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LICEO DE CAGAYAN UNIVERSITY College of Nursing Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City

School Code: 0835

Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:

ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University – Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA – Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012

Year: NOT APPLICABLE

I. MAJOR OPERATIONS No. 1

Date of Operation

Case No.

Name of Patient

Diagnosis

July 13, 2010

3785

Yasin, Anisah

Open Fracture Medial Third Tibia Fibula Right

September 27, 2010

763968

Ricky Llanto

2

Mandibular Fracture, depressed (right)

October 20, 2010

6085

Irene Tiu

3

Endometrial hyperplasia rule out Endometrial Carcinoma

Operation Performed

Types of Anesthesia

Name of Surgeon

Name of Hospital

Cagayan Polymedic General Hospital Northern Mindanao medial Center

Mrs. Maria Madel C. Reyes, RN

Cagayan Polymedic General Hospital

Jade Claire O. Alvarez, RN

Debridement Irrigation Open Reduction Inter-Medullary; Interlocking nail, right tibia Open Reduction Internal Fixation of depressed malar fracture using Titanium/ Orbityl plates; Open Reduction Internal Fixation of Mandiblar Fracture using Titanium plates; Mandibulomaxillary Fixation

Spinal anesthesia

Dr. Jovito Lao

General Anesthesia

Dr. Robert Gomez

Cervical punch biopsy, Fractional dilatation and curettage

Spinal Anesthesia

Dr. Jana Joy Tursalem

Name of Qualified OR Scrub Nurse

Fidelo Rey Mandawe, RN

Approved by: Prepared by:

NAME

Name and Signature of Student

Supervised by:

GINA S. BATASIN-IN

OR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN,MN PRC No: 0157111 Valid Until: December 10, 2013 PNA No: Valid Until: October 31, 2011

Noted by:

VIVIAN L. CEBALLOS

RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ________________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2014 PNA No: 17947 Valid Until: Lifetime Member

Concurred by: Concurred by:

MARIA CHONA V. PALOMARES Dean Liceo de Cagayan University Date Signed: _______________ Degree: B.S.N., M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ________________ Valid Until: December 31, 2011

Signature of Qualified OR Scrub Nurse

LICEO DE CAGAYAN UNIVERSITY College of Nursing Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City

School Code: 0835 Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:

ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University – Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA – Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012

Year: NOT APPLICABLE

II. MAJOR OPERATIONS No.

Date of Operation

Case No.

Name of Patient

Operation Performed

Diagnosis

1

May 26, 2011

02679

Quilab, Glyza Shamil

Cleft lip complete

Cheiloplasty

2

December 10, 2010

210272 4

Hibaya, Vanessa Myla

3

July 5, 2010

001105

Lota Generalao

Preterm cephalic not in labor oligohydramnios delivered live baby boy with an APGAR score of 10, body weight of 10 Mature Cataract Left Eye

Low section cesarean section myomectomy Phaco emulsification of Cataract Left Eye

Types of Anesthesia

Name of Surgeon

Name of Hospital

Name of Qualified OR Circulatinhg Nurse

General Endotracheal Anesthesia Spinal Anesthesia

Dr. Veronica Abelera

Kriss Kringle Virtudes, RN

Dr. Reynaldo Chu

Cagayan Polymedic General Hospital Madonna and Child Hospital

Retrobulbar block

Dr. Carlo Antonio J. Romero

Cagayan Polymedic General Hospital

RC Ann Macaranas, RN

Signature of Qualified OR Scrub Nurse

Letecia Reyes, RN

Prepared by:

PRC FORM TEMPLATE

Name and Signature of Student

Supervised by:

GINA S. BATASIN-IN

OR Clinical Instructor Liceo de Cagayan University Date Signed: _____________ Degree: BSN, RN, MN PRC No: 0157111 Valid Until: December 10, 2013 PNA No: Valid Until: December 31, 2011

Noted by:

VIVIAN L. CEBALLOS

RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ___________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947 Valid Until: Lifetime Member

Concurred by:

Concurred by:

Concurred by:

Approved by:

MARIA CHONA V. PALOMARES Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ________________ Valid Until: December 31, 2011

LICEO DE CAGAYAN UNIVERSITY College of Nursing Rodolfo N. Pelaez Boulevard Kauswagan , Cagayan de Oro City

School Code: 0835 Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:

ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University – Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA – Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012

Year: NOT APPLICABLE

III. HANDLED DELIVERIES No.

Case No.

