UNION CHRISTIAN COLLEGE

San Fernando City, La Union

Name of Student: Aguila, Jefferson Gomez
Name and Address of School: UNION CHRISTIAN COLLEGE, Widdoes Street, San Fernando City, 2500, La Union
Accreditation Level (if any): Level II Year Granted: 1999
Date School/Program was Recognized: June 14 Number: 198 Year: 1977
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: 2003
Year Graduated (BSN Program): 2007
II. MINOR OPERATIONS
No Date of Case No. Name of Patient Diagnosis Operation Type of Name of Name of Supervised by: Name &
. Operation Performed Anesthesia Surgeon Hospital Name & Signature of
Signature of O.R. Scrub
Qualified C.I. Nurse

1 February 8, Emergency Alexander James Carbuncle Incision and Drainage Local Jessie Miranda, MD City Health Flordeliza G. Emily Laroya
2007 Medical Gapac Anesthesia Office Galvez PRC No.: 0164680
Service City of San PRC No.: 0130411
Fernando, PNA No.: 16263
(E.M.S.) MAN units: 33 units
La Union

2 July 8, 2006 2006- Owen Oribello Seli Acute Emergency Subarachnoid Dolores Dicdican, Ilocos Training Flordeliza G. Elnar Jubilo
0015134 Appendicitis Appendectomy Block MD and Regional Galvez PRC No.: 0348366
Medical Center PRC No.: 0130411
PNA No.: 16263
(ITRMC) MAN units: 33 units
Bronchial Asthma,
3 June 22, 2006 2006- Redentor A. Soriano Pneumonia with Cut Down Insertion Local Edward Passi, MD Ilocos Training Flordeliza G. Divina Tabios
0008875 Moderate Anesthesia and Regional Galvez PRC No.: 0348392
Exacerbation Medical Center PRC No.: 0130411
PNA No.: 16263
(ITRMC) MAN units: 33 units

4 April 29, 2006 Emergency John Kirby Gregori Redundant Circumcision Local Jessie Miranda, MD City Health Flordeliza G. Emily Laroya
Medical Prepuce Anesthesia Office Galvez PRC No.: 0164680
Service City of San PRC No.: 0130411
Fernando, PNA No.: 16263
(E.M.S.) MAN units: 33 units
La Union

5 January 4, 84 Arturo A. Laigo Tendon Cyst Right Excision of Tendon Cyst Local Maria Teresa Bethany Flordeliza G. Cresencia
2006 Wrist Anesthesia Corpuz, MD Hospital Inc. Galvez Gonzales
PRC No.: 0130411 PNA No.: PRC No.: 0228817
16263
MAN units: 33 units
Prepared by:

AGUILA, Jefferson G.
Name of Student

Concurred by: Noted by: Approved by:

FLORDELIZA R. BOBILES, RN, MAN MARITES G. CALUGAN, RN, MAN NORBERTO G. PREPOSE, JR., RN, MAN
CRISTETA E. BAGTANG, RN, MPH, MAN
 Signature over printed name of Assistant Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of Clinical Coordinator
Signature over printed Name of Dean
Date Signed: ________________________ Date Signed: ________________________ Date Signed: _____________________ Date
Signed: ________________________
Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MPH, MAN
a. PRC NO.: 0114833 a. PRC NO.: 0166707 a. PRC No.: 0209483 a. PRC NO.: 125448
Valid Until: March 27, 2008 Valid Until: May 16, 2009 Valid Until: April 2, 2009 Valid
Until: October 24, 2009
b. PNA No.: 17945 b. PNA No.: 14801 b. PNA No.: 16232 b. PNA
No.: 3051
Valid Until: Lifetime Member Valid Until: Lifetime Member Valid Until: December 2007 Valid
Until: Lifetime Member
c. ANSAP No: 01324 c. ANSAP No: 00077 c. ADPCN No.:
356
Valid Until: December 2007 Valid Until: Lifetime Member Valid
Until: December 2007