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Republic of the Philippines

EASTERN VISAYAS CENTRAL COLLEGES


Catarman, Northern Samar
Name of Student: ADALLA, PHILIP ENZON
Accreditation Level (if any): N/A Year Granted: N/A
Date School/ Program was recognizes: March 20, 2007 Number: 5 Year: 2007
First Course (if any): Bachelor of Science in Biology School Graduated From: UEP Year: April 3, 2004
Years of Admission in Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN): March 25, 2009

WARNING: All statements are subject of verification and false statements any or misrepresentation made in this DOCUMENT is a ground for disqualification and criminal prosecution

I –MAJOR OPERATIONS

No. Date of Case Name of Patient Diagnosis Operation Performed Types of Name of Surgeon Name of Supervised By: Signature
Operations No. Anesthesia Hospital Name of Qualified C.I
Gravida4, Para4 (4003): Uteri, Total Abdominal Marissa S. Gomba, RN., MAN
1 August 30, 2007 070490 Turbanada, Rufina Abdominal Uterine bleeding S/P Hysterectomy Bilateral Epidural Dr. Tingkingco Northern Samar PRC No.: 0181067
Fractional Curettage Salphingo Oopherictomy Anesthesia Provincial Hospital Valid Until: 11-29-2009
Marissa S. Gomba, RN., MAN
2 January 14, 2008 075884 Mahinay, Romualdo Complete Fractured, Mid-Clavicle Open Reduction General Dr. Benjamen Ver Northern Samar PRC No.: 0181067
Left Internal Fixation Anesthesia Provincial Hospital Valid Until: 11-29-2009
Marissa S. Gomba, RN., MAN
3 April 21, 2008 079374 Delorino, Antonio Ruptured Appendicitis Drainage Appendectomy Spinal Dr. Joseph Estanislao Northern Samar PRC No.: 0181067
Psoas Abscess Right Anesthesia Provincial Hospital Valid Until: 11-29-2009
Extra capsular Cataract Extraction Jacob Chino F. Meimban, RN., MAN Ph.D.
4 July 31, 2008 522296 Lebico, Apolonio Posterior Sub scapular Cataract right with Posterior Chamber Local Dr. Elvera Lanuevo Northern Samar PRC No.: 0256777
eye, Nuclear Cataract right eye Intraocular Lens right eye Anesthesia Provincial Hospital Valid Until: 09-6-2009
Extra capsular Cataract Extraction Jacob Chino F. Meimban, RN., MAN Ph.D.
5 July 31, 2008 558407 Celajes, Elena Mature Cataract right eye with Posterior Chamber Local Dr. Mutia Northern Samar PRC No.: 0256777
Intraocular Lens right eye Anesthesia Provincial Hospital Valid Until: 09-6-2009

Prepared by: Noted by:


PHILIP E. ADALLA MA. SHIRLY J. ALBA, RN., MAN
Student Clinical Coordinator
(Signature over printed name) (Signature over printed name)
Date Signed:
a.) PRC No. 0247477 Valid Until: August 7, 2010
b.) PNA No. 0247477 Valid Until: Sept, 9, 2009

Concurred by: Approved by:


CESARITH P. HERNANDEZ, RN., MAN JACOB CHINO F. MEIMBAN, RN, MAN Ph. D.
Chief Nurse Dean
(Signature over printed name) (Signature over printed name)
Date Signed: Date Signed:
a.) PRC No. 013475 Valid Until: March 5, 2011 a.) PRC No. 0256777 Valid Until: September 6, 2009
b.) PNA No. 8375 Valid Until: Lifetime Member b.) PNA No. 0011010 Valid Until: January , 2010
c.) ANSAP No. Valid Until: c.) ADCPN No. 326 Valid Until: January , 2010
Republic of the Philippines
EASTERN VISAYAS CENTRAL COLLEGES
Catarman, Northern Samar
Name of Student: ADALLA, PHILIP ENZON
Accreditation Level (if any): N/A Year Granted: N/A
Date School/ Program was recognizes: March 20, 2007 Number: 5 Year: 2007
First Course (if any): Bachelor of Science in Biology School Graduated From: UEP Year: April 3, 2004
Years of Admission in Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN): March 25, 2009

WARNING: All statements are subject of verification and false statements any or misrepresentation made in this DOCUMENT is a ground for disqualification and criminal prosecution

