PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC. 1813 C.M. RECTO AVE.

, MANILA Date when school was recognized: October 24, 1996 NAME OF STUDENT: Crystal Fae S. Dorotan Name and Address of school: Philippine College of Health Sciences, Inc. 1813 C.M. Recto Avenue, Manila Recognition and Accreditation Level: CHED / Level IV I. MINOR OPERATIONS
No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Extra capsular cataract extraction with intraocular lens right eye Type of Anesthesia Name of Surgeon Name of Hospital Supervised by Qualified Clinical Instructor

First Course (if any): _____________________________________ School graduated: _____________________________________ Year of admission in the BSN Program: ______________________ Year graduated from the BSN Program:______________________

1.

January 15, 2011

542055 Dela Cruz, Edmon

Cataract mature right eye

Local Anesthesia Local Anesthesia General Anesthesia

Angelito F. Batooon, MD

Mandaluyong City Medical Center Serafin B. Solano Jr., R.N., M.A.N.

2.

January 19, 2011

542079

Cabato, Dennis

Mole at left bridge nose

Excision/Biopsy

Felipe C. Martines, MD

Mandaluyong City Medical Center

Serafin B. Solano Jr., R.N., M.A.N.

3.

January 23, 2011

542154

Ramirez, Gina

Cholecytectomy with Dehiscence

Emergency Wound Exploration

Mario C. Lato

Mandaluyong City Medical Center Serafin B. Solano Jr., R.N., M.A.N.

4.

January 27, 2011

542165

Tamondong, Vince

Inguinal Hernia Right Acute Appendicitis

Herniorrhaphy

Spinal Anesthesia Spinal Anesthesia

Jose Q. Melendres, MD

Mandaluyong City Medical Center Serafin B. Solano Jr., R.N., M.A.N.

5.

January 31, 2011

542201

De Luna, Dianne

Emergency Appendectomy

Cecilia T. Leyson, MD

Mandaluyong City Medical Center Serafin B. Solano Jr., R.N., M.A.N.

Prepared by: _______________________________________________ Signature over printed name Valid until: December 2011 Approved by: __________________________________ Signature over printed name of Chief Nurse Date Signed: Degree: B.S.N., M.A.N.______________ a. PRC No. 0127552________________ Valid until: October 2, 2013__________ b. PNA No. 17873__________________ Valid until: Lifetime Member__________ c. ANSAP No. 00615 Valid until: December 2011 MARY JANE F. VILLANUEVA., R.N., M.A.N. Signature over printed name of dean Date Signed: _______________ Degree: B.S.N., M.A.N. a. PRC No. 087415 Valid Until: June 24, 2011 b. PNA No. 5451 Valid until: Life member c. ADPCN No. 001

Concurred by:

PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC. 1813 C.M. RECTO AVE., MANILA
NAME OF STUDENT: ____________________________________ Name and Address of school: Philippine College of Health Sciences, Inc. 1813 C.M. Recto Avenue, Manila Recognition and Accreditation Level: CHED / Level IV Date when school was recognized: October 24, 1996 No . 1. 2. 3. 4. 5. Date of Operation Case No. Name of Patient Diagnosis First Course (if any): _____________________________________ School graduated: _____________________________________ Year of admission in the BSN Program: ______________________ Year graduated from the BSN Program:______________________

II. MINOR OPERATIONS Operation Type of Name of Surgeon Performed Anesthesia

Name of Hospital

Supervised by Qualified Clinical Instructor

Prepared by: ___________________________________________ Signature over printed name Concurred by: ___________________________________ Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: ___________________ a. PRC No. ___________________ Valid Until: ___________________ b. PNA No. Valid until: ___________________ ___________________ MARY JANE F. VILLANUEVA., R.N., M.A.N. Signature over printed name of dean Date Signed: _______________ Degree: B.S.N., M.A.N. a. PRC No. 087415 Valid Until: June 24, 2011 b. PNA No. 5451 Valid until: Life member

Approved by:

c. ADPCN No. 001 Valid until: December 2010

Noted by:

JOMAR C. CORDERO, R.N., M.A.N. Signature over printed name of clinical coordinator Date Signed: _________________ Degree: B.S.B.A., B.S.N., M.A.N. a. PRC No. 070751 Valid Until: May 3, 2012

b. PNA No. Valid until:

001729 December 2011

PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC. 1813 C.M. RECTO AVE., MANILA

NAME OF STUDENT: ____________________________________ Name and Address of school: Philippine College of Health Sciences, Inc. 1813 C.M. Recto Avenue, Manila Recognition and Accreditation Level: CHED / Level IV Date when school was recognized: October 24, 1996 No. Case No. 1. 2. 3. 4. 5. Diagnosi s Name Mother Age III. ACTUAL DELIVERIES Date of Time of Gender of Delivery Delivery Baby

First Course (if any): _____________________________________ School graduated: _____________________________________ Year of admission in the BSN Program: ______________________ Year graduated from the BSN Program:______________________

Name of Hospital

Type of Delivery

Supervised by Qualified Clinical Instructor

Prepared by: ___________________________________________ Signature over printed name Concurred by: ___________________________________ Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: ___________________ a. PRC No. ___________________ Valid Until: b. PNA No. Valid until: ___________________ ___________________ ___________________ Approved by: MARY JANE VILLANUEVA., R.N., M.A.N. Signature over printed name of dean Date Signed: _______________ Degree: B.S.N., M.A.N. a. PRC No. 087415

Valid Until: b. PNA No. Valid until: c. ADPCN No. Valid until:

June 24, 2011 5451 Life member 001 December 2011

Noted by:

Valid Until: b. PNA No. Valid until:

May 3, 2012 001729 December 2011

JOMAR C. CORDERO, R.N., M.A.N. Signature over printed name of clinical coordinator Date Signed: _________________ Degree: B.S.B.A., B.S.N., M.A.N. a. PRC No. 070751 PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC. 1813 C.M. RECTO AVE., MANILA

NAME OF STUDENT: ____________________________________ Name and Address of school: Philippine College of Health Sciences, Inc. 1813 C.M. Recto Avenue, Manila Recognition and Accreditation Level: CHED / Level IV Date when school was recognized: October 24, 1996 No. 1. 2. 3. 4. 5. Case No. Diagno sis Name of Patient Age IV. DELIVERIES ASSISTED Date of Time of Gender Delivery Delivery of Baby

First Course (if any): _____________________________________ School graduated: _____________________________________ Year of admission in the BSN Program: ______________________ Year graduated from the BSN Program:______________________

Name of Hospital

Type of Delivery

Supervised by Qualified Clinical Instructor

Prepared by: ___________________________________________ Signature over printed name Concurred by: ___________________________________ Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: ___________________ a. PRC No. ___________________ Valid Until: b. PNA No. Valid until: ___________________ ___________________ ___________________ Approved by: MARY JANE F. VILLANUEVA., R.N., M.A.N. Signature over printed name of dean Date Signed: _______________ Degree: B.S.N., M.A.N. a. PRC No. 087415

Valid Until: b. PNA No. Valid until: c. ADPCN No. Valid until:

June 24, 2011 5451 Life member 001 December 2011

Noted by:

Valid Until: b. PNA No. Valid until:

May 3, 2012 001729 December 2011

JOMAR C. CORDERO, R.N., M.A.N. Signature over printed name of clinical coordinator Date Signed: _________________ Degree: B.S.B.A., B.S.N., M.A.N. a. PRC No. 070751 PHILIPPINE COLLEGE OF HEALTH SCIENCES, INC. 1813 C.M. RECTO AVE., MANILA

NAME OF STUDENT: ____________________________________ Name and Address of school: Philippine College of Health Sciences, Inc. 1813 C.M. Recto Avenue, Manila Recognition and Accreditation Level: CHED / Level IV Date when school was recognized: October 24, 1996 No. 1. 2. 3. 4. 5. Case No. Date Performed Name of Baby Gender of Baby V. CORD DRESSING Name of Mother Age

First Course (if any): _____________________________________ School graduated: _____________________________________ Year of admission in the BSN Program: ______________________ Year graduated from the BSN Program:______________________

Name of Hospital

Supervised by Qualified Clinical Instructor

Prepared by: ___________________________________________ Signature over printed name Concurred by: ___________________________________ Signature over printed name of Chief Nurse Date Signed: ___________________ Degree: a. PRC No. Valid Until: b. PNA No. Valid until: ___________________ ___________________ ___________________ ___________________ ___________________

Approved by: MARY JANE F. VILLANUEVA., R.N., M.A.N.

Signature over printed name of dean Date Signed: _______________ Degree: B.S.N., M.A.N. a. PRC No. 087415 Valid Until: June 24, 201 b. PNA No. 5451 Valid until: Life member c. ADPCN No. 001 Valid until: December 2011 Noted by: JOMAR C. CORDERO, R.N., M.A.N. Signature over printed name of clinical coordinator Date Signed: _________________ Degree: B.S.B.A., B.S.N., M.A.N. a. PRC No. 070751 Valid Until: May 3, 2012 b. PNA No. 001729 Valid until: December 2011