West Visayas State University La Paz, Iloilo City Name of Student: Date School/Program was Recognized: April 21, 1977 Accreditation Level: Level III AACCUP (2007) First Course (if any): N/A School Graduated from: N/A Year of Admission in the BSN Program: 2008 Year Graduated from the BSN Program: 2012 I. MAJOR OPERATIONS No. Time Started Time Ended Date of Operation Case No. Name of Patient Operation Performed Type of Anesthesia Name of Surgeon Year: N/A
Prepared by:
Supervised by:
Noted by:
Approved by:
SHEILA P. BELIRAN, M.A.N. Associate Dean/Clinical Coordinator Date Signed: _______________ CTC Number: Date Place : : Units Earned Beyond BSN: Date Signed: _______________ Degree: Bachelor of Science in Nursing Date Signed: _______________ Degree: Master of Arts in Nursing
ROSANA GRACE B. BELO, Ed. D. OIC - DEAN Date Signed: _______________ Degree: Master in Public Health, Master in Nursing, Doctor of Education
a) PRC No. : Valid Until: b) PNA No. : Valid Until:
a) b)
PRC No. : 0277468 Valid Until: September 4, 2012 PNA No. : 022997 Valid Until: October 31, 2010
a) b)
PRC No. : 0084964 Valid Until: October 22, 2012 PNA No. : 06-IL-0487-1 Valid Until: Life
Visayas State University La Paz, Iloilo City Year: N/A
AJOR OPERATIONS Name of Surgeon Name of Hospital
Concurred by:
Chief Nurse Date Signed: _______________ Degree:
a) PRC No.
:
Valid Until: b) PNA No. : Valid Until:
West Visayas State University La Paz, Iloilo City Name of Student: Date School/Program was Recognized: April 21, 1977 Accreditation Level: Level III AACCUP (2007) First Course (if any): N/A School Graduated from: N/A Year of Admission in the BSN Program: 2006 Year Graduated from the BSN Program: 2010 I. MAJOR OPERATIONS No. Time Started Time Ended Date of Operation Case No. Name of Patient Operation Performed
Prepared by:
Supervised by:
Noted by:
Approved by:
SHEILA P. BELIRAN, M.A.N. Associate Dean/Clinical Coordinator Date Signed: _______________ CTC Number: Date Place : : Units Earned Beyond BSN: Date Signed: _______________ Degree: Bachelor of Science in Nursing Date Signed: _______________ Degree: Master of Arts in Nursing
ROSANA GRACE B. BE OIC - DEAN
Date Signed: _________
Degree: Master in Public Nursing, Doctor of Educa
a) PRC No. : Valid Until: b) PNA No. : Valid Until:
a) b)
PRC No. : 0277468 Valid Until: September 4, 2012 PNA No. : 022997 Valid Until: October 31, 2010
a) b)
PRC No. : 0084964 Valid Until: October Valid Until: Life
PNA No. : 06-IL-04
ayas State University Paz, Iloilo City Year: N/A
OR OPERATIONS Type of Anesthesia Name of Surgeon Name of Hospital
Concurred by:
ROSANA GRACE B. BELO, Ed. D. Chief Nurse Date Signed: _______________ Degree: Master in Public Health, Master in Nursing, Doctor of Education Date Signed: _______________ Degree:
a) b)
PRC No. : 0084964 Valid Until: October 22, 2012 PNA No. : 06-IL-0487-1 Valid Until: Life
a) PRC No.
:
Valid Until: b) PNA No. : Valid Until: Life
West Visayas State University La Paz, Iloilo City Name of Student: Date School/Program was Recognized: April 21, 1977 Accreditation Level: Level III AACCUP (2007) First Course (if any): N/A School Graduated from: N/A Year of Admission in the BSN Program: 2008 Year Graduated from the BSN Program: 2012 I. MAJOR OPERATIONS No. Time Started Time Ended Date of Operation Case No. Name of Patient Operation Performed Type of Anesthesia Name of Surgeon Year: N/A
Prepared by:
Supervised by:
Noted by:
Approved by:
SHEILA P. BELIRAN, M.A.N. Associate Dean/Clinical Coordinator Date Signed: _______________ CTC Number: Date Place : : Units Earned Beyond BSN: Date Signed: _______________ Degree: Bachelor of Science in Nursing Date Signed: _______________ Degree: Master of Arts in Nursing
ROSANA GRACE B. BELO, Ed. D. OIC - DEAN Date Signed: _______________ Degree: Master in Public Health, Master in Nursing, Doctor of Education
a) PRC No. : Valid Until: b) PNA No. : Valid Until:
a) b)
PRC No. : 0277468 Valid Until: September 4, 2012 PNA No. : 022997 Valid Until: October 31, 2010
a) b)
PRC No. : 0084964 Valid Until: October 22, 2012 PNA No. : 06-IL-0487-1 Valid Until: Life
isayas State University La Paz, Iloilo City Year: N/A