Saint Mary’s University

SCHOOL OF HEALTH SCIENCES

Bayombong, Nueva Vizcaya
Name of Student: SHEYENNE JOY APONGOL MARATA Name and Address of School: SAINT MARY’ UNIVERSITY, BAYOMBONG, NUEVA VIZCAYA
Accreditation Level: (if any) NONE___________________________ Year Granted: NONE____________________________________________________ _
Date When School/Program was recognized :September 28, 1998_ __ Number: 234_______________________________________________ Year: 1998___ _
First Course (if any): NONE__________________________________ School Graduated From: NONE____________________________ Year: _NONE_____ _ _
Year of Admission in the Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN Program): _2009_______________________________________ _

I. MAJOR OPERATIONS
Case Name of Type of Name of Name of Supervised by: Name, Registration No. and Supervised by: Name, Registration No. and
No. Date Diagnosis Operation Performed
No. Patient Anesthesia Surgeon Hospital Signature of C.I. Signature of O.R. SCRUB Nurse

Jonard Veterans Mark Anthony B. Ramel, R.N. Rosemarie C. Bicad, R.N., MSN
November Subarachnoid Dr. Welbert A.
1. 29 Ligmayo Regional PRC#:0376177 Valid Until: October 28, 2011 PRC#:0127446 Valid Until: January 9, 2012
12, 2007 Acute Appendicitis Emergency Appendectomy Block Reyes
Lanbayo Hospital PNA#: 007865 Valid Until: December 31, 2009 PNA#:9938 Valid Until: Lifetime
Date Signed:__________ Date Signed:__________

Veterans Mark Anthony B. Ramel, R.N. Antonio A. Manubay, R.N.

November Wilfredo Tumor Recurrence, Exploratory Laparotomy, Subarachnoid Dr. Raul
2. 58 Regional PRC#:0376177 Valid Until: October 28, 2011 PRC#:0260262 Valid Until: June 19, 2011
19, 2007 Castillo Osio descending colon S/P side to side anastomosis, Block Emiliano G. Par
Hospital PNA#: 007865Valid Until: December 31, 2009 PNA#:18491 Valid Until: Lifetime
Right hemicolectomy ileum-sigmoid
Date Signed:__________ Date Signed:__________
Celestino Emergency Wound
Fracture, Open General Veterans Mark Anthony B. Ramel, R.N. Antonio A. Manubay, R.N.
November Balabbo Debridement Myoraphy. Dr. Antonio
3. 85 Complete, D/3rd Ulna Anesthesia Regional PRC#:0376177 Valid Until: October 28, 2011 PRC#:0260262 Valid Until: June 19, 2011
27, 2007 Jimenez Ligation of Bleeders, Mijares
Right Tendon Mask Hospital PNA#: 007865 Valid Until: December 31, 2009 PNA#:18491 Valid Until: Lifetime
Tenorraphy
Transection Date Signed:__________ Date Signed:__________
Governor
Desiree Edmar S. Licodini, R.N. Teresita M. Castañeda,R.N.
February Spinal Dra. Emma Ruth Faustino N. Dy
4. 480423 Perolin Exploratory Laparotomy PRC#:0482213Valid Until: November 16, 2011 PRC#:0035851 Valid Until: October 6,2010
23, 2009 Ectopic Pregnancy Anesthesia P. Aquitania Sr. Memorial
Right Salphingectomy PNA#:008127Valid Until: December 31, 2009 PNA#:039059 Valid Until: December 31, 2009
Right Hospital
Date Signed:__________ Date Signed:__________
Governor
Edmar S. Licodini, R.N. Teresita M. Castañeda,R.N.
February Jerdilyn Spinal Dr. Ferdinand O. Faustino N. Dy
5. 698523 PRC#:0482213Valid Until: November 16, 2011 PRC#:0035851 Valid Until: October 6,2010
24, 2009 Mangaus Ruptured Appendicitis Appendectomy Anesthesia Cacal Sr. Memorial
PNA#:008127Valid Until: December 31, 2009 PNA#:039059 Valid Until: December 31, 2009
Hospital
Date Signed:__________ Date Signed:__________

Prepared by:

SHEYENNE JOY APONGOL MARATA

(Name of Student)

Supervised/Noted by: Concurred by: Concurred by: Approved by:

RUBEN RAMUEL C. AMBATALI II NELIA M. VICENTE CRISTINA A. DUARTE JHORDIN JAMES C. MONTEGRICO
Signature over Printed name of Signature over Printed name of Signature over Printed name of Signature over Printed name of
Clinical Coordinator Chief Nurse of Veterans Regional Hospital Chief Nurse of Gov. Faustino N. Dy Sr. Memorial Hospital Dean of School of Health Sciences
Date signed: ______________________ Date signed: ______________________ Date signed: ______________________ Date signed: ______________________
Degree: RN, MSN Degree: RN, MAN Degree: RN, MSN Degree: RN, MSN
a) PRC No.: 0382671 a) PRC No.: 0090287 a) PRC No.: 0065793 a) PRC No.: 0239713
Valid until: September 6, 2012 Valid until: March 20, 2012 Valid until: March 13,2010 Valid until: May 7,2010
b) PNA No.: 008136 b) PNA No.:5465 b) PNA No.:002410 b) PNA No.:008135
Valid until: December 31, 2009 Valid until: Lifetime Valid until: December 31, 2009 Valid until: December 31,2009
c) ANSAP No.: 071193 c) ANSAP No.:0311 c) ANSAP No.: 090093 c) ADPCN No.: 0830
Valid Until; February 23, 2010 Valid until: Lifetime Valid until: December 31, 2009 Valid until: Lifetime
 Saint Mary’s University
SCHOOL OF HEALTH SCIENCES
Bayombong, Nueva Vizcaya
Name of Student: SHEYENNE JOY APONGOL MARATA Name and Address of School: SAINT MARY’ UNIVERSITY, BAYOMBONG, NUEVA VIZCAYA
Accreditation Level: (if any) NONE____________________________ Year Granted: NONE______________________________________________________ _
Date When School/Program was recognized :September 28, 1998 __ Number: 234_______________________________________________ Year: 1998___ _
First Course (if any): NONE__________________________________ School Graduated From: NONE____________________________ Year: _NONE_____ _ _
Year of Admission in the Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN Program): _2009_______________________________________ __

II. MINOR OPERATIONS

Case Operation Type of Name of Name of Supervised by: Name, Registration No. and Supervised by: Name, Registration No. and
No. Date Name of Patient Diagnosis
No. Performed Anesthesia Surgeon Hospital Signature of C.I. Signature of O.R. SCRUB Nurse

March 17, Veterans Rosalie C. Carreon, R.N. Cheryl M. Bautista, R.N.

Hacked Wound Posterior Local Dr. Sherwin T.
1. 2008 1172 Edgar I. Collado Suturing Regional PRC#: 0130443 Valid Until: December 19, 2010 PRC#:0256933 Valid Until: February 6, 2012
Forearm (4cm) Anesthesia Valdez
Hospital PNA#: 007871 Valid Until: December 31, 2009 PNA#: 16561 Valid Until: Lifetime
Date Signed:__________ Date Signed:__________

September Veterans Rosalie C. Carreon, R.N. Jennifer E. Valdez, R.N.

Francisco B. Lacerated Wound 3cm Left Local Dr. Frederick
2. 15, 2008 1052 Suturing Regional PRC#: 0130443 Valid Until: December 19, 2010 PRC#: 0207028 Valid Until: November 24,2011
Malana Eyebrow Anesthesia P. Fabian
Hospital PNA#: 007871 Valid Until: December 31, 2009 PNA#: 16556 Valid Until: Lifetime
Date Signed:__________ Date Signed:__________

Roden D. Removal of Veterans Rosalie C. Carreon, R.N. Nicanor P. Dela Cruz Jr., R.N.
October S/P Subclavian Catheter
3. 1861 Gatmaitan Subclavian Local Dr. Sherwin T. Regional PRC#: 0130443 Valid Until: December 19, 2010 PRC#:0242470 Valid Until: February 1, 2012
16, 2008 Insertion for Hemodialysis
Catheter Anesthesia Valdez Hospital PNA#: 007871 Valid Until: December 31, 2009 PNA#:16373 Valid Until: Lifetime
Date Signed:__________ Date Signed:__________
Governor
Lailanie Dela Gerald Roy R. Nipal, R.N. Amelia A. Romero, R.N.
February Faustino N. Dy
4. 278920 Cruz Dilatation and Dra. Elsie V. PRC#:0425978 Valid Until: August 3, 2010 PRC#:0107146 Valid Until: May 5, 2011
21, 2009 Incomplete Abortion IV Sedation Sr. Memorial
Curettage Cruz PNA#: 00786 Valid Until: December 31,2009 PNA#:002413 Valid Until: December 31, 2009
Hospital
Date Signed:__________ Date Signed:__________
Governor
Edmar S. Licodini, R.N. Amelia A. Romero, R.N.
February Maxene Alliah Faustino N. Dy
5. 408622 Abscess Frontal Head Incision and Local Dr. Joseph A. PRC#:0482213Valid Until: November 16, 2011 PRC#:0107146 Valid Until: May 5, 2011
22, 2009 Iralabad Sr. Memorial
Right Drainage Anesthesia Tibio PNA#:008127Valid Until: December 31, 2009 PNA#:002413 Valid Until: December 31, 2009
Hospital
Date Signed:__________ Date Signed:__________

Prepared by:

SHEYENNE JOY APONGOL MARATA

(Name of Student)

Supervised/Noted by: Concurred by: Concurred by: Approved by:

RUBEN RAMUEL C. AMBATALI II NELIA M. VICENTE CRISTINA A. DUARTE JHORDIN JAMES C. MONTEGRICO
Signature over Printed name of Signature over Printed name of Signature over Printed name of Signature over Printed name of
Clinical Coordinator Chief Nurse of Veterans Regional Hospital Chief Nurse of Gov. Faustino N. Dy Sr. Memorial Hospital Dean of School of Health Sciences
Date signed: ______________________ Date signed: ______________________ Date signed: ______________________ Date signed: ______________________
Degree: RN, MSN Degree: RN, MAN Degree: RN, MSN Degree: RN, MSN
a) PRC No.: 0382671 a) PRC No.: 0090287 a) PRC No.: 0065793 a) PRC No.: 0239713
Valid until: September 6, 2012 Valid until: March 20, 2012 Valid until: March 13,2010 Valid until: May 7,2010
b) PNA No.:5465
b) PNA No.: 008136
Valid until: Lifetime
b) PNA No.:002410 b) PNA No.: 008135
Valid until: December 31, 2009 Valid until: December 31, 2009 Valid until: December 31,2009
 c) ANSAP No.:071193 c) ANSAP No.:0311
Valid Until: February 23, 2010 Valid until: Lifetime
c) ANSAP No.: 090093 c) ADPCN No.: 0830
Valid until: December 31, 2009 Valid until: Lifetime

Saint Mary’s University

SCHOOL OF HEALTH SCIENCES
Bayombong, Nueva Vizcaya

Name of Student: SHEYENNE JOY APONGOL MARATA Name and Address of School: SAINT MARY’ UNIVERSITY, BAYOMBONG, NUEVA VIZCAYA
Accreditation Level: (if any) NONE____________________________ Year Granted: NONE_____________________________________________________ _ _
Date When School/Program was recognized :September 28, 1998___ Number: 234_______________________________________________ Year: 1998__ _
First Course (if any): NONE_______________________________ _ _ School Graduated From: NONE____________________________ Year: _NONE_____ _ _
Year of Admission in the Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN Program): _2009_______________________________________ _

III. ACTUAL DELIVERIES

Case Date of Time of Gender of Supervised by: Name, Registration No. and Signature of
No. Diagnosis Name of Mother Age Name of Hospital Type of Delivery
No. Delivery Delivery Baby C.I.

Normal Spontaneous Delivery Mark Anthony B. Ramel, R.N.

Gravida 2 Para 1, Pregnancy November Veterans Regional
1. 120 Joanne Gambo Baria 28 12:53 am Male Right Medio-Lateral Episiotomy PRC#:0376177 Valid Until: October 28, 2011
Uterine Full Term Cephalic in Labor 14, 2007 Hospital
Repair PNA#: 007865Valid Until: December 31, 2009
Date Signed:__________

Governor Faustino Gerald Roy R. Nipal, R.N.

Gravida 7 Para 5, Pregnancy December
2. 943623 Rosemir Bautista 32 9:02 pm Male N. Dy Sr. Memorial PRC#:0425978 Valid Until: August 3, 2010
Uterine, 40 weeks Age of Gestation 2, 2008 Normal Spontaneous Delivery
Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Governor Faustino Gerald Roy R. Nipal, R.N.

Gravida 2 Para 0, Pregnancy December
3. 293623 Raquel Lucero 28 7:40 am Male N. Dy Sr. Memorial Normal Spontaneous Delivery PRC#:0425978 Valid Until: August 3, 2010
Uterine, 40 weeks Age of Gestation 3,2008
Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Governor Faustino Gerald Roy R. Nipal, R.N.

Gravida 2 Para 0, 40 weeks Age of Liezl Estorninis February
4. 824723 22 8:50 am Male N. Dy Sr. Memorial PRC#:0425978 Valid Until: August 3, 2010
Gestation 22, 2009 Normal Spontaneous Delivery
Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Gravida 2 Para 1, Pregnancy Governor Faustino Gerald Roy R. Nipal, R.N.

February
5. 108923 Uterine Full Term 38 1/7 wk Age of Jinky Marquez 28 6:05 am Male N. Dy Sr. Memorial PRC#:0425978 Valid Until: August 3, 2010
24, 2009 Normal Spontaneous Delivery
Gestation Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Prepared by:

SHEYENNE JOY APONGOL MARATA

(Name of Student)

Supervised/Noted by: Concurred by: Concurred by: Approved by:

RUBEN RAMUEL C. AMBATALI II NELIA M. VICENTE CRISTINA A. DUARTE JHORDIN JAMES C. MONTEGRICO
Signature over Printed name of Signature over Printed name of Signature over Printed name of Signature over Printed name of
Clinical Coordinator Chief Nurse of Veterans Regional Hospital Chief Nurse of Gov. Faustino N. Dy Sr. Memorial Hospital Dean of School of Health Sciences
Date signed: ______________________ Date signed: ______________________ Date signed: ______________________ Date signed: ______________________
Degree: RN, MSN Degree: RN, MAN Degree: RN, MSN Degree: RN, MSN
a) PRC No.: 0382671 a) PRC No.: 0090287 a) PRC No.: 0065793 a) PRC No.: 0239713
Valid until: September 6, 2012 Valid until: March 20, 2012 Valid until: March 13,2010 Valid until: May 7,2010
 b) PNA No.: 008136 b) PNA No.:5465 b) PNA No.:002410 b) PNA No.: 008135
Valid until: December 31, 2009 Valid until: Lifetime Valid until: December 31, 2009 Valid until: December 31,2009
c) ANSAP No.:071193
Valid Until: February 23, 2010
c) ANSAP No.:0311 c) ANSAP No.: 090093 c) ADPCN No.: 0830
Valid until: Lifetime Valid until: December 31, 2009 Valid until: Lifetime

Saint Mary’s University

SCHOOL OF HEALTH SCIENCES
Bayombong, Nueva Vizcaya
Name of Student: SHEYENNE JOY APONGOL MARATA Name and Address of School: SAINT MARY’ UNIVERSITY, BAYOMBONG, NUEVA VIZCAYA
Accreditation Level: (if any) NONE____________________________ Year Granted: NONE______________________________________________________ _
Date When School/Program was recognized :September 28, 1998___ Number: 234_______________________________________________ Year: 1998___
First Course (if any): NONE_______________________________ __ School Graduated From: NONE____________________________ Year: _NONE_____ _ _
Year of Admission in the Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN Program): _2009_______________________________________ _

IV. DELIVERIES ASSISTED

Case Date of Time of Gender of Supervised by: Name, Registration No. and
No. Diagnosis Name of Mother Age Name of Hospital Type of Delivery
No. Delivery Delivery Baby Signature of C.I.

Gravida 1 Para 0, Pregnancy Mark Anthony B. Ramel, R.N.

November Veterans Regional Normal Spontaneous Delivery with
1. 165 Uterine Full Term, Cephalic in Jayren Florendo Marcos 18 6:00 pm Male PRC#:0376177 Valid Until: October 28, 2011
19, 2007 Hospital Medial Episiotomy Repair
Beginning Labor PNA#: 007865Valid Until: December 31, 2009
Date Signed:__________

Gravida 1 Para 0, Pregnancy Governor Faustino N. Gerald Roy R. Nipal, R.N.

810523 November
2. Uterine, 40 weeks Age of Cris Delight Limon 20 11:47 am Female Dy Sr. Memorial PRC#:0425978 Valid Until: August 3, 2010
24, 2008 Normal Spontaneous Delivery
Gestation Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Gravida 1 Para 0, Pregnancy Governor Faustino N. Gerald Roy R. Nipal, R.N.

741223 December
3. Uterine, 39 weeks Age of Crislyn Lumawig 18 11:23 pm Female Dy Sr. Memorial Normal Spontaneous Delivery PRC#:0425978 Valid Until: August 3, 2010
1,2008
Gestation Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Gravida 2 Para 1, Pregnancy Governor Faustino N. Gerald Roy R. Nipal, R.N.

February
4. 445423 Uterine, 40 weeks Age of Lailanie Dancel 24 1:56 am Male Dy Sr. Memorial Normal Spontaneous Delivery PRC#:0425978 Valid Until: August 3, 2010
21, 2009
Gestation Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Governor Faustino N. Gerald Roy R. Nipal, R.N.

Gravida 2 Para 1, 40 weeks Age Rowena Topinio February
5. 926423 26 7:56 pm Male Dy Sr. Memorial Normal Spontaneous Delivery PRC#:0425978 Valid Until: August 3, 2010
of Gestation 22, 2009
Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Prepared by:

SHEYENNE JOY APONGOL MARATA

(Name of Student)

Supervised/Noted by: Concurred by: Concurred by: Approved by:

RUBEN RAMUEL C. AMBATALI II NELIA M. VICENTE CRISTINA A. DUARTE JHORDIN JAMES C. MONTEGRICO
Signature over Printed name of Signature over Printed name of Signature over Printed name of Signature over Printed name of
Clinical Coordinator Chief Nurse of Veterans Regional Hospital Chief Nurse of Gov. Faustino N. Dy Sr. Memorial Hospital Dean of School of Health Sciences
Date signed: ______________________ Date signed: ______________________ Date signed: ______________________ Date signed: ______________________
Degree: RN, MSN Degree: RN, MAN Degree: RN, MSN Degree: RN, MSN
a) PRC No.: 0382671 a) PRC No.: 0090287 a) PRC No.: 0065793 a) PRC No.: 0239713
 Valid until: September 6, 2012 Valid until: March 20, 2012 Valid until: March 13,2010 Valid until: May 7,2010
b) PNA No.: 008136 b) PNA No.:5465 b) PNA No.:002410 b) PNA No.: 008135
Valid until: December 31, 2009 Valid until: Lifetime Valid until: December 31, 2009 Valid until: December 31,2009
c) ANSAP No.:071193
Valid Until: February 23, 2010
c) ANSAP No.:0311 c) ANSAP No.: 090093 c) ADPCN No.: 0830
Valid until: Lifetime Valid until: December 31, 2009 Valid until: Lifetime

