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    This document contains information about Dee Hwa Liong College Foundation in the Philippines including its address, accreditation details, date of government recognition, and a student's admission and graduation details from the Bachelor of Science in Nursing program. It also includes a table with information about 3 medical procedures performed including patient name, diagnosis, operation details, anesthesia used, surgeon name, hospital, and operating room staff signatures. Clinical coordinators, chief nurse, and dean signatures are also provided.

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    CASES FORM PRC NEW

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    This document contains information about Dee Hwa Liong College Foundation in the Philippines including its address, accreditation details, date of government recognition, and a student's admission and graduation details from the Bachelor of Science in Nursing program. It also includes a table with information about 3 medical procedures performed including patient name, diagnosis, operation details, anesthesia used, surgeon name, hospital, and operating room staff signatures. Clinical coordinators, chief nurse, and dean signatures are also provided.

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    Attribution Non-Commercial (BY-NC)
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    6K tayangan12 halaman

    Cases Form PRC New

    Diunggah oleh

    DHLCF Nursing files
    This document contains information about Dee Hwa Liong College Foundation in the Philippines including its address, accreditation details, date of government recognition, and a student's admission and graduation details from the Bachelor of Science in Nursing program. It also includes a table with information about 3 medical procedures performed including patient name, diagnosis, operation details, anesthesia used, surgeon name, hospital, and operating room staff signatures. Clinical coordinators, chief nurse, and dean signatures are also provided.

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 12

    DEE HWA LIONG COLLEGE FOUNDATION

    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac,Duquit, Mabalacat, Pampanga___________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition – March 21__________ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    I. Major Operations
    Signature
    Name of
    Date of Case Name of Type of Name of of O.R.
    No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
    Operation No. Patient Anesthesia Surgeon Scrub
    Nurse
    Nurse
    Colloidal Adenomatous Total Lobectomy Left General Dr. Allan M. Jose B. Lingad Memorial Elizabeth L.
    1.
    Goiter Left Thyroid Gland Anesthesia Magday Regional Hospital Lazatin, RN
    Diabetes Milletus Foot Spinal Dr. Julius C. Jose B. Lingad Memorial Marissa C.
    2. Above Knee Amputation
    Gangrene Left Anesthesia Bumadilla Regional Hospital Fronda, RN

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student _ __________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    I. Major Operations
    Signature
    Name of
    Date of Case Name of Type of Name of of O.R.
    No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
    Operation No. Patient Anesthesia Surgeon Scrub
    Nurse
    Nurse
    Gravida 4, Para 4,
    Pregnancy Uterine 38
    5/7 weeks Age of
    Emergency, Classical Spinal Dra. Daisy May Jose B. Lingad Memorial Mark Louie
    3. Gestation, Previous
    Cessarean Section III Anesthesia L. Santos Regional Hospital S. Puyat, RN
    Cessarean Section 3x2˚
    Hydrocephalus in
    beginning labor

    Prepared by: Noted by: Concurred by: Approved by:

    __________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 7368_____________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: Lifetime_______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: __________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition - March 21___________ Number: HER-023 ___________Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    I. Major Operations
    Signature
    Name of
    Date of Case Name of Type of Name of of O.R.
    No. Diagnosis Operation Performed Name of Hospital O.R. Scrub
    Operation No. Patient Anesthesia Surgeon Scrub
    Nurse
    Nurse
    Gravida 2, Para 2,
    Status post Low Low Segment Cessarean Spinal Dr. Reynaldo S. Escolastica Romero Elvira A,
    4.
    Segment Cessarean Section II Anesthesia Alipio District Hospital Morales, RN
    Section
    Spinal and
    Dr. Jaime P. Escolastica Romero Elvira A.
    5. Gallbladder Stone Cholecystectomy intravenous
    Flores District Hospital Morales, RN
    Anesthesia

    Prepared by: Noted by: Concurred by: Approved by:

    __________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: July 2008_____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 11901_______________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008______ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: __________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition_- March 21_________ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    II. Minor Operation


    Signature of
    Date of Case Operation Type of Name of Name of O.R.
    No. Name of Patient Diagnosis Name of Hospital O.R. Scrub
    Operation No. Performed Anesthesia Surgeon Scrub Nurse
    Nurse
    Jose B. Lingad
    Post Partum Gravida 3, Bilateral Tubal Local Dra. Jaimie Ma. Josefina S.
    1. Memorial Regional
    Para 3, Ligation Anesthesia A. Ocampo Basilio, RN
    Hospital
    Jose B. Lingad
    Prolapsed Submucus Spinal Dra. Imelda Marissa C.
    2. Fructional Curretage Memorial Regional
    Myoma Anesthesia S. Calonzo Fronda, RN
    Hospital
    Jose B. Lingad
    Acute Appendicitis Emergency Spinal Dr. Julius C. Marissa C.
    3. Memorial Regional
    Suppurative Appendix Appendectomy Anesthesia Bumadilla Fronda, RN
    Hospital