II –MINOR OPERATIONS

No. Date of Case Name of Patient Diagnosis Operation Types of Name of Surgeon Name of Supervised By: Signature
Operations No. Performed Anesthesia Hospital Name of Qualified C.I
Jacob Chino F. Meimban, RN., MAN Ph.D.
1 April 7, 2008 078942 Rivera, Nina 10 cm Lacerated wound at Right leg Wound Suturing Local Dr. Vincent Belicena Northern Samar PRC No.: 0256777
2 cm Lacerated wound at Left leg Anesthesia Provincial Hospital Valid Until: 09-6-2009

2 October 22, 2008 086192 Barberde, Grace Gravida1, Para0 (1000) 40-41 weeks age of Left Medio-lateral Local Northern Samar Ma. Shirly J. Alba, RN., MAN
gestation delivered to alive baby boy Episorrhaphy Anesthesia Dr. Elizabeth N.Nochete Provincial Hospital PRC No.: 0247477
abortion complete. Valid Until: 8-7-2010
Ma. Shirly J. Alba, RN., MAN
3 October 22, 2008 086202 Cotero, Nora Retained Placenta Dilatation & Local Dr. Elinabeth N.Nochete Northern Samar PRC No.: 0247477
Curettage Anesthesia Provincial Hospital Valid Until: 8-7-2010
Jacob Chino F. Meimban, RN., MAN Ph.D.
4 January 26, 2009 102639 Lunit, Jesus Lymphoma Right Traperius Excision Local Dr. Phil Frarabough Northern Samar PRC No.: 0256777
Anesthesia Provincial Hospital Valid Until: 09-6-2009
Jacob Chino F. Meimban, RN., MAN Ph.D.
5 January26, 2009 Cupido, Ma. Julita Sebaceous cyst under the chest Excision Dr.Anna Theresa Dolina Northern Samar PRC No.: 0256777
15931 Local Provincial Hospital Valid Until: 09-6-2009
Anesthesia

Prepared by: Noted by:


PHILIP E. ADALLA MA. SHIRLY J. ALBA, RN., MAN
Student Clinical Coordinator
(Signature over printed name) (Signature over printed name)
Date Signed:
a.) PRC No. 0247477 Valid Until: August 7, 2010
b.) PNA No. 0247477 Valid Until: Sept, 9, 2009

Concurred by: Approved by:


CESARITH P. HERNANDEZ, RN., MAN JACOB CHINO F. MEIMBAN, RN, MAN Ph. D.
Chief Nurse Dean
(Signature over printed name) (Signature over printed name)
Date Signed: Date Signed:
a.) PRC No. 013475 Valid Until: March 5, 2011 a.) PRC No. 0256777 Valid Until: September 6, 2009
b.) PNA No. 8375 Valid Until: Lifetime Member b.) PNA No. 0011010 Valid Until: January , 2010
c.) ANSAP No. Valid Until: c.) ADCPN No. 326 Valid Until: January , 2010
Republic of the Philippines
EASTERN VISAYAS CENTRAL COLLEGES
Catarman, Northern Samar
Name of Student: ADALLA, PHILIP ENZON
Accreditation Level (if any): N/A Year Granted: N/A
Date School/ Program was recognizes: March 20, 2007 Number: 5 Year: 2007
First Course (if any): Bachelor of Science in Biology School Graduated From: UEP Year: April 3, 2004
Years of Admission in Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN): March 25, 2009

WARNING: All statements are subject of verification and false statements any or misrepresentation made in this DOCUMENT is a ground for disqualification and criminal prosecution

III –ACTUAL DELIVERIES

No. Case Diagnosis Name of Patient Age Date of Time of Gender of Name of Type of Supervised By: Signature
No. Delivery Delivery Baby Hospital delivery Name of Qualified C.I
Gravida3, Para3 (3003) weeks age of gestation Normal Ma. Shirly J. Alba, RN., MAN
1 073250 delivered to alive baby boy. Romines, Annabel April 15, 2008 6:19pm Male Northern Samar Spontaneous PRC No.: 0247477
Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010
Gravida1, Para0 (1000) 40-41 weeks age of Normal Ma. Shirly J. Alba, RN., MAN
2 086192 gestation delivered to alive baby boy abortion Barberde, Grace 19 October 22, 2008 12:41am Male Northern Samar Spontaneous PRC No.: 0247477
complete. Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010
Gravida1, Para1 (1001) 35 weeks age of gestation Normal
3 086495 cephalic delivered by normal spontaneous vaginal Tonog, Abba 21 October 30, 2008 12:50am Male Northern Samar Spontaneous Ma. Shirly J. Alba, RN., MAN
delivery to alive baby boy, Provincial Hospital Vaginal Delivery PRC No.: 0247477
Valid Until: 8-7-2010
Normal
4 088458 Gravida3,Para3 (3003)Pregnancy Uterine Full Caparic, Cristine 35 December. 22, 2008 5:47 am Female Northern Samar Spontaneous Ma. Shirly J. Alba, RN., MAN
Term, cephalic in labor delivered by normal Provincial Hospital Vaginal Delivery PRC No.: 0247477
spontaneous vaginal delivery to alive baby girl, Valid Until: 8-7-2010
Normal
5 088471 Gravida3, Para3 (3003) 40 weeks age of gestation Trongcoso, Celsa 32 December 23, 2008 12:05 am Female Northern Samar Spontaneous Ma. Shirly J. Alba, RN., MAN
delivered by normal spontaneous vaginal delivery Provincial Hospital Vaginal Delivery PRC No.: 0247477
to alive baby girl, Valid Until: 8-7-2010

Prepared by: Noted by:


PHILIP E. ADALLA MA. SHIRLY J. ALBA, RN., MAN
Student Clinical Coordinator
(Signature over printed name) (Signature over printed name)
Date Signed:
a.) PRC No. 0247477 Valid Until: August 7, 2010
b.) PNA No. 0247477 Valid Until: Sept, 9, 2009

Concurred by: Approved by:


CESARITH P. HERNANDEZ, RN., MAN JACOB CHINO F. MEIMBAN, RN, MAN Ph. D.
Chief Nurse Dean
(Signature over printed name) (Signature over printed name)
Date Signed: Date Signed:
a.) PRC No. 013475 Valid Until: March 5, 2011 a.) PRC No. 0256777 Valid Until: September 6, 2009
b.) PNA No. 8375 Valid Until: Lifetime Member b.) PNA No. 0011010 Valid Until: January , 2010
c.) ANSAP No. Valid Until: c.) ADCPN No. 326 Valid Until: January , 2010
Republic of the Philippines
EASTERN VISAYAS CENTRAL COLLEGES
Catarman, Northern Samar

Name of Student: ADALLA, PHILIP ENZON


Accreditation Level (if any): N/A Year Granted: N/A
Date School/ Program was recognizes: March 20, 2007 Number: 5 Year: 2007
First Course (if any): Bachelor of Science in Biology School Graduated From: UEP Year: April 3, 2004
Years of Admission in Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN): March 25, 2009

WARNING: All statements are subject of verification and false statements any or misrepresentation made in this DOCUMENT is a ground for disqualification and criminal prosecution
Catarman, Northern Samar

IV- DELIVERIES ASSISTED

No. Case Diagnosis Name of Patient Age Date of Time of Gender of Name of Type of Supervised By: Signature
No. Delivery Deliver Baby Hospital delivery Name of Qualified C.I
y
Pregnancy Uterine Full Term, cephalic in labor delivered Normal Ma. Shirly J. Alba, RN., MAN
1 069835 by normal spontaneous vaginal delivery to alive baby boy, Chin, Carmela 34 August 10, 2007 9:40 am Male Northern Samar Spontaneous PRC No.: 0247477
Gravida3, Para 3(3003) Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010
Pregnancy Uterine Full Term, cephalic in labor delivered Normal Ma. Shirly J. Alba, RN., MAN
2 069745 by normal spontaneous vaginal delivery to alive baby boy, Martines, Jovelyn 22 August 11, 2007 3:11pm Male Northern Samar Spontaneous PRC No.: 0247477
Gravida1, Para 1(1001) Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010
Pregnancy Uterine Full Term, cephalic in labor delivered Northern Samar Normal Ma. Shirly J. Alba, RN., MAN
3 079268 by normal spontaneous vaginal delivery to alive baby, Arca, Riza 32 April 16, 2008 12:55am Male Provincial Hospital Spontaneous PRC No.: 0247477
Gravida4, Para 4(4004) Vaginal Delivery Valid Until: 8-7-2010
Pregnancy Uterine Full Term, cephalic in labor delivered Normal Ma. Shirly J. Alba, RN., MAN
4 086201 by normal spontaneous vaginal delivery to alive baby boy, Rosario A. Espina 34 October. 22,2008 5:22am Male Northern Samar Spontaneous PRC No.: 0247477
Gravida2, Para 2(2002) Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010
Pregnancy Uterine Full Term, cephalic in labor delivered Normal Ma. Shirly J. Alba, RN., MAN
5 088456 by normal spontaneous vaginal delivery to alive baby girl, Acot-Acot, Venus 26 December. 22, 2008 3:47am Female Northern Samar Spontaneous PRC No.: 0247477
Gravida3, Para3 (3003) Provincial Hospital Vaginal Delivery Valid Until: 8-7-2010