1

1231

2

1175

3

1161

Diagnosis

Name of Mother

Date of Delivery

Age Delivery term spontaneous an alive baby boy weighing 6.5 pounds with an APGAR score of 9. Gravida 1, Parity 1, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 5 pounds with an APGAR score of 9. Gravida 1, Parity 0, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 7.8 pounds with an APGAR score of 9. Gravida 3, Parity 3, Cephalic Presentation

Time of Delivery

Gender of Baby

Name of Hospital

Types of Delivery

Nurse/Midwife Name and Signature of Qualified DR On duty Clinical Instructor

Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home

Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Lovel Catiil,RN

Mr. Andy Roy Salabas, Rn

Lovel Catiil,RN

Mrs. Elvyn Mabao, RN MN

Lovel Catiil,RN

Mrs. Elvyn Mabao, RN MN

Barbara Baculio

20

July 11, 2010

2:55 AM

Male

Tara Paula Joyce Amahan

19

June 13, 2010

1: 58 PM

Male

Jocelyn Lague

30

June 5, 2010

4: 51 AM

Male

Concurred by:

Prepared by:

PRC FORM TEMPLATE

Name and Signature of Student

Noted by:

VIVIAN L. CEBALLOS

RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ________________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947 Valid Until: Lifetime Member

Concurred by:

Approved by:

MARIA CHONA V. PALOMARES Dean Liceo de Cagayan University Date Signed: _____________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: _______________ Valid Until: December 31, 2011

LICEO DE CAGAYAN UNIVERSITY College of Nursing Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City

School Code: 0835

Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized:

ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University – Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA – Level III AUTONOMOUS First Course (if any): NOT APPLICABLE OCTOBER 2008 NOVEMBER 2009 School Graduated from: NOT APPLICABLE June 1972 Year of Admission in the BSN Program : 2008 Year Graduated (BSN Program) : 2012

Year: NOT APPLICABLE

IV. ASSISTED DELIVERIES No.

Case No.

1

1174

2

1217

3

650, 563

Diagnosis

Name of Mother

Delivery term spontaneous an alive baby boy weighing 7 pounds with an APGAR score of 9. Gravida 1, Parity 0, Cephalic Presentation Delivery term spontaneous an alive baby boy weighing 5.6 pounds with an APGAR score of 9. Gravida 2, Parity 2, Cephalic Presentation Delivery term spontaneous an alive baby girl weighing 3.4 kilograms with an APGAR score of 9. Gravida 1, Parity 1, Cephalic Presentation

PRC FORM TEMPLATE

Name and Signature of Student

Date of Delivery

Time of Delivery

Gender of Baby

Name of Hospital Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home JR Borja Memorial Hospital

Goldie Mae Bustamante

20

June 13, 2010

11: 29 AM

Male

Stephanie Paclar

32

July 3, 2010

5:03 PM

Male

Stephanie Decipolo

23

July 24, 2010

11; 21 PM

Female

Noted by: Prepared by:

Age

VIVIAN L. CEBALLOS

RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ________________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947 Valid Until: Lifetime Member

Concurred by:

Concurred by:

Concurred by:

Types of Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Name and Signature of Qualified DR Clinical Instructor Mrs. Elvyn Mabao, RN MN

Mrs. Ester Sy, RN MN

Mrs. Florence Baluran, RN MN

Approved by:

MARIA CHONA V. PALOMARES Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: ______________ Valid Until: December 31, 2011

LICEO DE CAGAYAN UNIVERSITY College of Nursing Rodolfo N. Pelaez Boulevard Kauswagan, Cagayan de Oro City

School Code: 0835

Name of Student: Name and Address of School: Recognition and Accreditation Level: Year Granted: Date when school was recognized: Number:

ORONG, ALTHEA PAZ BALODO Liceo de Cagayan University – Rodolfo N. Pelaez Boulevard, Kauswagan, Cagayan de Oro City PACUCOA – Level III First Course (if any): Not Applicable 2008 School Graduated from: June 1972 Year of Admission in the BSN Program: 2008 37 Year Graduated (BSN Program): 2012

Year:

V. IMMEDIATE NEWBORN CARE Case No.

Date Performed

Name of Baby

No.

Gender of Baby

Name of Mother

Age

1

1167

June 8, 2010

Baby Boy Martinez

Male

Mayette Martinez

20

2

1218

June 23, 2010

Baby Boy Dumaog

Male

Annaliza Dumaog

33

3

650, 473

July 25, 2010

Baby Boy Ebal

Male

WIlda Ebal

26

Nurse/Midwife On duty

Name of Hospital Nucleus Medical Clinic and Birthing Home Nucleus Medical Clinic and Birthing Home JR Borja Memorial Hospital

Name and Signature of Qualified DR Clinical Instructor

Lovel Catiil, RN

Mrs. Elvyn Mabao, RN MN

Lovel Catiil, RN

Mrs. Ester Sy, RN MN

Gemma Omonbos, RN

Mrs. Florence Baluran, RN MN

Approved by:

Prepared by:

ORONG, ALTHEA PAZ Name and Signature of Student

Noted by:

VIVIAN L. CEBALLOS

RLE Chairperson /Clin. Coor. Liceo de Cagayan University Date Signed: ________________ Degree: BSN, RN, MAN PRC No: 0171698 Valid Until: September 7, 2011 PNA No: 17947 Valid Until: Lifetime Member

Concurred by:

Concurred by:

Concurred by:

MARIA CHONA V. PALOMARES Dean Liceo de Cagayan University Date Signed: ______________ Degree: B.S.N. RN M.A.N. PRC No.: 0080354 Valid Until: September 23, 2013 PNA No: 17266 Valid Until: Lifetime Member ADPCN No: _______________ Valid Until: December 31, 2011

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