ARELLANO UNIVERSITY

COLLEGE OF NURSING
Jose Abad Santos
University Seal

NAME OF STUDENT: SABERDO, JohnMark Bulalaque First Course:

Name and Address of School: Arellano University School Graduated from:
3058 Taft Avenue, Pasay City Year: __________________________________
Accreditation Level (if any): Year Granted: Year of Admission in the BSN Program:
Date of School/Program was recognized: Number: Year: Year Graduated from BSN Program:

III. ACTUAL DELIVERIES

Case DATE of TIME of GENDER of NAME of TYPE of Name and Signature of Qualified
No. DIAGNOSIS NAME of MOTHER AGE
DELIVERY DELIVERY BABY HOSPITAL DELIVERY Clinical Instructor
No.
1 523110 PU39 2/7 wks AOG G1P0 Castillo Maria Salve 20 7/22/09 2:25PM Male MCMC NSD

LEGEND:
Concurred by:
Prepared by:
__ ___, Chief Nurse
JOHNMARK B. SABERDO Date Signed:
Student Degree:
a.) PRC No. Valid Until:
b.) PNA No. Valid Until:
c.) ANSAP No. Valid Until:

Supervised by: Noted by: Approved by:

Arlene Blaize T. Cortez, Ed.D
Clinical Instructor Clinical Coordinator Dean
Date Signed: ____________________________________________________ Date Signed: _____________________________________________________ Date Signed: _____
Degree: Degree: Degree: __________________________________________________________
a.) PRC No. Valid Until: a.) PRC No. _____ Valid Until: a.) PRC No Valid Until
b.) PNA No. Valid Until: b.) PNA No. Valid Until: b.) PNA No. Valid Until:
c.) ANSAP No. Valid Until: c.) ADPCN No. Valid Until: