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: Myra May I. Sumonod 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: NOT APPLICABLE Year: NOT APPLICABLE June 1972 Year of Admission in the BSN Program: 2006 Year Graduated (BSN Program): April 2011

I. MAJOR OPERATIONS
N o.
1 2 3

Date of Operati on
Jan. 27,2009

Case No.
130

Name of Patient
Dela Cruz, Leonila

Diagnosis
Cataract mature right eye status post extra capsular lens extraction with intraocular lens left eye

Operation Performed
Phacoemulsification

Types of Anesthe sia

Retrobulbar Block

Name of Surgeon
Dr. Carlo Romero

Name of Hospital
Polymedic General Hospital

Name of Qualified OR Scrub Nurse

Tan Nery, Ma. Aimee

Signature of OR Scrub Nurse

5
Prepared by: Supervised by:

Noted by: VIVIAN L. CEBALLOS

Clinical Coordinator/RLE Chairperson Liceo de Cagayan University Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947

Concurred by: DOROTHEA N. ROQUE

Chief Nurse Northern Mindanao Medical Center Date Signed: ____________ Degree: BSN, RN, MAN,EdD PRC No: 0041397 Valid Until: Febuary 6,2013 PNA No: 024482

Approved by:

Name and Signature of Student IN OR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN, MN PRC No:

GINA S. BATASIN-

GEORGE MICHEAL P. LIM

Chief Nurse Cagayan de Oro Polymedic General Hospital Date Signed: ____________ Degree: BSN, RN, MN PRC No: 300900 Valid Until: January 17,2011 PNA No: 19270 Valid Until: October 31,

MA. CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: BSN, RN, MAN PRC No.: 0080354 Valid Until:

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:

Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III Autonomous Level November, 2009 First Course (if any): NOT APPLICABLE October, 2008 School Graduated from: NOT APPLICABLE Year: NOT APPLICABLE June 1972 Year of Admission in the BSN Program: June 2006 Year Graduated (BSN Program): March 2010

II. MINOR OPERATIONS

No .
1

Date of Operati on
Feb. 14, 2010 Feb. 14, 2010 Feb. 26, 2010 Feb. 24, 2010 Feb. 14, 2010

Case No.
706120

Name of Patient
Alongay, Rhebin Listohan, Erning Malong, Dandy Boncales, Benjamin Catabanus, Polybenus

Diagnosis
Lacerated Wound, 2cm Parietal Area

Operation Performed
Suturing and Dressing Finger Splint Left Debribement Removal of Foreign Bodies Suturing and Dressing

Types of Anesthesi a
Local Anesthesia Local Anesthesia Local Anesthesia Local Anesthesia Local Anesthesia

Name of Surgeon
Dr. Mauro C. Bravo III Dr. Balaba Dr. Dean Marvin Eduave Dr. Ryan Serra Dr. Mauro C. Bravo III

Name of Hospital
Northern Mindanao Medical Center Northern Mindanao Medical Center Bukidnon Provincial Medical Center Bukidnon Provincial Medical Center Northern Mindanao Medical Center

Name of OR Scrub Nurse

Alma Gina M. Cartagena, RN Alma Gina M. Cartagena, RN Maribel V. Deleonio, RN Maribel V. Deleonio, RN Alma Gina M. Cartagena, RN

Signatur e of OR Scrub Nurse

706473 376885 378684 706103

Transection of Flexor Tendon Avulsed Wound 1cm left Leg Punctured Wound with retained Foreign Bodies (Bamboo) Lacerated Wound 4 cm, Ankle ( Achillis Aspect) Left

2 3 4

Prepared by:

Supervised by:

Noted by: VIVIAN L. CEBALLOS

Clinical Coordinator/RLE Chairperson Liceo de Cagayan University Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947

Concurred by: DOROTHEA N. ROQUE

Chief Nurse Northern Mindanao Medical Center Date Signed: ____________ Degree: BSN, RN, MAN,EdD PRC No: 0041397 Valid Until: Febuary 6,2013 PNA No: 024482 Valid Until: October 31,

Concurred by: CORAZON J. JAMERO

Chief Nurse Bukidnon Provincal Medical Center Date Signed: ____________ Degree: BSN, RN, MAN,EdD PRC No: 0041397 Valid Until: Febuary 6,2013 PNA No: 024482 Valid Until: October 31,

Approved by:

Name and Signature of Student IN

GINA S. BATASINOR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN, MN PRC No:

MA. CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: BSN, RN, MAN PRC No.: 0080354

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:

Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III Autonomous Level November, 2009 First Course (if any): NOT APPLICABLE October, 2008 School Graduated from: NOT APPLICABLE Year: NOT APPLICABLE June 1972 Year of Admission in the BSN Program: June, 2006 Year Graduated (BSN Program): March 2010

III. HANDLED DELIVERIES

N o.
1

Case No.
144296 619693

Diagnosis
Delivery Term Spontaneous a live Baby Boy 2.9 Kg. Cephalic, Previous Cesarian Section, Gravida2 Parity2 Delivery Term Spontaneous with an APGAR Score of 9, Gravida 4, Parity 4 Pregnancy Uterine Full Term Deliver Spontaneously Live Term Baby Boy Cephalic, Birth weight,-3200grams/ Preeclampsia; Gravida 3 Paity 1 Delivery term Spontanous to an alive Baby Boy, Birht weight 3250 grams, Left Occiput Anterior, Gravida1 Parity1 Pregnancy Uterine 40 weeks Age of Gestation, Gravida 2 Parity 1 Term 2 Post-term 1 A-0 Live 2 Concurred by: Noted by: VIVIAN L. CEBALLOS
Clinical Coordinator/RLE Chairperson Liceo de Cagayan University Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947

Name of Mother
Christy Lee Ybanez Analyn Unabia Cabanig, Ivy A. Angaon, Elizabeth Merida, Gina T

Age
20year s old 29 years old 30 years old 26 years old 24 years old

Date of Delivery
March 6, 2010 May 26, 2009

Time of Deliv ery

7:41 PM 2:21 AM

Gende r of Baby
MALE MALE

Name of Hospital
Bukidnon Provincial Medical Center JR Borja General Hospital Bukidnon provincial HospitalMaramag Northern Mindanao Medical Center Northern Mindanao Medical Center

Type of Delivery
Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery
Approved by:

Name and Signature of Qualified DR Clinical Instructor

Zolivenn S. Pablillaran, RN, Arlene Maria Caranatan, RN, MN Ana Marie A. Ambat, RN

2 3

007034

July 24, 2008 December 4, 2009 October 27, 2009

1:57 AM

MALE

4 5

4718339 665041

7:50 AM 12:05 AM

MALE FEMALE

Elvyn Mabao, RN Elvyn Mabao, RN

Prepared by:

CORAZON J. JAMERO

DOROTHEA N. ROQUE
Chief Nurse Northern Mindanao Medical Center Date Signed: ____________ Degree: BSN, RN, MAN,EdD PRC No: 0041397 Valid Until: Febuary 6,2013 PNA No: 024482 Valid Until: October 31, 2010

Name and Signature of Student

Chief Nurse LANNIE O. Bukidnon Provincal Medical CAPINPUYAN Center Chief Nurse Date Signed: ____________ J.R Borja General City Degree: BSN, RN, Hospital MAN,EdD Date Signed: ____________ PRC No: 0041397 Degree: BSN, RN, MAN Valid Until: Febuary PRC No: 0118996 6,2013 Valid Until: October PNA No: 024482 19,2010 Valid Until: October 31, PNA No: 024484 2010

MA. CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: BSN, RN, MAN PRC No.: 0080354

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:

Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III Autonomous Level November, 2009 First Course (if any): NOT APPLICABLE October, 2008 School Graduated from: NOT APPLICABLE Year: NOT APPLICABLE June 1972 Year of Admission in the BSN Program: June, 2006 Year Graduated (BSN Program): March 2010

IV. ASSISTED DELIVERIES

N o.
1

Case No.
43883 2 66504 6 471339 14427 3 09045

Diagnosis
Delivery Term Spontaneous and Alive Baby Boy, Left Occiput Anterior, Gravida 1 Parity 1 Pregnancy Uterine, 36 weeks Age of Gestation Gravida 1 Parity 1 Delivery Term Spontaneous and Alive Baby Boy Cephalic Presentation, Gravida 1 Parity 1 Delivery Term Spontaneous Alive Baby Boy Cephalic Nuchial Cord coil one Pregnancy Uterine Full Term, Age of Gestation-38 weeks, Cephalic Presentation to alive Baby Girl, Gravida 4, Parity 4 Noted by: VIVIAN L. CEBALLOS

Name of Mother
Jeniffer v. Fernandez Karen joy Lintawahan Elizabeth Anga-on Janeth Orellan Caseres Josephine Dahan

Age
22 years old 21 years old 26 years old 31 years old 38 years old

Date of Delivery
December 21, 2009 October 27, 2009 December 21, 2009 March 6, 2010 March 14, 2010

Time of Deliver y
4:59 PM

Gend er of Baby
MALE

Name of Hospital
Northern Mindanao Medical Center Northern Mindanao Medical Center Northern Mindanao Medical Center Bukidnon Provincial HospitalMalaybalay Barangay 24 Health Center

Types of Delivery
Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Name and Signature of Qualified DR Clinical Instructor

Elvyn B. Mabao, RN

2 3

2:43 AM

MALE

Elvyn B. Mabao, RN

7:50 AM

MALE

Elvyn B. Mabao, RN

6:08 PM

MALE

Zolivenn S. Pablillaran, RN,

2:27PM

FEMALE

Rowena B. Chua, RN, MN

Approved by:

Prepared by:

Concurred by: DOROTHEA N. ROQUE Iryn Salcedo CORAZON J. JAMERO

Chief Nurse Bukidnon Provincial HospitalMalaybalay Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0095999 Valid Until: January 4,2012 PNA No: 19483 Valid Until: Lifetime Member ANSAP No.: 05144 Valid Until: December 31,

Name and Signature of Student

Chief Nurse Clinical Coordinator/RLE Northern Mindanao Medical Chairperson Center Liceo de Cagayan University Date Signed: ____________ Date Signed: ____________ Degree: BSN, RN, Degree: BSN, RN, MAN MAN,EdD PRC No: 0171698 PRC No: 0041397 Valid Until: September 7, Valid Until: Febuary 2011 6,2013 PNA No: 17947 PNA No: 024482 Valid Until: October 31,

MA. CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: BSN, RN, MAN PRC No.: 0080354

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:

Liceo de Cagayan University Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA Level III Autonomous Level November, 2009 First Course (if any): NOT APPLICABLE October, 2008 School Graduated from: NOT APPLICABLE Year: NOT APPLICABLE June 1972 Year of Admission in the BSN Program: June, 2006 Year Graduated (BSN Program): March 2010

V. IMMEDIATE NEWBORN CARE

No .
1 2 3 4 5

Case No.
613862 -A 007494 683044 666013 619554

Date Performed
May 26, 2009 July 25, 2008 December 21, 2009 October 27, 2009 May 25, 2009

Name of Baby
Baby Boy Andevor Baby Boy Tampipi Baby Boy Baconga Baby Boy Cabangbang Baby Boy Dongalio

Gende r of Baby
MALE MALE MALE MALE MALE

Name of Mother
Rachelle Andevor Liezel Tampipi Florepe Baconga Ruth Cabangbang Alma Dongalio

Age
14years old 24years old 36 years old 32 years old 31 years old

Name of Hospital
JR Borja General Hospital Bukidnon Provincial HospitalMalaybalay Northern Mindanao Medical Center Northern Mindanao Medical Center JR Borja General Hospital

Types of Delivery
Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Cesarean Section Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Name and Signature of Qualified DR Clinical Instructor

Arlen Maria Caranatan, RN,MN Ana Marie A. Ambat, RN Elvyn B. Mabao, RN Elvyn B. Mabao, RN Arlen Maria Caranatan, RN,MN

Prepared by:

Noted by: VIVIAN L. CEBALLOS

Clinical Coordinator/RLE Chairperson Liceo de Cagayan University Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947

Concurred by: DOROTHEA N. ROQUE CORAZON J. JAMERO

Chief Nurse Bukidnon Provincial HospitalChief Nurse Malaybalay Northern Mindanao Date Signed: ____________ Medical Center Degree: BSN, RN, MAN Date Signed: ____________ PRC No: 0095999 Degree: BSN, RN, Valid Until: January 4,2012 MAN,EdD PNA No: 19483 PRC No: 0041397 Valid Until: Lifetime Valid Until: Febuary Member 6,2013 ANSAP No.: 05144 PNA No: 024482 Valid Until: December 31,

Approved by:

Name and Signature of Student

LANNIE O. CAPINPUYAN
Chief Nurse J.R Borja General City Hospital Date Signed: ____________ Degree: BSN, RN, MAN PRC No: 0118996 Valid Until: October 19,2010

MA. CHONA V. PALOMARES

Dean Liceo de Cagayan University Date Signed: _______________ Degree: BSN, RN, MAN PRC No.: 0080354 Valid Until:

000