Name of Students: Ronie Mae J.

Miranda
Name and Address of School: Holy Child Colleges of Butuan, 2nd street Guingona Subdivision, Butuan City
Accreditation Level (if any): None Year Granted:
Date of School/Program was recognized: Number: Year:
First Course (if any): None School Graduated From: Year:
Year of Admission in Bachelor of Science in Nursing Program: 2002
Year Graduate (BSN Program): 2011

I. MAJOR OPERATIONS
No. Date of Case Name of Patient Diagnosis Operation Performed Type of Name of Name of Name of O.R Signature of O.R Supervisor by Name: and
Operation No. Anesthesia Surgeon Hospital Scrub Nurse Scrub nurse Signature of Qualified C.I
1

Prepared By: RONIE MAE J. MIRANDA

Concurred By: Approved By::
Noted By: Concurred By:

KEVINMAR E. MUÑOZ, RN, MAN JEMIMAH l. BRINGAS, RN, MN HELEN T. GONZALES, RN, MN FLORDELIZA C. BARRIL, RN,MN
Signature over Printed Name of Clinical Coordinator Signature Over Printed Name Chief Nurse (ADNPH) Signature over Printed Name of Dean
Date Signed: Date Signed: Signature over Printed Name of Chief Nurse (BMC) Date Signed:
Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Date Signed: Degree: Bachelor of Science in Nursing
Master of Arts in Nursing Master of Arts in Nursing Degree: Bachelor of Science in Nursing Master of Arts in Nursing
PRC No: 0432869 PRC No: 0089396 Master of Arts in Nursing PRC No: 0270917
Valid Until: December 2013 Valid Until: May 2011 PRC No: 0063678 Valid Until: October 2013
PNA No: 030888 PNA No: 030814 Valid Until: August 2013 PNA No: 030817
Valid Until: December 2010 Valid Until: December 2010 PNA No: 2504 Valid Until: December 2010
Valid Until: Lifetime