COLEGIO DE DAGUPAN

Formerly COMPUTRONIX COLLEGE

COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT:
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
I. MAJOR OPERATIONS
Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors

Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011

b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010

c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010
Prepared by:
_____________________
MEJIA, AIJEM RYAN V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT:
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
II. MINOR OPERATIONS
Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors

Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010
c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010

Prepared by:
_____________________
MEJIA, AIJEM RYAN V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT:
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
III. MINOR OPERATIONS
Supervised by: Name and
DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors

Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010
c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010

Prepared by:
_____________________
MEJIA, AIJEM RYAN V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT:
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
III. DELIVERIES HANDLED
Supervised by: Name and
DATE OF TIME OF GENDER
NO. CASE NO. DIAGNOSIS NAME OF MOTHER AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
1.
2.
3.
4
5.
Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010
c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010

Prepared by:
_____________________
MEJIA, AIJEM RYAN V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
IV. DELIVERIES ASSISTED
Supervised by: Name and
DATE OF TIME OF GENDER
3 CASE NO. DIAGNOSIS NAME OF MOTHER AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
Pangasinan Provincial Normal Spontaneous
1.
Hospital Delivery
2.
3
4
5
Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010
c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010

Prepared by:
_____________________
MEJIA, AIJEM RYAN V.
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan
NAME OF STUDENT:
Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs
V. CORD DRESSING
DATE OF GENDER OF Supervised by: Name and Signature of Qualified
NO. CASE NO. NAME OF BABY NAME OF MOTHER AGE NAME OF HOSPITALS
PERFORMED BABY Clinical Instructors

Concurred by: Approved by: Noted by:

MRS. MARIE FE G. DELA CRUZ MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL HOSPITAL COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: BSN, RN, MAN Degree: BSN, RN, MAN Degree: BSN, RN, MAN
a. PRC No.: 0238673 Valid Until: August 12, 2011 a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
b. PNA No.: 17480 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime b. PNA No.:029081 Valid Until: December 31,2010
c. ANSAP No.: 01349 Valid Until: December 31, 2010 c. ADPCN No.: 0632 Valid Until: December 31, 2010
Prepared by:
_____________________
MEJIA, AIJEM RYAN V.