UNIVERSITY OF PANGASINAN

COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

I. MAJOR OPERATION
TIME of PATIENT’S
DATE of TYPE of
OPERATION INITIALS OPERATION NAME of Name & Signature of Qualified
No. OPERATIO DIAGNOSIS ANESTHESI NAME of SURGEON
STARTED- PERFORMED HOSPITAL Clinical Instructor
N CASE NO. A
ENDED
Status Post Partum,
M.J.C Normal Spontaneous
1 May 5, 2010 12:25 pm-12:50 pm Delivery, With Vaginal Perineorrhaphy Local Dr. Frederick G. Lalas MapCH
Laceration, Gravid 2 Maria Leah G. Barangan, RN
00894
Para 2 (1-0-0-1)
LEGEND: MapCH – Mapandan Community Hospital

Concurred by: GRACE Z. JOVELIANOS

Prepared by: Chief Nurse
PRC I.D. No.: 0064042 Valid Until: September 16, 2011
JOAN T. OVIEDO PNA No.: 029073 Valid Until: October 31,2010
Date document is signed: Time:
Student Please specify Highest Nursing Degree Earned: BSN-RN

Supervised by: MARIA LEAH G. BARANGAN Noted by: ZENAIDA M. BAUTISTA Approved by: MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: BSN-RN PNA No.: 029069 Valid Until: October 31, 2010_______ PNA No.: 013739 ________ Valid Until: October 31, 2010
PRC I.D. No.: 0392061 Valid Until: September 27, 2012 Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: 031851 Valid Until: October 31, 2010 Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

II. MINOR OPERATION

TIME of PATIENT’S
DATE of OPERATION TYPE of NAME of NAME of Name & Signature of Qualified
No. OPERATION INITIALS DIAGNOSIS
OPERATION PERFORMED ANESTHESIA SURGEON HOSPITAL Clinical Instructor
STARTED-ENDED CASE NO.

M.V.B Punctured Wound, Removal of Local Dr. Jaime R. Maron LDH

1
June 22, 2010 10:25 pm-11:30 pm (needle) Hand Right Foreign Body Marnie P. Fernandez, RN
06-356-10
LEGEND: LDH - Lingayen District Hospital (Primary)

Concurred by: LANI N. CRUZ

Prepared by: Chief Nurse
PRC I.D. No.: 0131408 Valid Until: November 25, 2010
JOAN T. OVIEDO PNA No.: Valid Until:
Student Date document is signed: Time:
Please specify Highest Nursing Degree Earned: BSN – RN, MAN on Progress

Supervised by: MARNIE P. FERNANDEZ Noted by: ZENAIDA M. BAUTISTA Approved by: MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: BSN- RN PNA No.: 029069 ________ Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
PRC I.D. No.: 0270269 Valid Until: November 06, 2011 Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: 013759 Valid Until: October 31, 2010 Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

II. MINOR OPERATION

TIME of PATIENT’S
DATE of OPERATION INITIALS OPERATION TYPE of NAME of Name & Signature of
No. DIAGNOSIS NAME of SURGEON Qualified Clinical Instructor
OPERATION STARTED- PERFORMED ANESTHESIA HOSPITAL
ENDED CASE NO.
K.C.D
12:25 pm-12:35 pm Lacerated Wound Suturing Local Dr. Virginia C. Petrola LDH
1 June 8, 2010 12419 Right Arm Florence Lomibao

LEGEND: LDH - Lingayen District Hospital (Primary)

Concurred by:
Prepared by: Chief Nurse
PRC I.D. No.: Valid Until:
JOAN T. OVIEDO PNA No.: Valid Until:
Student Date document is signed: Time:
Please specify Highest Nursing Degree Earned:

Supervised by: FLORENCE LOMIBAO Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: ________ PNA No.: 029069 ________ Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

II. MINOR OPERATIONS

TIME of PATIENT’S
DATE of OPERATION INITIALS OPERATION TYPE of NAME of Name & Signature of Qualified
No. DIAGNOSIS NAME of SURGEON
OPERATION STARTED- PERFORMED ANESTHESIA HOSPITAL Clinical Instructor
ENDED CASE NO.
9:00 am-9:30 am N.D.T Redundant Circumcision Local Dr. Frederick G. Lalas MapCH
1
April 26, 2010 03944 Prepuce Maria Leah G. Barangan
2:00 pm-2:02 pm D.T.S Abscess Right Incision And None Dr. Erl danielsson P. Javier MapCH
2 April 29, 2010 Thumb Drainage Maria Leah G. Barangan
03956
LEGEND: MapCH - Mapandan Community Hospital (Primary)