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN__ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga __________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition - March 21_____ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    II. Minor Operation


    Signature of
    Date of Case Operation Type of Name of Name of O.R.
    No. Name of Patient Diagnosis Name of Hospital O.R. Scrub
    Operation No. Performed Anesthesia Surgeon Scrub Nurse
    Nurse
    Gravida 1, Para 1, Pregnancy Right
    Uterine Full term, Delivered Mediolateral Local Dr.Zennon V. Escolastica Romero Cristina S.
    4.
    spontaneously to a live baby episiotomy + Anesthesia Ponce District Hospital Lagman, RN
    boy repair
    Local Dra. Carlota Escolastica Romero Jane L. Barrera
    5. Uncircumcised Penis Circumcision
    Anesthesia M. Gutierres District Hospital RN, MAN

    Prepared by: Noted by: Concurred by: Approved by:

    _________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No.: 0254235________________ a.) PRC No.: 57881_____________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. :1901________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008_____ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition - March 21__ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    V. Cord Dressing
    Case Date Gender of Supervised by:
    No. Name of Baby Name of Mother Age Name of Hospital
    No. Performed Baby Name & Signature of Qualified C.I.
    1. Baby Boy Peralta Male 37 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN
    Baby Boy
    2. Male 41 y/o Escolastica Romero District Hospital
    Duinagracia Agnes N.Alipio RN, MAN
    3. Baby Boy Pagusan Male 26 y/o Escolastica Romero District Hospital Agnes N.Alipio RN, MAN

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No.: 0254235_______________ a.) PRC No.: 57881______________ a.) PRC No. 0054482______________
    Valid Until: July 2009_______________ Valid Until: July 2008 ____________ Valid Until: December 2010 _________
    b.) PNA No.: 43057_________________ b.) PNA No.: 11901________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008___ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition - March 21____ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    V. Cord Dressing
    Case Date Gender of Supervised by:
    No. Name of Baby Name of Mother Age Name of Hospital
    No. Performed Baby Name & Signature of Qualified C.I.
    4. Baby Boy Asures Male 35 y/o Jose B. Lingad Memorial Regional Hospital Nerissa A. Mercado, RN, MAN
    5. Baby Boy Sulano Male 28 y/o Jose B. Lingad Memorial Regional Hospital
    Nerissa A. Mercado, RN, MAN

    Prepared by: Noted by: Concurred by: Approved by:

    ___________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN __ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 0041328______________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011 ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 7368_______________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until:Lifetime_______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga___________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    III. Actual Deliveries


    No. Supervised by:
    Name of Date of Time of Gender
    Case No. Diagnosis Age Name of Hospital Type of Delivery Name & Signature of
    Mother Delivery Delivery of Baby
    Qualified C.I.
    Gravida 3, Para 3, Pregnancy
    Jose B. Lingad Normal
    Uterine delivered spontaneously September
    1. 2:17 pm Male Memorial Regional Spontaneous
    to a live baby boy, 39 weeks 18, 2006 Hospital Anna Jane B. Lozano RN,
    Delivery
    Age of Gestation, cephalic MAN
    Gravida 7, Para 6, Pregnancy
    Jose B. Lingad Normal
    Uterine delivered spontaneously November
    2.
    1: 50 pm Male Memorial Regional Spontaneous
    to a live baby boy, 40 weeks 15, 2007 Hospital Anna Jane B. Lozano RN,
    Delivery
    Age of Gestation, cephalic MAN

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 0041328________________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 7368________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: _lifetime______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang_Maisac, Duquit, Mabalacat, Pampanga __________________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition- March 21__ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    III. Actual Deliveries


    No. Supervised by:
    Name of Date of Time of Gender Type of
    Case No. Diagnosis Age Name of Hospital Name & Signature of
    Mother Delivery Delivery of Baby Delivery
    Qualified C.I.
    Gravida 3, Para 3, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
    3. Male Spontaneous
    to a live baby boy 38 – 39 weeks District Hospital RN, MAN
    Delivery
    Age of Gestation, cephalic
    Gravida 1, Para 1, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
    4.
    Male Spontaneous
    to a live baby boy 40 weeks Age District Hospital RN, MAN
    Delivery
    of Gestation, cephalic
    Gravida 1, Para 1, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
    5.
    Female Spontaneous
    to a live baby girl 40 weeks Age District Hospital RN, MAN
    Delivery
    of Gestation, cephalic

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008__ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized: Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    IV. Deliveries Assisted


    No. Supervised by:
    Name of Date of Time of Gender
    Case No. Diagnosis Age Name of Hospital Type of Delivery Name & Signature of
    Mother Delivery Delivery of Baby
    Qualified C.I.
    Gravida 3, Para 3, Pregnancy Jose B. Lingad Normal
    1. Uterine delivered spontaneously Female Memorial Regional Spontaneous Anna Jane B. Lozano RN,
    to a live baby girl Hospital Delivery MAN

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Julita M. Latosquin, RN, MAN Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 0041328_______________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: April 2011____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 6378________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: _Lifetime______________ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga ___________________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition- March 21__ __ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    IV. Deliveries Assisted


    No. Supervised by:
    Name of Date of Time of Gender Type of
    Case No. Diagnosis Age Name of Hospital Name & Signature of
    Mother Delivery Delivery of Baby Delivery
    Qualified C.I.
    Gravida 2, Para 2, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero
    2. Male District Hospital
    Spontaneous
    to a live baby boy 40 weeks Age Cynthia F. Deogracias,
    Delivery
    of Gestation, cephalic RN, MAN
    Gravida 1, Para 1, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
    3. Male District Hospital
    Spontaneous
    to a live baby boy 39 - 40 weeks RN, MAN
    Delivery
    Age of Gestation, cephalic

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008____ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________
    DEE HWA LIONG COLLEGE FOUNDATION
    Sapang Maisac, Duquit, Mabalacat, Pampanga

    Name of Student: ___________________________________________________________________________________________________


    Name and Address of School: Dee Hwa Liong College Foundation, Sapang Maisac, Duquit, Mabalacat, Pampanga _______________________________
    Accreditation Level: (If any) ________________________________________________________________________ Year Granted: ________________________
    Date School/ Program was Recognized:Government Recognition- March 21__ _ Number: HER-023 ___________ Year: 2007_____________________
    First Course (If any): _______________________________________________ School Graduated From: __________________ Year: _________________________
    Year of admission in the Bachelor of Science in Nursing Program: 2004_____________________________________________________________________________
    Year Graduated (BSN Program): 2008________________________________________________________________________________________________________

    IV. Deliveries Assisted


    No. Supervised by:
    Name of Date of Time of Gender Type of
    Case No. Diagnosis Age Name of Hospital Name & Signature of
    Mother Delivery Delivery of Baby Delivery
    Qualified C.I.
    Gravida 1, Para 1, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero
    4. Female Spontaneous
    to a live baby girl 38-39 weeks District Hospital Cynthia F. Deogracias,
    Delivery
    Age of Gestation, cephalic RN, MAN
    Gravida 1, Para 1, Pregnancy
    Normal
    Uterine delivered spontaneously Escolastica Romero Cynthia F. Deogracias,
    5.
    Female Spontaneous
    to a live baby girl 39 - 40 weeks District Hospital RN, MAN
    Delivery
    Age of Gestation, cephalic

    Prepared by: Noted by: Concurred by: Approved by:

    ____________ Geraldine M. Garcia, RN , MSN______ Priscila M. Mascareñas, RN, MAN__ Florencia G. Nabong, RN, MAN____
    Signature Over Printed Name Student Signature Over Printed Name of Clinical Signature Over Printed Name of Chief Signature Over Printed Name of Dean
    Coordinator Nurse
    Date Signed: ______________ Date Signed: ______________________ Date Signed: __ __________________ Date Signed: _____________________
    Degree: BSN______________ Degree: BSN, MSN_________________ Degree: BSN, MAN_______________ Degree: BSN, MAN_______________
    a.) PRC No. 0254235_________________ a.) PRC No. 57881________________ a.) PRC No. 0054482_______________
    Valid Until: July 2009_______________ Valid Until: July 2008_ ____________ Valid Until: December 2010 _________
    b.) PNA No. 43057_________________ b.) PNA No. 11901________________ b.) PNA No.5485 _________________
    Valid Until: December 2008__________ Valid Until: December 2008 ___ Valid Until: Lifetime ____________
    c.) ADPCN No. 0397 _______________
    Valid Until: 2008 _________________

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