89

San Juan De
College of Nursing
2772-2774 Roxas Boulevard, Name of Student: Name & Address of School:

Dios Educational Foundation, Inc.

Pasay City

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. 2772-2774 ROXAS BOULEVARD, PASAY CITY 1300 Accreditation Level: (if any) CHED ORDER NO. 31, s, LEVEL I Date School/Program was recognized: JUNE 2, 1975 Number: 278 First Course (if any): School Graduated From: Year of Admission in the Bachelor of Science in Nursing Program: 2006 Year Graduated (BSN Program): 2010 I. MAJOR OPERATIONS
No. 1 Date of Operation June 27, 2009 Case No. 09-303834 Name of Patient Michelle Irlanda Lotino Diagnosis G4 P3 PU 36 2/7 weeks prev. c/s I Inguinal Hernia Operation Performed LT c/s II and BTL Type of Anesthesia Spinal Anesthesia

Year Granted: Year: Year:

2003 1975

Name of Surgeon Dra. Veneranda P. Despabiladeras

Name of Hospital Dr. Jose Fabella Memorial Hospital

Name of OR Scrub Nurse Joseph Calcaben

Signature of OR Scrub Nurse

Sept. 3, 2009

265200

OBERES, Mikyle Jae S.

Explore Laparotomy Bilateral Herniotomy Appendectomy

General Anesthesia

Dr. Catangui

San Juan De Dios Hospital

S. Escototo, R.N

3 4 5

Sept. 12, 2009

09-313262

Concurred by: MR. RODOLFO C. BORROMEO, RN, MAN Signature over printed name of Chief Nurse Date Signed: Degree: RN, MAN a) PRC No. Valid until: b) PNA No. Valid until:

Approved by: SR. HEIDI A. FACTO Signature over printed name of Dean Date Signed: Degree: RN, MAN a) PRC No. Valid until: b) PNA No. Valid until:

Noted by: MRS. MA. CLEOFE G. BAARIA, RN, MAN Signature over printed name of Clinical Coordinator Date Signed: Degree: RN, MAN a) PRC No. Valid until: b) PNA No. Valid until:

c) ADPCN No. Valid until: Prepared by: ________________________________ STUDENT

San Juan De
College of Nursing
2772-2774 Roxas Boulevard, Name of Student: Name & Address of School:

Dios Educational Foundation, Inc.

Pasay City

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. 2772-2774 ROXAS BOULEVARD, PASAY CITY 1300 Accreditation Level: (if any) CHED ORDER NO. 31, s, LEVEL I Date School/Program was recognized: JUNE 2, 1975 Number: 278 First Course (if any): School Graduated From: Year of Admission in the Bachelor of Science in Nursing Program: 2006 Year Graduated (BSN Program): 2010 II. MINOR OPERATIONS
No. 1 Date of Operation Sept. 4, 2009 Case No. Name of Patient DIANO, Donna Aviado Diagnosis Operation Performed Excision Biopsy Lipoma, Bilateral V.A 2 3 4 5 Concurred by: MR. RODOLFO C. BORROMEO, RN, MAN Signature over printed name of Chief Nurse Date Signed: Degree: RN, MAN a) PRC No. Valid until: Approved by: SR. HEIDI A. FACTO Signature over printed name of Dean Date Signed: Degree: RN, MAN a) PRC No. Valid until: Oct. 15, 2009 22452 MOANTARA, Sadam Patino Wound suturing Local Type of Anesthesia Local

Year Granted: Year: Year:

2003 1975

Name of Surgeon Dr. A. Santos

Name of Hospital San Juan De Dios Hospital

Name of OR Scrub Nurse Angelo Macalino, R.N

Signature of OR Scrub Nurse

Dr. Gonzales

San Juan De Dios Hospital

Noted by: MRS. MA. CLEOFE G. BAARIA, RN, MAN Signature over printed name of Clinical Coordinator Date Signed: Degree: RN, MAN a) PRC No. Valid until:

b) PNA No. Valid until:

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

b) PNA No. Valid until: Prepared by: ________________________________ STUDENT

San Juan De
College of Nursing
2772-2774 Roxas Boulevard, Name of Student: Name & Address of School:

Dios Educational Foundation, Inc.

Pasay City

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. 2772-2774 ROXAS BOULEVARD, PASAY CITY 1300 Accreditation Level: (if any) CHED ORDER NO. 31, s, LEVEL I Date School/Program was recognized: JUNE 2, 1975 Number: 278 First Course (if any): School Graduated From: Year of Admission in the Bachelor of Science in Nursing Program: 2006 Year Graduated (BSN Program): 2010 III.ACTUAL DELIVERIES
No. 1 Date of Operation May 18, 2009 Case No. 261751 Name of Patient Maria Dayola Diagnosis PUFT, G5 P4 40 weeks PU 40 6/7 weels G1 P0 Operation Performed NSD Type of Anesthesia

Year Granted: Year: Year:

2003 1975

Name of Surgeon

Name of Hospital Ospital ng Sampaloc

Name of OR Scrub Nurse

Signature of OR Scrub Nurse

July 30, 2009 2 3 4 5 Concurred by:

265524

RODRIGO, Gleza Bayan

NSD

Ospital ng Sampaloc

Approved by: SR. HEIDI A. FACTO Signature over printed name of Dean Date Signed: Degree: RN, MAN

Noted by: MRS. MA. CLEOFE G. BAARIA, RN, MAN Signature over printed name of Clinical Coordinator Date Signed: Degree: RN, MAN

MR. RODOLFO C. BORROMEO, RN, MAN Signature over printed name of Chief Nurse Date Signed: Degree: RN, MAN

a) PRC No. Valid until: b) PNA No. Valid until:

a) PRC No. Valid until: b) PNA No. Valid until: c) ADPCN No. Valid until:

a) PRC No. Valid until: b) PNA No. Valid until: Prepared by: ________________________________ STUDENT

San Juan De
College of Nursing
2772-2774 Roxas Boulevard, Name of Student: Name & Address of School:

Dios Educational Foundation, Inc.

Pasay City

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. 2772-2774 ROXAS BOULEVARD, PASAY CITY 1300 Accreditation Level: (if any) CHED ORDER NO. 31, s, LEVEL I Date School/Program was recognized: JUNE 2, 1975 Number: 278 First Course (if any): School Graduated From: Year of Admission in the Bachelor of Science in Nursing Program: 2006 Year Graduated (BSN Program): 2010 IV. DELIVERIES ASSISTED
No. 1 Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia

Year Granted: Year: Year:

2003 1975

Name of Surgeon

Name of Hospital

Name of OR Scrub Nurse

Signature of OR Scrub Nurse

2 3 4 5 Concurred by: MR. RODOLFO C. BORROMEO, RN, MAN Signature over printed name of Chief Nurse Approved by: SR. HEIDI A. FACTO Signature over printed name of Dean Noted by: MRS. MA. CLEOFE G. BAARIA, RN, MAN Signature over printed name of Clinical Coordinator

Date Signed: Degree: a) PRC No. Valid until: b) PNA No. Valid until:

RN, MAN

Date Signed: Degree: a) PRC No. Valid until: b) PNA No. Valid until: c) ADPCN No. Valid until:

RN, MAN

Date Signed: Degree: a) PRC No. Valid until: b) PNA No. Valid until:

RN, MAN

Prepared by: ________________________________ STUDENT

San Juan De
College of Nursing
2772-2774 Roxas Boulevard, Name of Student: Name & Address of School:

Dios Educational Foundation, Inc.

Pasay City

SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. 2772-2774 ROXAS BOULEVARD, PASAY CITY 1300 Accreditation Level: (if any) CHED ORDER NO. 31, s, LEVEL I Date School/Program was recognized: JUNE 2, 1975 Number: 278 First Course (if any): School Graduated From: Year of Admission in the Bachelor of Science in Nursing Program: 2006 Year Graduated (BSN Program): 2010 V. CORD DRESSING
No. 1 Date of Operation Feb. 17, 2009 Case No. 34924 Name of Patient Baby Boy Manipol Diagnosis Operation Performed Type of Anesthesia

Year Granted: Year: Year:

2003 1975

Name of Surgeon

Name of Hospital Paraaque Community Hospital

Name of OR Scrub Nurse

Signature of OR Scrub Nurse

2 3 4 5 Concurred by: MR. RODOLFO C. BORROMEO, RN, MAN Signature over printed name of Chief Nurse Date Signed: Approved by: SR. HEIDI A. FACTO Signature over printed name of Dean Date Signed: Noted by: MRS. MA. CLEOFE G. BAARIA, RN, MAN Signature over printed name of Clinical Coordinator Date Signed:

Degree: a) PRC No. Valid until: b) PNA No. Valid until:

RN, MAN

Degree: a) PRC No. Valid until: b) PNA No. Valid until: c) ADPCN No. Valid until:

RN, MAN

Degree: a) PRC No. Valid until: b) PNA No. Valid until:

RN, MAN

Prepared by: ________________________________ STUDENT