Concurred by: GRACE Z. JOVELIANOS

Prepared by: Chief Nurse
PRC I.D. No.: 0064042 Valid Until: September 16, 2011
JOAN T. OVIEDO PNA No.: 029073 Valid Until: October 31,2010
Student Date document is signed: Time:
Please specify Highest Nursing Degree Earned: BSN-RN

Supervised by: MARIA LEAH G. BARANGAN Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: BSN-RN PNA No.: 029069 ________ Valid Until: October 31, 2010 PNA No.: 013739 ________ Valid Until: October 31, 2010
PRC I.D. No.: 0392061 Valid Until: September 27, 2012 Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: 031851 Valid Until: October 31, 2010 Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

III. ACTUAL DELIVERIES

MOTHER’S INITIALS TIME of TYPE NAME of Name & Signature of Qualified
No. DIAGNOSIS AGE DATE of DELIVERY GENDER of BABY
CASE NO. DELIVERY of DELIVERY HOSPITAL Clinical Instructor
Pregnancy Uterine V.B.M
1 Full Term, 37 weeks 35 June 15, 2010 12:20 pm Baby Girl Normal Spontaneous ManCH Florence Lomibao
2586
And 1/7 days Delivery
LEGEND: ManCH – Manaoag Community Hospital

Concurred by:
Prepared by: Chief Nurse
PRC I.D. No.: Valid Until:
JOAN T. OVIEDO PNA No.: Valid Until:
Student Date document is signed: Time:
Please specify Highest Nursing Degree Earned:

Supervised by: FLORENCE LOMIBAO Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: ________ PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT:
OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

IV. ASSISTED DELIVERIES

MOTHER’S INITIALS DATE of TIME of TYPE NAME of Name & Signature of
No. DIAGNOSIS AGE GENDER of BABY
CASE NO. DELIVERY DELIVERY of DELIVERY HOSPITAL Qualified Clinical Instructor

5
LEGEND:

Concurred by:
Prepared by: Chief Nurse
PRC I.D. No.: Valid Until:
PNA No.: Valid Until:
JOAN T. OVIEDO Date document is signed: Time:
Student Please specify Highest Nursing Degree Earned:
Approved by: PROF. MARIA TERESA R. FAJARDO
Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Dean
Clinical Instructor Clinical Coordinator PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PNA No.: 013739 Valid Until: October 31, 2010
Degree: PNA No.: 029069 Valid Until: October 31, 2010 ADPCN No.: Valid Until:
PRC I.D. No.: Valid Until: Date document is signed: Time: Date document is signed: Time:
PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
Arellano St., Dagupan City University Seal
Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Level I PACUCOA; Year Granted: March 05, 2007)
(Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976)

NAME OF STUDENT: First course (if any): Bachelor of Science in Physical Therapy
School graduated from: Lyceun Northwestern University,
Dagupan City, Pangasinan
Year: 2002
Year of admission in the BSN Program: June 2006
Year graduated from BSN Program: 2011

V. IMMEDIATE NEWBORN CORD CARE

TIME OF BABY’S INITIALS Name & Signature of
No. DATE PERFORMED GENDER of BABY MOTHER’S INITIALS AGE NAME of HOSPITAL
DELIVERY CASE NO. Qualified Clinical Instructor
Baby R
1 August 16, 2010 4:21 pm Female K.S.R 26
10-09 Bambi E. Escano
LEGEND: Dr. Marcelo M. Chan Memorial Hospital

Concurred by:
Prepared by: Chief Nurse
PRC I.D. No.: Valid Until:
JOAN T. OVIEDO PNA No.: Valid Until:
Student Date document is signed: Time:
Please specify Highest Nursing Degree Earned:

Supervised by: Noted by: PROF. ZENAIDA M. BAUTISTA Approved by: PROF. MARIA TERESA R. FAJARDO
Clinical Instructor Clinical Coordinator Dean
Date signed: PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PRC I.D. No.: 0160104 Valid Until: September 9, 2010
Degree: PNA No.: 029069 Valid Until: October 31, 2010 PNA No.: 013739 Valid Until: October 31, 2010
PRC I.D. No.: Valid Until: Date document is signed: Time: ADPCN No.: Valid Until:
PNA No.: Valid Until: Please specify Highest Nursing Degree Earned: Date document is signed: Time:
Please specify Highest Nursing Degree Earned: