PRC Case Form (or-DR Filled) - Final

XAVIER UNIVERSITY- ATENEO DE CAGAYAN
Corrales Ave, Cagayan de Oro City, Philippines

School Code: 0839
Name of Student: Valdevilla, Julio Aldyn P.

Name and Address of School: Xavier University- Ateneo de Cagayan, Corrales St., Cagayan de Oro City
Accreditation Level (if any): None Year Granted: Not Applicable
Date School/Program was Recognized: June 9 Number: 008 Year: 1992
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: 2007
Year Graduated (BSN Program): 2011
I. MAJOR OPERATIONS
No Signature of O.R.
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
PUFT Prolonged Second Stage Misamis Oriental
May 1, 2010 23- 78- 56 Dulce, Amor 2° to CPD extracted a live term Cesarean Section Epidural Anesthesia Dr. Maria Resuel M. Arnado Provincial Joel V. Llagas, BSN, RN
1.
Bb. Boy BW 2.9kg, AS 8,9,10, Hospital- Gingoog
PROM G2P2002
Misamis Oriental
2. May 5, 2010 25- 92- 19 Manzano, Ruselle Fistula in anus Fistulectomy Spinal Anesthesia Dr. Joel A. Babanto Jr. Provincial Corazon C. Reyes, BSN, RN
Hospital- Gingoog
Xavier University
3. May 21, 2010 05- 100- Jamil, Teopanis Cataract, Senile Mature OD PECLE OD with PCIOL P21.5 Retrobulbar Block Dr. Augusto V. Dejos Community Health Teofanes D. Guinita, BSN, RN
209- 10 Care Center
Misamis Oriental
4. December 21, 2010 26- 13- 06 Labor, Monica Cataract, Senile Mature OS PECLE, OS Retrobulbar Block Dr. Augusto V. Dejos Provincial Fe T. Teope, BSN, RN
Hospital- Gingoog
April 20, 2011 82- 24- 71 Cabatuan, Retroperitoneal tumor perirenal EN BLOC resection of Epidural Anesthesia, Dr. Claire D. Meso Northern Anna Kattrina G. Epon, BSN, RN
5. Carmeilita left probably sarcoma retroperitoneal tumor with General Anesthesia Dr. Philip Jason V. Antinero Mindanao Medical
nephrectomy left lavage Dr. Ivan Benjamin M. Bagas Center
Prepared By: Supervised By: Noted By: Concurred By: Concurred By: Concurred by: Approved By:
VALDEVILLA, JULIO ALDYN P. MILDRED N. PINQUE CHRISTY G. DABLO JULIANA L. JAVIER EVA R. LLENO DR. DOROTHEA N. ROQUE DR. RAMONA HEIDI C. PALAD
Name of Student Clinical Instructor Clinical Instructor Chief Nurse Chief Nurse Chief Nurse Dean, College of Nursing
Xavier University- Ateneo de Cagayan Xavier University- Ateneo de Cagayan Misamis Oriental Provincial Hospital- Xavier University Community Health Northern Mindanao Medical Center Xavier University- Ateneo de Cagayan
Gingoog Care Center
Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed:
Degree: BSN, RN, MN Degree: BSN, RN, MN, MAN Degree: BSN, RN Degree: BSN, RN, MHA Degree: BSN, RN, MAN, Ed D Degree: BSN, RN, MAN, MAEd, PhD
a) PRC No: 0229025 a)PRC No: 0222342 a)PRC No: 0077182 a)PRC No: 0091662 a)PRC No: 0041397 a)PRC No: 0053722
Valid Until: March 21, 2014 Valid Until: November 22, 2013 Valid Until: December 10, 2013 Valid Until: August 9, 2012 Valid Until: February 6, 2013 Valid Until: August 31, 2012
b) PNA No: 045489 b) PNA No: 045476 b) PNA No: b) PNA No: 18586 b) PRC No: 045650 b) PNA No: 11836
Valid Until: October 11, 2011 Valid Until: October 21, 2011 Valid Until: Valid Until: Lifetime Valid Until: October 31, 2011 Valid Until: Lifetime
c) ANSAP No: 0523 c) ANSAP No: 10-0305 c) ADPCN No: 0063
Valid Until: Lifetime Valid Until: Valid Until: October 31, 2011
School Code: 0839

II. Minor Operations

Date of Name of O.R. Scrub Signature of O.R. Scrub
No. Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital
Operation Nurse Nurse
January 20, 05- 99753- 10 Mosqueda, Cliff Mass Alveolopalato Excision of Mass, Local Anesthesia Dr. Bernabe P. Mendoza Xavier University Teofanes D. Guinita,
1. 2010 Gingival Anterior GIngivobucco Community Health Care BSN, RN
Area Alveoloplasty Center
April 20, 2010 24- 87- 62 Mediante, Sheena Marie Post- Wart Wart Cauterization Local Anesthesia Dr. Manuel B. Lumayag Misamis Oriental Joel V. Llagas, BSN, RN
2. Cauterization at Left Provincial Hospital-
hand Gingoog
April 27, 2010 25- 92- 49 Granada, Charles Joshua Post- Circumcision Circumcision Local Anesthesia Dr. Manuel B. Lumayag Misamis Oriental Joel V. Llagas, BSN, RN
3. Provincial Hospital-
Gingoog
April 27, 2010 25- 92- 50 Yamaro, Joshua Post- Circumcision Circumcision Local Anesthesia Dr. Manuel B. Lumayag Misamis Oriental Joel V. Llagas, BSN, RN
4. Provincial Hospital-
Gingoog
October 21, 17- 40- 23 Balcorza, Emmanuel Lacerated wound, Suturing, 1 stitch Local Anesthesia Dr. Dionne Marie Genise R. Misamis Oriental Joel V. Llagas, BSN, RN
5. 2010 1cm , right arm Almero Provincial Hospital-
Gingoog
Prepared By: Supervised By: Noted By: Concurred By: Concurred By: Approved By:
VALDEVILLA, JULIO ALDYN P. MILDRED N. PINQUE CHRISTY G. DABLO JULIANA L. JAVIER EVA R. LLENO DR. RAMONA HEIDI C. PALAD
Name of Student Clinical Instructor Clinical Instructor Chief Nurse Chief Nurse Dean, College of Nursing
Xavier University- Ateneo de Cagayan Xavier University- Ateneo de Cagayan Misamis Oriental Provincial Hospital- Xavier University Community Health Care Xavier University- Ateneo de Cagayan
Gingoog Center
Date Signed: Date Signed: Date Signed: Date Signed: Date Signed:
Degree: BSN, RN, MN Degree: BSN, RN, MN, MAN Degree: BSN, RN Degree: BSN, RN, MHA Degree: BSN, RN, MAN, MAEd, PhD
a) PRC No: 0229025 a)PRC No: 0222342 a)PRC No: 0077182 a)PRC No: 0091662 a)PRC No: 0053722
Valid Until: March 21, 2014 Valid Until: November 22, 2013 Valid Until: December 10, 2013 Valid Until: August 9, 2012 Valid Until: August 31, 2012
b) PNA No: 045489 b) PNA No: 045476 b) PNA No: b) PNA No: 18586 b) PNA No: 11836
Valid Until: October 11, 2011 Valid Until: October 21, 2011 Valid Until: Valid Until: Lifetime Valid Until: Lifetime
c) ANSAP No: 0523 c) ADPCN No: 0063
Valid Until: Lifetime Valid Until: October 31, 2011
School Code: 0839

III. ACTUAL DELIVERIES

Date of Time of Gender Type of Supervised by: Name and Signature of Qualified
No. Case No. Diagnosis Name of Mother Age Name of Hospital
Delivery Delivery of Baby Delivery C.I.
06-90-39 PUFT delivered NSD female 3.1kg AS 9, Rabe, Josephine 19 April 27, 2010 3:55 PM Female Misamis Oriental Provincial NSVD
1. 10, Thickly meconium, G1P1001 Yuson years Hospital- Gingoog
old Christy G. Dablo, BSN, RN, MN, MAN
22- 84- 27 PUFT delivered by NSD to alive baby girl, Salva, Suzette 19 October 21, 10:23 PM Female Misamis Oriental Provincial NSVD with right
2. BW 3.2kg, AS 4,6 years 2010 Hospital- Gingoog mediolateral
old Crizelda S. Bagares, BSN, RN, MN
26- 45- 33 PUFT delivered by NSD a live baby boy Estrada, Angie 24 October 22, 5:05 AM Male Misamis Oriental Provincial NSVD
3. AS 8,9, BW 2.7 kg years 2010 Hospital- Gingoog
19- 76- 70 PUFT delivered NSD male 4.2kg AS 9,10 Hallasgo, Miraluna 33 December 21, 12:28 PM Male Misamis Oriental Provincial NSVD
4. G4P4004, Chronic Hypertensive, Anemia C. years 2010 Hospital- Gingoog
old Ivy R. Go, BSN,RN, MAN
26- 82- Delivered term to a Bb Boy 2.4kg APGAR Gabales, Gerlie 37 February 26, 4:15 AM Male Misamis Oriental Provincial NSVD
5. 64 8, 9 via NSVD cephalic G3P3(3003) years 2011 Hospital- Gingoog
old Ivy R. Go, BSN,RN, MAN
Prepared By: Supervised By: Noted By: Concurred By: Approved By:
VALDEVILLA, JULIO ALDYN P. MILDRED N. PINQUE CHRISTY G. DABLO JULIANA L. JAVIER DR. RAMONA HEIDI C. PALAD
Name of Student Clinical Instructor Clinical Instructor Chief Nurse Dean, College of Nursing
Xavier University- Ateneo de Cagayan Xavier University- Ateneo de Cagayan Misamis Oriental Provincial Hospital- Gingoog Xavier University- Ateneo de Cagayan
Date Signed: Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MN Degree: BSN, RN, MN, MAN Degree: BSN, RN Degree: BSN, RN, MAN, MAEd, PhD
a) PRC No: 0229025 a)PRC No: 0222342 a)PRC No: 0077182 a)PRC No: 0053722
Valid Until: March 21, 2014 Valid Until: November 22, 2013 Valid Until: December 10, 2013 Valid Until: August 31, 2012
b) PNA No: 045489 b) PNA No: 045476 b) PNA No: b) PNA No: 11836
Valid Until: October 11, 2011 Valid Until: October 21, 2011 Valid Until: Valid Until: Lifetime
c) ADPCN No: 0063
Valid Until: October 31, 2011
School Code: 0839

IV. DELIVERIES ASSISTED

Date of Time of Gender Type of Supervised by: Signature of
No. Case No. Diagnosis Name of Mother Age Name of Hospital
Delivery Delivery of Baby Delivery Qualified C.I.
25- 92- 01 PUFT delivered by NSD a live baby girl Lorico, Joem 27 April 26, 2007 8: 50 AM Female Misamis Oriental Provincial Hospital- Gingoog NSVD
1. AS 8,9, BW 2.5g, AOG 38- 40 wks, Jamero years
G1P001 old Christy G. Dablo, BSN, RN, MN, MAN
25- 61- 07 PUFT delivered NSD to a live term baby Garcia, Wendy 26 April 28, 2010 3:13 PM Male Misamis Oriental Provincial Hospital- Gingoog NSVD
2. boy BW 3.1kg, AS of 8,9,10 Librando years
old Christy G. Dablo, BSN, RN, MN, MAN
22- 76- 59 PUFT delivered NSD to a live term baby Ligahon, 22 October 19, 4:48 PM Male Misamis Oriental Provincial Hospital- Gingoog NSVD
3. boy BW 3.2 kg, AS of 8,9 Shangrila years 2010
old CrizeldaS. Bagares, BSN, RN, MN
26- 15- 18 PUFT delivered NSD to alive term baby Adanza, Lea 27 October 19, 7:38 PM Female Misamis Oriental Provincial Hospital- Gingoog NSVD
4. girl BW 2.4kg, AS 9, 10, G2P0A1L0 Kristy M. years 2010
26- 44- 98 PUFT delivered NSVD to alive term Bb Cotmaya, Elvie 26 October 21, 12:34 AM Female Misamis Oriental Provincial Hospital- Gingoog NSVD
5. female BW 2.6kg, AS 9,10, G1P0 years 2010

c) ADPCN No: 0063
School Code: 0839

V. CORD DRESSING
No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Supervised by: Signature of Qualified C.I.
25- 64- 76 April 28, 2010 Bb Boy Alcala Male Alcala, Jennifer B. 33 years old Misamis Oriental Provincial Hospital- Gingoog
1.
Christy G. Dablo, BSN, RN, MN, MAN
23- 08- 92 May 1, 2010 Bb Girl Salva Female Salva, Len Fabre 17 years old Misamis Oriental Provincial Hospital- Gingoog
2.
Christy G. Dablo, BSN, RN, MN, MAN
24- 64- 48 October 19, 2010 Bb Boy Pacot Male Pacot, Charlotte 22 years old Misamis Oriental Provincial Hospital- Gingoog
3.
Crizelda S. Bagares, BSN, RN, MN
26- 15- 18 October 19, 2010 Bb Girl Adanza Female Adanza, Lea Kristy M. 27 years old Misamis Oriental Provincial Hospital- Gingoog
4.
26- 45- 39 October 22, 2010 Bb Boy Papolonias Male Papolonias, Kristine Grace 19 years old Misamis Oriental Provincial Hospital- Gingoog
5.

c) ADPCN No: 0063

PRC Case Form (or-DR Filled) - Final

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XAVIER UNIVERSITY- ATENEO DE CAGAYAN

Corrales Ave, Cagayan de Oro City, Philippines

Name of Student: Valdevilla, Julio Aldyn P.

Name of Student: Valdevilla, Julio Aldyn P.

II. Minor Operations

Name of Student: Valdevilla, Julio Aldyn P.

III. ACTUAL DELIVERIES

Date Signed: Date Signed: Date Signed: Date Signed:

Name of Student: Valdevilla, Julio Aldyn P.

IV. DELIVERIES ASSISTED

Date Signed: Date Signed: Date Signed: Date Signed:

Name of Student: Valdevilla, Julio Aldyn P.

Date Signed: Date Signed: Date Signed: Date Signed:

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