CDD Sample Caseload

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
DATE OF OPERATION TYPES OF Supervised by: Name and
NAME OF NAME OF
NO. CASE NO. DIAGNOSIS NAME OF SURGEON Signature of Qualified
PATIENTS HOSPITALS
OPERATION PERFORMED ANESTHESIA Clinical Instructors
Concurred by: Approved by: Noted by:

MRS. GLORIA M. ERIVE 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.: 0082420 Valid Until: December 5, a. PRC No.: 0301235 Valid Until: August 8,
a. PRC No.: 0324668 Valid Until: April 20, 2011
2010 2012
b. PNA No.:013755 Valid Until: December

b. PNA No.: 11972 Valid Until: Lifetime b. PNA No.:16540 Valid Until: Lifetime
31,2010
c. ADPCN No.: 0632 Valid Until: December 31,

c. ANSAP No.: 0469 Valid Until: Lifetime
2010
Prepared by:
_____________________
COLEGIO DE DAGUPAN
COLLEGE OF NURSING
NAME OF STUDENT:

Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs:
II. MINOR OPERATIONS

DATE OF OPERATION TYPES OF Supervised by: Name and
NAME OF NAME OF
NO. CASE NO. DIAGNOSIS NAME OF SURGEON Signature of Qualified
PATIENTS HOSPITALS
OPERATION PERFORMED ANESTHESIA Clinical Instructors
a. PRC No.: 0301235 Valid Until: August 8,

2012
b. PNA No.:16540 Valid Until: Lifetime b. PNA No.: :013755 Valid Until: December
31,2010

2010
Prepared by:
_____________________
COLEGIO DE DAGUPAN
COLLEGE OF NURSING
NAME OF STUDENT
Year of Admission in Bachelor Science in Nursing: Year Graduated in Bachelor Science Nursing Programs:
III. DELIVERIES HANDLED

Supervised by: Name
GENDER
DATE OF TIME OF and Signature of
CASE AG
NO. DIAGNOSIS NAME OF MOTHER NAME OF HOSPITALS TYPE OF Qualified
NO. E OF
DELIVERY DELIVERY
BABY
DELIVERY Clinical Instructors
Concurred by:
Approved by: Noted by:
MRS. GLORIA M. ERIVE

MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse
Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL
COLLEGE OF NURSING COLLEGE OF NURSING
HOSPITAL
Date Signed: Date Signed:

Date Signed:
Degree: BSN, RN, MAN Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
a. PRC No.: 0082420 Valid Until: December

a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
5, 2010
b. PNA No.:013755 Valid Until: December 31,

2010
c. ANSAP No.: 0469 Valid Until: Lifetime c. ADPCN No.: 0632 Valid Until: December 31, 2010
Prepared by:
_____________________
COLEGIO DE DAGUPAN
COLLEGE OF NURSING
NAME OF STUDENT: Mejia, Aijem Ryan V.
Year of Admission in Bachelor Science in Nursing: 2008 Year Graduated in Bachelor Science Nursing Programs: 2010
IV. DELIVERIES ASSISTED

Supervised by: Name
GENDER
DATE OF TIME OF and Signature of
NAME OF
NO. CASE NO. DIAGNOSIS AGE NAME OF HOSPITALS TYPE OF Qualified
MOTHER OF
DELIVERY DELIVERY
BABY
DELIVERY Clinical Instructors
Concurred by:
Approved by: Noted by:
MRS. GLORIA M. ERIVE

MRS. AIDA D. SORIANO MRS. MARIVIC C. VERGONIA
Chief Nurse
Dean Clinical Coordinator, Level IV
DAGUPAN DOCTOR’S VILLAFLOR MEMORIAL
COLLEGE OF NURSING COLLEGE OF NURSING
HOSPITAL
Date Signed: Date Signed:

Date Signed:
Degree: BSN, RN, MAN Degree: BSN, RN, MAN
Degree: BSN, RN, MAN
a. PRC No.: 0082420 Valid Until:

a. PRC No.: 0301235 Valid Until: August 8, 2012 a. PRC No.: 0324668 Valid Until: April 20, 2011
December 5, 2010

31,2010
c. ANSAP No.: 0469 Valid Until: Lifetime c. ADPCN No.: 0632 Valid Until: December 31, 2010
Prepared by:
_____________________
COLEGIO DE DAGUPAN
COLLEGE OF NURSING
NAME OF STUDENT:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs:
V. CORD DRESSING
DATE OF GENDER OF
CASE Supervised by: Name and Signature of
NO. NAME OF BABY NAME OF MOTHER AGE NAME OF HOSPITALS
NO. Qualified Clinical Instructors
PERFORMED BABY

a. PRC No.: 0082420 Valid Until: December 5, a. PRC No.: 0301235 Valid Until: August 8,
2010 2012

31,2010

c. ANSAP No.: 0469 Valid Until: Lifetime
2010
Prepared by:
_____________________
MEJIA, AIJEM RYAN V.

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COLEGIO DE DAGUPAN

Formerly COMPUTRONIX COLLEGE

First Course (If any): None School Graduated from Year:

Concurred by: Approved by: Noted by:

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:

b. PNA No.:013755 Valid Until: December

c. ADPCN No.: 0632 Valid Until: December 31,

First Course (If any): None School Graduated from Year:

II. MINOR OPERATIONS

Concurred by: Approved by: Noted by:

MRS. GLORIA M. ERIVE 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:

a. PRC No.: 0301235 Valid Until: August 8,

c. ADPCN No.: 0632 Valid Until: December 31,

First Course (If any): None School Graduated from Year:

III. DELIVERIES HANDLED

MRS. GLORIA M. ERIVE

Date Signed: Date Signed:

a. PRC No.: 0082420 Valid Until: December

b. PNA No.:013755 Valid Until: December 31,

First Course (If any): None School Graduated from Year:

IV. DELIVERIES ASSISTED

MRS. GLORIA M. ERIVE

Date Signed: Date Signed:

a. PRC No.: 0082420 Valid Until:

b. PNA No.:013755 Valid Until: December

First Course (If any): None School Graduated from Year:

Concurred by: Approved by: Noted by:

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:

b. PNA No.:013755 Valid Until: December

c. ADPCN No.: 0632 Valid Until: December 31,

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