Office of the City Health Officer

City of San Fernando, La Union

CERTIFICATION
This is to certify that MR. JEFFERSON GOMEZ AGUILA of Union Christian
College had two minor operation cases during his days of duty in this institution.

MINOR OPERATIONS

No. Date of Case Name Diagno Operatio Type of Name Name of Supervised by: Name &
Operatio No. of sis n Anesthes of Hospital Name & Signature of
n Patient Performe ia Surgeo Signature of O.R. Scrub
d n Qualified C.I. Nurse

1 Februar E.M.S. Alexand Carbunc Incision Local Dr. City Flordeliza G. Emily Laroya
y 8, er le and Anesthesi Jessie Health Galvez PRC No.:
2007 James Drainage a Miranda Office PRC No.: 0130411 0164680
Gapac PNA No.: 16263 PNA No.: 16293
MAN units: 33 units

2 April 29, E.M.S. John Redund Circumcisi Local Dr. City Flordeliza G. Emily Laroya
2006 Kirby ant on Anesthesi Jessie Health Galvez PRC No.:
Gregori Prepuce a Miranda Office PRC No.: 0130411 0164680
PNA No.: 16263 PNA No.: 16293
MAN units: 33 units

This certification is issued to MR. JEFFERSON GOMEZ AGUILA this 19th of

March 2007 for all good intents and purposes it may serve.

_______________________________________ ____ ______________________________________

NIEVES T. RIPARIP, RM EMILY LAROYA, RN

Date Signed: _________ Date Signed: _________
Midwife II Nurse III
License No. 0062347 a. License No. 0164680
Valid Until: August 18, 2008 Valid Until: December 22, 2008
b. PNA No.: 16293
Valid Until: December 2007
c. ANSAP No.: 09241
Valid Until: December 2007

____________________________________
EDUARDO S. POSADAS, MD
Date Signed: _________
City Health Officer II