UNIVERSITY OF PANGASINAN Phinma Education Network COLLEGE OF NURSING Dagupan City University Seal CLINICAL ROTATION Name: LEGASPI,

Mark Daniel Tomaneng Date Started in BSN Program: June 2008 Date Graduated From BSN Program: 2012
DEPARTMENT or AREA of ASSIGNMENT Classroom Instruction (Return Demonstration) Brgy. Guilig, Mangaldan Pantal 3 Pediatric Ward Obstetric & Surgical Ward General Ward Pantal I Dagupan General Ward Medical Ward RHU I-Manaoag Medical Ward Pavilion 1 Pediatric Ward Operating Room Operating Room General Ward Emergency & Delivery Room Emergency, Delivery & Operating Room Delivery Room Emergency & Operating Room Pediatric Ward Emergency, Operating, Delivery Room & General Ward Delivery Room & Neonatal Intensive Care Unit Emergency Room Supervised by: NAME of CLINICAL INSTRUCTOR Ethel Q. Fernandez Lourdes C. Salvador Juliet A. Pineda Joseph M. Cornelio McMillan M. Tagulinao Kristine Isabel R. Dy Jona G. Agtarap Avril B. Junio Krystabelle S. Lee Shirley Corazon C. Vergara Eljohn P. Zulueta Juliet A. Pineda Apolonia M. Dela Cruz Stephane E. De Vera Dejay E Paras Maria Diana A. Victorio Nasser C. Quisora Noemi Garcia Bryan B. Junio Noella V. Pearalta Myla Dee F. De Guzman Freda B. Lopez Maureen F. Manuel & Maria Diana A. Victorio Eljohn P. Zulueta

COURSE NO. Health Care I Health Care II

YEAR

MONTH

HOSPITAL Nursing Laboratory PHN PHN R1MC PMC MCD PHN BDH PMC PHN PPH NCMH SLH PMC TPH POC ManCH EGH BDH MCD R1MC CHI R1MC PPH

2009 2009-2010 2010 2010

June October November January February March June July August September November January February October 25-29 March 28- April 1 April 18-29 May 2-13 May 30-June 3 June July August September October November December January February March

NCM 101

2010 2010 2010 2010 2010 2011 2011 2010 2011 2011 2011 2011 2011 2011 2011 2011 2011

NCM 102

NCM 103

NCM 104

NCM 105

2011 2011 2012 2012 2012

Prepared by: MARK DANIEL T. LEGASPI Student AFFILIATING HOSPITALS/AGENCIES LEGEND: TERTIARY
BFDGH EGH JNGH MCD PCFMI PDH PMC PPH R1MC TPH - Blessed Family Doctors General Hospital, San Carlos City, Pangasinan - Elguira General Hospital, San Carlos City, Pangasinan - Jesus Nazarene General Hospital, Lingayen, Pangasinan - Medical Centrum Dagupan, Dagupan City, Pangasinan - Pangasinan Center for Family Medicine, Incorporated, Dagupan City, Pangasinan - Pangasinan Doctors Hospital, San Carlos City, Pangasinan - Pangasinan Medical Center, Dagupan City, Pangasinan (BASE HOSPITAL) - Pangasinan Provincial Hospital, San Carlos City, Pangasinan - Region 1 Medical Center, Dagupan City, Pangasinan (BASE HOSPITAL) - Tarlac Provincial Hospital, Tarlac City, Tarlac

Signature

SECONDARY
BDH CHI WPDH DMMCMH - Bayambang District Hospital, Bayambang, Pangasinan - Cuison Hospital Incorporated, Dagupan City, Pangasinan - Western Pangasinan District Hospital, Alaminos City Pangasinan - Dr. Marcelo M. Chan Memorial Hospital, Carmen, Rosales, Pangasinan

PRIMARY
CDVMH CHO, DC DLMLC DMCH LDH LCH ManCH MapCH MCHP MMH RHU-RCLC RHU - Col. Domingo Valdez Memorial Hospital, Dasol, Pangasinan - City Health Office, Dagupan City, Pangasinan - Dr. De Leon Maternity and Lying-in Clinic, Alaminos City, Pangasinan - Decena Medical Clinic and Hospital, Dagupan City, Pangasinan - Lingayen District Hospital, Lingayen, Pangasinan (formerly DMCVMH) - Labrador Community Hospital, Labrador, Pangasinan - Manaoag Community Hospital, Manaoag, Pangasinan - Mapandan Comuunity Hospital, Mapandan, Pangasinan - Missionaries of Charity Home of Peace, Dagupan City, Pangasinan - Malasiqui Municipal Hospital, Malasiqui, Pangasinan - Rural Health Unit Rosales Community and Lying-in Clinic, Rosales, Pangasinan - Rural Health Unit I and II Calasiao, Pangasinan - Rural Health Unit I Binmaley, Pangasinan - Rural Health Unit I Lingayen, Pangasinan - Rural Health Unit I Malasiqui, Pangasinan - Rural Health Unit I Manaoag, Pangasinan - Rural Health Unit I Mangaldan, Pangasinan - Rural Health Unit I Mapandan, Pangasinan

SPECIAL HOSPITALS
DJNRMH NCMH POC SLH *DMCVMH *FGH - Dr. Jose N. Rodriguez Memorial Hospital, Tala, Caloocan City - National Center for Mental Health, Mandaluyong City - Philippine Orthopedic Center, Banawe St., Quezon City - San Lazaro Hospital, Sta. Cruz, Manila - Don Mariano C. Versoza Memorial Hospital, Lingayen, Pangasinan - Francisco General Hospital, Urdaneta City, Pangasinan

Noted by: ZENAIDA M. BAUTISTA Clinical Coordinator

Date Signed: Degree: B.S.N., R.N., M.A.N., Ed.D a) PRC No.: 0133422 Valid Until: July 27, 2014 b) PNA No.: 026200 Valid Until: October 31, 2012

Approved by: MARIA TERESA R. FAJARDO Dean

Date Signed: Degree: B.S.N., R.N., M.A.N. a) PRC No.: 0160104 Valid Until: September 09. 2013 b) PNA No.: 026194 Valid Until: October 31, 2012 c) ADPCN No.: 011260 Valid Until: May 31,2012

NOTE: 1. 2. 3. 4. CHECK ALL ENTRIES ALL NAMES OF CIS SHOULD HAVE MIDDLE INITIALS FOLLOW THE FORMAT AFFIL DUTIES SHOULD HAVE SPECIFIC DATES 5. PHOTOCOPY OF RLE CARD should be attached 6. ANY HOSPITAL WHICH IS NOT IN THE LIST?