Lifetime___ Valid Until: _2011____ Valid Until: 2011_

Mindanao Sanitarium & Hospital College

Barangay San Miguel, Iligan City 9200

Name of the Student: Krisleen S. Caulawon _________

Name & Address of School: Mindanao Sanitarium and Hospital College, Barangay San Miguel, Iligan City School code:1362_____________________________________________
Accreditation Level: Level 1 Year Granted: February 28, 2008 _________
Date School Program was Recognized: October 17, 2002 Number: 0043 Year: 2002
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: 2006
Year Graduated from the BSN Program: 2010

IV. DELIVERIES ASSISTED

Time of Gender of
NO. Case No. Diagnosis Name of Patient Age Date of Delivery Name of Hospital Type of Delivery Supervised by:
Delivery Baby

Faculty with Master’s Degree/ Clinical Instructor Nurse/Midwife (On Duty)

Pregnancy Uterine Full Mindanao Normal
Term Delivered Ninayah Macarampat July 31, 2008 12:24 am Sanitarium and Spontaneous
1 036330 18 Male Vaginal Delivery
Spontaneously Cephalic Hospital EVALYN M. LECCIONES, MN, RN
to Alive Baby Boy PRC No.: 0245303 PNA No.: 024303
Valid Until: May 9, 2012 Valid Until: October 31, 2010
Date Signed:__________

Pregnancy Uterine Full

Term Delivered Gregorio T. Lluch Normal DARILYN G. LITERATUS, MN, RN
162382 Maribel C. Delfin February 27, 2009 3:45 am Female
2 Spontaneously Cephalic 27 Memorial Hospital Spontaneous PRC No.: 0301632 PNA No.: 16829
to Alive BabyGirl As-7.9 Vaginal Delivery Valid Until: November 25, 2012 Valid Until: Lifetime
Date Signed:__________

Pregnancy Uterine Full Normal DARILYN G. LITERATUS, MN, RN

Term Delivered Gregorio T. Lluch
3 006657 Spontaneously Cephalic Anita Lantingan 42 September 15, 2009 4:52 am Female Spontaneous PRC No.: 0301632 PNA No.: 16829
Memorial Hospital Valid Until: November 25, 2012 Valid Until: Lifetime
to Alive BabyGirl As-8.9 Vaginal Delivery
Date Signed:__________

Pregnancy Uterine Full Rural Health Unit Normal

Term Delivered LORELEI J. CABALUNA, MN, RN FE S. CASAS, RM
4 4406 Spontaneously Cephalic
Conception Paras 36 December 7, 2009 6:30 pm Male Sta. Filomena, Spontaneous PRC No.:0244767 PNA No.: 18838 PRC No.: 0042480
to Alive Baby Boy Iligan City Vaginal Delivery Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Pregnancy Uterine Full Rural Health Unit Normal FE S. CASAS, RM

Term Delivered LORELEI J. CABALUNA, MN, RN
5 4500 Spontaneously Cephalic
Charissa Quidlat 20 December 8, 2009 8:30 pm Male Sta. Filomena, Spontaneous PRC No.:0244767 PNA No.: 18838 PRC No.: 0042480
to Alive Baby Boy Iligan City Vaginal Delivery Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Prepared by: Noted by: Concurred by: Approved by:

Krisleen S. Caulawon PRIMITIVO G. SANTIAS, MN, RN NOEMI T. MORENTE, MAN, RN MYRNA P. SUAN, MN, RN_ G’TER G. GAID, MAN, RN
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Student Clinical Instructor Chief Nurse (MSH) Chief Nurse (GTLMH) Dean
 Date Signed: _____________ Date Signed: ______________ Date Signed: ______________ Date Signed:______________ Date Signed:______________
a.) PRC No.: 0284464 a.) PRC No.: 0161458 a.) PRC No: 78434____ a.) PRC No.: 0302269
Valid Until: November 12, 2011 Valid Until: November 12, 2011 Valid Until: April 8, 2012__ Valid Until: September 13, 2012
b.) PNA No.: 15666 b.) PNA No.: 15666_ b.) PNA No: 4249__ b.) PNA No: 16832________
Valid Until: Lifetime Valid Until: January 11, 2011 Valid Until: Lifetime___ Valid Until: Lifetime
c.) ANSAP No: 025_____ c.) ADPCN No.: 0768_
Valid Until: 2011____ Valid Until: 2011_

