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LICEO DE CAGAYAN UNIVERSITY College of Nursing
Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City
School Code: 0835
Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:
ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012
Year: NOT APPLICABLE
I. MAJOR OPERATIONS
No.
1
Date of Operation
July 13, 2010 September 27, 2010
Case No.
3785
Name of Patient
Diagnosis
Operation Performed
Types of Anesthesia
Spinal anesthesia General Anesthesia
Name of Surgeon
Name of Hospital
Name of Qualified OR Scrub Nurse

Mrs. Maria Madel C. Reyes, RN Fidelo Rey Mandawe, RN
Signature of Qualified OR Scrub Nurse
Yasin, Anisah
Open Fracture Medial Third Tibia Fibula Right Mandibular Fracture, depressed (right)
763968
Ricky Llanto
Debridement Irrigation Open Reduction Inter-Medullary; Interlocking nail, right tibia Open Reduction Internal Fixation of depressed malar fracture using Titanium/ Orbityl plates; Open Reduction Internal Fixation of Mandiblar Fracture using Titanium plates; Mandibulomaxillary Fixation Cervical punch biopsy, Fractional dilatation and curettage
Dr. Jovito Lao
Dr. Robert Gomez
Cagayan Polymedic General Hospital Northern Mindanao medial Center
October 20, 2010
6085
Irene Tiu
Endometrial hyperplasia rule out Endometrial Carcinoma
Spinal Anesthesia
Dr. Jana Joy Tursalem
Cagayan Polymedic General Hospital
Jade Claire O. Alvarez, RN
Approved by: Prepared by: Supervised by: Noted by: Concurred by: Concurred by:
MARIA CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: B.S.N., M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ________________ Valid Until: December 31, 2011
NAME
Name and Signature of Student
GINA S. BATASIN-IN
OR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN,MN PRC No: 0157111 Valid Until: December 10, 2013 PNA No: Valid Until: October 31, 2011
VIVIAN L. CEBALLOS
RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ________________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2014 PNA No: 17947 Valid Until: Lifetime Member

School Code: 0835 Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized: ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012
II. MAJOR OPERATIONS

No.
1
Date of Operation
May 26, 2011 December 10, 2010 July 5, 2010
Case No.
02679
Name of Patient Diagnosis

Quilab, Glyza Shamil Hibaya, Vanessa Myla Lota Generalao Cleft lip complete
Operation Performed
Cheiloplasty
Types of Anesthesia
General Endotracheal Anesthesia Spinal Anesthesia Retrobulbar block
Name of Surgeon
Name of Hospital
Name of Qualified OR Circulatinhg Nurse

Kriss Kringle Virtudes, RN Letecia Reyes, RN
Signature of Qualified OR Scrub Nurse
Dr. Veronica Abelera Dr. Reynaldo Chu Dr. Carlo Antonio J. Romero
210272 4 001105
Preterm cephalic not in labor oligohydramnios delivered live baby boy with an APGAR score of 10, body weight of 10 Mature Cataract Left Eye
Low section cesarean section myomectomy Phaco emulsification of Cataract Left Eye
Cagayan Polymedic General Hospital Madonna and Child Hospital Cagayan Polymedic General Hospital
RC Ann Macaranas, RN
Prepared by:
PRC FORM TEMPLATE
Supervised by:
Noted by:
Concurred by:
Concurred by:
Concurred by:
Approved by:
GINA S. BATASIN-IN
VIVIAN L. CEBALLOS
OR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN, MN PRC No: 0157111 Valid Until: December 10, 2013 PNA No: Valid Until: December 31, 2011
RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ___________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947 Valid Until: Lifetime Member

Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ________________ Valid Until: December 31, 2011

Rodolfo N. Pelaez Boulevard Kauswagan , Cagayan de Oro City
School Code: 0835 Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized: ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012
III. HANDLED DELIVERIES

No.
1
Case No.
1231
Diagnosis
Name of Mother Age
Date of Delivery
July 11, 2010
Time of Delivery
2:55 AM
Gender of Baby
Male
Name of Hospital
Types of Delivery
Nurse/Midwife Name and Signature of Qualified DR On duty Clinical Instructor

Lovel Catiil,RN Lovel Catiil,RN Lovel Catiil,RN Mr. Andy Roy Salabas, Rn Mrs. Elvyn Mabao, RN MN Mrs. Elvyn Mabao, RN MN
1175
1161
Delivery term spontaneous an alive baby boy weighing 6.5 pounds with an APGAR score of 9. Gravida 1, Parity 1, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 5 pounds with an APGAR score of 9. Gravida 1, Parity 0, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 7.8 pounds with an APGAR score of 9. Gravida 3, Parity 3, Cephalic Presentation
Barbara Baculio
20
Tara Paula Joyce Amahan Jocelyn Lague
19
June 13, 2010
1: 58 PM
Male
30
June 5, 2010
4: 51 AM
Male
Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home
Concurred by:
Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery
Approved by:
Prepared by:
Noted by:
Concurred by:

Dean Liceo de Cagayan University Date Signed: _____________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: _______________ Valid Until: December 31, 2011
PRC FORM TEMPLATE
VIVIAN L. CEBALLOS

School Code: 0835
Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:
ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012
IV. ASSISTED DELIVERIES

No.
1
Case No.
1174
Diagnosis
Delivery term spontaneous an alive baby boy weighing 7 pounds with an APGAR score of 9. Gravida 1, Parity 0, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 5.6 pounds with an APGAR score of 9. Gravida 2, Parity 2, Cephalic Presentation Delivery term spontaneous an alive baby girl weighing 3.4 kilograms with an APGAR score of 9. Gravida 1, Parity 1, Cephalic Presentation
Name of Mother
Goldie Mae Bustamante Stephanie Paclar
Age
20
Date of Delivery
June 13, 2010
Time of Delivery
11: 29 AM
Gender of Baby
Male
Name of Hospital
Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home JR Borja Memorial Hospital
Types of Delivery
Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery
Name and Signature of Qualified DR Clinical Instructor

Mrs. Elvyn Mabao, RN MN
1217
32
July 3, 2010
5:03 PM
Male
Mrs. Ester Sy, RN MN
650, 563
Stephanie Decipolo
23
July 24, 2010
11; 21 PM
Female
Mrs. Florence Baluran, RN MN
Noted by: Prepared by:
Concurred by:
Concurred by:
Concurred by:
Approved by:
VIVIAN L. CEBALLOS

Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ______________ Valid Until: December 31, 2011
PRC FORM TEMPLATE

School Code: 0835
Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized: Number:
ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III First Course (if any): Not Applicable 2008 School Graduated from: June 1972 Year of Admission in the BSN Program: 2008 37 Year Graduated (BSN Program): 2012
Year:
V. IMMEDIATE NEWBORN CARE

Case No. No.
1 2 3 1167 1218 650, 473 June 8, 2010 June 23, 2010 July 25, 2010 Baby Boy Martinez Baby Boy Dumaog Baby Boy Ebal
Date Performed
Name of Baby
Gender of Baby
Male Male Male
Name of Mother
Mayette Martinez Annaliza Dumaog WIlda Ebal
Age
20 33 26
Name of Hospital
Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home JR Borja Memorial Hospital
Nurse/Midwife On duty
Lovel Catiil, RN Lovel Catiil, RN Gemma Omonbos, RN
Name and Signature of Qualified DR Clinical Instructor

Mrs. Elvyn Mabao, RN MN Mrs. Ester Sy, RN MN Mrs. Florence Baluran, RN MN
Approved by:
Prepared by:
Noted by:
Concurred by:
Concurred by:
Concurred by:

Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: _______________ Valid Until: December 31, 2011
ORONG, ALTHEA PAZ

VIVIAN L. CEBALLOS

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LICEO DE CAGAYAN UNIVERSITY College of Nursing

Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City

School Code: 0835

Year: NOT APPLICABLE

Name of Qualified OR Scrub Nurse

Signature of Qualified OR Scrub Nurse

Dr. Jovito Lao

Dr. Robert Gomez

Cagayan Polymedic General Hospital Northern Mindanao medial Center

October 20, 2010

Endometrial hyperplasia rule out Endometrial Carcinoma

Dr. Jana Joy Tursalem

Cagayan Polymedic General Hospital

Jade Claire O. Alvarez, RN

MARIA CHONA V. PALOMARES

Name and Signature of Student

LICEO DE CAGAYAN UNIVERSITY College of Nursing

Year: NOT APPLICABLE

II. MAJOR OPERATIONS

Name of Patient Diagnosis

Name of Qualified OR Circulatinhg Nurse

Signature of Qualified OR Scrub Nurse

PRC FORM TEMPLATE

Name and Signature of Student

MARIA CHONA V. PALOMARES

LICEO DE CAGAYAN UNIVERSITY College of Nursing

Year: NOT APPLICABLE

III. HANDLED DELIVERIES

Name of Mother Age

Nurse/Midwife Name and Signature of Qualified DR On duty Clinical Instructor

Tara Paula Joyce Amahan Jocelyn Lague

June 13, 2010

MARIA CHONA V. PALOMARES

PRC FORM TEMPLATE

Name and Signature of Student

LICEO DE CAGAYAN UNIVERSITY College of Nursing

School Code: 0835

Year: NOT APPLICABLE

IV. ASSISTED DELIVERIES

Name and Signature of Qualified DR Clinical Instructor

Mrs. Ester Sy, RN MN

July 24, 2010

Mrs. Florence Baluran, RN MN

Noted by: Prepared by:

MARIA CHONA V. PALOMARES

PRC FORM TEMPLATE

Name and Signature of Student

LICEO DE CAGAYAN UNIVERSITY College of Nursing

School Code: 0835

V. IMMEDIATE NEWBORN CARE

Name and Signature of Qualified DR Clinical Instructor

MARIA CHONA V. PALOMARES

ORONG, ALTHEA PAZ

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