Prepared by: Noted by:


PHILIP E. ADALLA MA. SHIRLY J. ALBA, RN., MAN
Student Clinical Coordinator
(Signature over printed name) (Signature over printed name)
Date Signed:
a.) PRC No. 0247477 Valid Until: August 7, 2010
b.) PNA No. 0247477 Valid Until: Sept, 9, 2009

Concurred by: Approved by:


CESARITH P. HERNANDEZ, RN., MAN JACOB CHINO F. MEIMBAN, RN, MAN Ph. D.
Chief Nurse Dean
(Signature over printed name) (Signature over printed name)
Date Signed: Date Signed:
a.) PRC No. 013475 Valid Until: March 5, 2011 a.) PRC No. 0256777 Valid Until: September 6, 2009
b.) PNA No. 8375 Valid Until: Lifetime Member b.) PNA No. 0011010 Valid Until: January , 2010
c.) ANSAP No. Valid Until: c.) ADCPN No. 326 Valid Until: January , 2010
Republic of the Philippines
EASTERN VISAYAS CENTRAL COLLEGES
Catarman, Northern Samar

Name of Student: ADALLA, PHILIP ENZON


Accreditation Level (if any): N/A Year Granted: N/A
Date School/ Program was recognizes: March 20, 2007 Number: Government Recognition No. 5 Year: 2007
First Course (if any): Bachelor of Science in Biology School Graduated From: UEP Year: April 3, 2004
Years of Admission in Bachelor of Science in Nursing Program: 2005 Year Graduated (BSN): March 25, 2009

WARNING: All statements are subject of verification and false statements any or misrepresentation made in this DOCUMENT is a ground for disqualification and criminal prosecution

V-CORD DRESSING

No. Case Date Performed Name of Baby Gender of Name of Mother Age Name of Supervised By: Signature
No. Baby Hospital Name of Qualified C.I
Ma. Shirly J. Alba, RN., MAN
1 073826 April 22, 2007 Fajardo, baby boy Male Fajardo, Ronaliza 22 Northern Samar PRC No.: 0247477
Provincial Hospital Valid Until: 8-7-2010
Ma. Shirly J. Alba, RN., MAN
2 079260 April 15, 2008 Galit, baby boy Male Galit, Nenita P. 42 Northern Samar PRC No.: 0247477
Provincial Hospital Valid Until: 8-7-2010
Northern Samar Ma. Shirly J. Alba, RN., MAN
3 083500 August 19, 2008 Alcayde, baby boy Male Alcayde, Encarnacion 30 Provincial Hospital PRC No.: 0247477
Valid Until: 8-7-2010
Ma. Shirly J. Alba, RN., MAN
4 088463 December 23, 2008 Subrio, baby boy Male Subrio, Rosemarie 34 Northern Samar PRC No.: 0247477
Provincial Hospital Valid Until: 8-7-2010
Ma. Shirly J. Alba, RN., MAN
5 088497 December 23, 2008 Sarmiento, baby girl Female Sarmiento, Baby Dona 20 Northern Samar PRC No.: 0247477
Provincial Hospital Valid Until: 8-7-2010

Prepared by: Noted by:


PHILIP E. ADALLA MA. SHIRLY J. ALBA, RN., MAN
Student Clinical Coordinator
(Signature over printed name) (Signature over printed name)
Date Signed:
a.) PRC No. 0247477 Valid Until: August 7, 2010
b.) PNA No. 0247477 Valid Until: Sept, 9, 2009

Concurred by: Approved by:


CESARITH P. HERNANDEZ, RN., MAN JACOB CHINO F. MEIMBAN, RN, MAN Ph. D.
Chief Nurse Dean
(Signature over printed name) (Signature over printed name)
Date Signed: Date Signed:
a.) PRC No. 013475 Valid Until: March 5, 2011 a.) PRC No. 0256777 Valid Until: September 6, 2009
b.) PNA No. 8375 Valid Until: Lifetime Member b.) PNA No. 0011010 Valid Until: January , 2010
c.) ANSAP No. Valid Until: c.) ADCPN No. 326 Valid Until: January , 2010