Mindanao Sanitarium & Hospital College

Barangay San Miguel, Iligan City 9200

Name of the Student: Krisleen S. Caulawon ____________

Name & Address of School: Mindanao Sanitarium and Hospital College, Barangay San Miguel, Iligan City School code: 1362_______________________________________________
Accreditation Level: Level 1 Year Granted: February 28, 2008 _____________________________
Date School Program was Recognized: October 17, 2002 Number: 0043 Year: 2002 ___
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: 2006 ____________
Year Graduated from the BSN Program: 2010 ____________

V. CORD DRESSING

Name of Hospital/Lying In
NO. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Supervised by:
Clinic/ Home Delivery

Faculty with Master’s Degree/ Clinical Instructor Nurse/Midwife (On Duty)

1 002191 February 20, 2009 Baby Boy Lastimosa Male Lovely Lastimosa 21 Lanao del Norte Provincial
DAVERLY M. CAŇEDA, MN, RN
Hospital PRC No.: 0364265 PNA No.: 18841
Valid Until: April 18, 2013 Valid Until: Lifetime
Date Signed:__________

Rural Health Unit

LORELEI J. CABALUNA, MN, RN FE S. CASAS, RM
2 4203 December 4, 2009 Baby Girl Bancong Female 21 Sta. Filomena, PRC No.:0244767 PNA No.: 18838 PRC No.: 0042480
Charlita Bancong
Iligan City Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Rural Health Unit

4206 Baby Boy Paras Conception Paras LORELEI J. CABALUNA, MN, RN FE S. CASAS, RM
3 December 7, 2009 Male 36 Sta. Filomena, PRC No.:0244767 PNA No.: 18838 PRC No. : 0042480
Iligan City Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Rural Health Unit LORELEI J. CABALUNA, MN, RN FE S. CASAS, RM

4 4407 December 8, 2009 Symon Christian Quidlat Male Charissa Quidlat 20 Sta. Filomena, PRC No.:0244767 PNA No.: 18838 PRC No.: 0042480
Iligan City Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Rural Health Unit FE S. CASAS, RM

LORELEI J. CABALUNA, MN, RN
5 4421 December 22, 2009 Baby Boy Benzon Male Liezel Benzon 23 Sta. Filomena, PRC No.:0244767 PNA No.: 18838 PRC No. : 0042480
Iligan City Valid Until: July 21, 2012 Valid Until: Lifetime Valid Until: May 21, 2012
Date Signed:__________ Date Signed:__________

Prepared by: Noted by: Concurred by: Approved by:

Krisleen S. Caulawon PRIMITIVO G. SANTIAS, MN, RN TRANSFIGURACION C. LEE, MN, RN G’TER G. GAID, MAN, RN
Signature Over Printed Name Signature Over Printed Name
Student Clinical Instructor
Date Signed: _____________ Date Signed: ______________
a.) PRC No.: 0284464
Valid Until: November 12, 2011
b.) PNA No.: 15666
Valid Until: Lifetime__
Signature Over Printed Name
Chief Nurse (LNPH)
Date Signed: ______________
a.) PRC No.: 0059974_
Valid Until: Lifetime___
b.) PNA No.: 21____
Valid Until: Lifetime___
c.) ANSAP No: 21____
Valid Until: Lifetime___
Signature Over Printed Name
Dean
Date Signed: ______________
a.) PRC No.: 0302269
Valid Until: September 13, 2012
b.) PNA No: 16832
Valid Until: Lifetime__
c.) ADPCN No.: 0768__
Valid Until: 2011________