Saint Mary’s University

SCHOOL OF HEALTH SCIENCES
Bayombong, Nueva Vizcaya
Name of Student: SHEYENNE JOY APONGOL MARATA Name and Address of School: SAINT MARY’ UNIVERSITY, BAYOMBONG, NUEVA VIZCAYA
Accreditation Level: (if any) NONE__________________________ Year Granted: NONE______________________________________________________ _
Date When School/Program was recognized :September 28, 1998___ Number: 234_______________________________________________ Year: 1998___
First Course (if any): NONE_______________________________ __ School Graduated From: NONE____________________________ Year: _NONE_____ _ _
Year of Admission in the Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN Program): _2009_______________________________________ _

V. CORD DRESSING
Supervised by: Name, Registration No. and
No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital
Signature of C.I.

Mark Anthony B. Ramel, R.N.

Veterans Regional
1. 106 November 13, 2007 Bb Boy Reyes Male Jean Babaran Reyes 23 PRC#:0376177 Valid Until: October 28, 2011
Hospital
PNA#: 007865Valid Until: December 31, 2009
Date Signed:__________

Mark Anthony B. Ramel, R.N.

181 Veterans Regional
2. November 21, 2007 Bb Boy Caramat Male Maricel Abella Caramat 27 PRC#:0376177 Valid Until: October 28, 2011
Hospital
PNA#: 007865Valid Until: December 31, 2009
Date Signed:__________

Mark Anthony B. Ramel, R.N.

Bb Boy Bayangan Veterans Regional
3. 242 November 28, 2007 Male Melody Lumano Bayangan 25 PRC#:0376177 Valid Until: October 28, 2011
Hospital
PNA#: 007865Valid Until: December 31, 2009
Date Signed:__________

Governor Faustino N. Gerald Roy R. Nipal, R.N.

4. 965223 February 21, 2009 Bb Boy Dela Cruz Male Charity Dela Cruz 29 Dy Sr. Memorial PRC#:0425978 Valid Until: August 3, 2010
Hospital PNA#: 00786 Valid Until: December 31,2009
Date Signed:__________

Governor Faustino N. Gerald Roy R. Nipal

Vanessa Castillo
5. 98923 February 23, 2009 Bb Boy Castillo Male 20 Dy Sr. Memorial PRC#:0425978 Valid Until:8-03-10
Hospital PNA#: 00786 Valid Until:12-31-09
Date Signed:__________

Prepared by:

SHEYENNE JOY APONGOL MARATA

(Name of Student)

Supervised/Noted by: Concurred by: Concurred by: Approved by:

RUBEN RAMUEL C. AMBATALI II NELIA M. VICENTE CRISTINA A. DUARTE JHORDIN JAMES C. MONTEGRICO
Signature over Printed name of Signature over Printed name of Signature over Printed name of Signature over Printed name of
Clinical Coordinator Chief Nurse of Veterans Regional Hospital Chief Nurse of Gov. Faustino N. Dy Sr. Memorial Hospital Dean of School of Health Sciences
Date signed: ______________________ Date signed: ______________________ Date signed: ______________________ Date signed: ______________________
Degree: RN, MSN Degree: RN, MAN Degree: RN, MSN Degree: RN, MSN
a) PRC No.: 0382671 a) PRC No.: 0090287 a) PRC No.: 0065793 a) PRC No.: 0239713
 Valid until: September 6, 2012 Valid until: March 20, 2012 Valid until: March 13,2010 Valid until: May 7,2010
b) PNA No.: 008136 b) PNA No.:5465 b) PNA No.:002410 b) PNA No.: 008135
Valid until: December 31, 2009 Valid until: Lifetime Valid until: December 31, 2009 Valid until: December 31,2009
c) ANSAP No.:071193
Valid Until: February 23, 2010
c) ANSAP No.:0311 c) ANSAP No.: 090093 c) ADPCN No.: 0830
Valid until: Lifetime Valid until: December 31, 2009 Valid until: Lifetime