Prepared by: First Course (If Any): None

Name of Student: Van Kristine Joy M. Baluyut School Graduated From: Not Applicable Year: Not Applicable
Name & Address of School: Philippine Rehabilitation Institute Foundation, Inc.,
Olongapo Gapan Road San Matias, Guagua Pampanga
Accreditation Level (If Any): Not Applicable Year Granted: Not Applicable Year of Admission in the Bachelor of Science in Program: 2007
Date School / Program were Recognized: February 18, 2009 Number: 008 Year: 2011 Year Graduated: 2011
I. MAJOR OPERATION

Supervised by: Name

Case Name of OR Scrub
No. Date of Operation Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital & Signature of
Number Nurse
Qualified C.I

Gravida2 Para1 Emergency Low

1 March 13, 2010 15-50-38 Norely Guintu Spinal Anesthesia Dr. Ferdinand Pabustan Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Previous Caesarean Transverse Caesarean
District Hospital R.N. Quintela, R.N., M.A.N.
Section in Labor Section 1
(ue)

Gravida1 Para0 Cephalo Emergency Low

2 April 24, 2010 15-50-83 Arly Sampang Spinal Anesthesia Dr. Ferdinand Pabustan Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Pelvic Disproportion in Transverse Caesarean
District Hospital R.N. Quintela, R.N., M.A.N.
Labor 38-39 Weeks Section 1
(ue)

Total Abdominal
Hysterectomy Bilateral
3 February 2, 2011 15-93-33 Ludivina Bustamante Myoma Uteri Spinal Anesthesia Dr. Fausto Mallari Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Salphyngo
Dr. Abenir Tungol District Hospital R.N. Quintela, R.N., M.A.N.
Oophorectomy
(ue)

To Consider Peri-
Open Reduction
4 March 3, 2011 15-98-47 Eduard Carpio Implant Infection Spinal Anesthesia Dr. Chad Reyes Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Internal Fixation
Femural District Hospital R.N. Quintela, R.N., M.A.N.
(ue)

Gravida2 Para1
Gravida2 Para1
Pregnancy Uterine in
5 March 16, 2011 15-99-08 Jem-Jem Tayuc Pregnancy Uterine in Spinal Anesthesia Dr. Fausto Mallari Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Labor, Cephalopelvic
labor District Hospital R.N. Quintela, R.N., M.A.N.
Disproportion
(ue)

Noted by: Concurred by: Approved by:

Nancy M. Legaspi, BSN, RN, MAN Ester Mendiola, BSN, RN. Maria Remedios S. Garcia, RN, MAN
Signature over Printed Name Signature over Printed Name Signature over Printed Name of Dean
Date Signed: ____________ Date Signed: _____________ Date Signed: _____________
Degree: Bachelor of Science in Nursing Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing, Master of Arts in Nursing
a) PRC No.:0178352 a) PRC No.:0052065 a) PRC No.: 0102024
Valid Until. March 20 2012 Valid Until: Aug 21, 2012 Valid Until: 07/01/2012
PNA No. 0178352 b) PNA No.:11940 b) PNA No.: 049199
Valid Until: 12 – 10 - 2011 Valid Until: Lifetime Valid Until: 2011
c) ADCPN No.: 0799
Valid Until: 2011
Prepared by: First Course (If Any): None
Name of Student: Van Kristine Joy M. Baluyut School Graduated From: Not Applicable Year: Not Applicable
Name & Address of School: Philippine Rehabilitation Institute Foundation, Inc.,
Olongapo Gapan Road San Matias, Guagua Pampanga
Accreditation Level (If Any): Not Applicable Year Granted: Not Applicable Year of Admission in the Bachelor of Science in Program: 2007
Date School / Program was Recognized: February 18, 2009 Number: 008 Year: 2011 Year Graduated: 2011
Ii. MINOR OPERATION

Supervised by: Name

Case Name of OR Scrub
No. Date of Operation Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital & Signature of
Number Nurse
Qualified C.I

Gravida3 Para3 Post Bilateral Tubal ligation,

15-48-83 Rocel Ramos Partum Sterilization Mini Laparotomy under Local Anesthesia Dr. Antonio Aquino Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
1 April 14, 2010
Day 1 Local Anesthesia District Hospital R.N. Quintel, R.N., M.A.N.
(ue)

2 May 3, 2010 15-48-74 Jowella Suerte Gravida3 Para3 Bilateral Tubal ligation Local Anesthesia Dr. Fausto Mallari Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
District Hospital R.N. Quintel, R.N., M.A.N.
(ue)

3 May 4, 2010 15-51-54 Eduardo Gulapa Indirect Inguinal Hernia Herniorrhaphy Spinal Anesthesia Dr. Antonio Aquino Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
District Hospital R.N. Quintel, R.N., M.A.N.
(ue)

Bilateral Tubal Ligation,

Gravida5 Para5 Post
Mini Laparotomy under
4 May 12, 2010 15-52-36 Jona Araneta Partum Sterilization Local Anesthesia Dr. Ferdinand Pabustan Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
Local Anesthesia
Day 3 District Hospital R.N. Quintel, R.N., M.A.N.
(ue)

5 May 31, 2010 15-55-00 Mylene Tamayo External Hemorrhoids Hemorrhoidectomy Spinal Anesthesia Dr. Antonio Aquino Romana Pangan Mrs. Teresita Almario, Mrs. Jennifer Q.
District Hospital R.N. Quintel, R.N., M.A.N.
(ue)

Noted by: Concurred by: Approved by:

Nancy M. Legaspi, BSN, RN, MAN Ester Mendiola, BSN, RN Maria Remedios S. Garcia, RN, MAN
Signature over Printed Name: Clinical Coordinator Signature over Printed Name: Chief Nurse Signature over Printed Name: Dean
Date Signed: ____________ Date Signed: _____________ Date Signed: _____________
Degree: Bachelor of Science in Nursing, Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing, Master of Arts in Nursing
a) PRC No.:0178352 a) PRC No.:0052065 a) PRC No.: 0102024
Valid Until. March 20 2012 Valid Until: Aug 21, 2012 Valid Until: 07/01/2012
PNA No. 0178352 b) PNA No.:11940 b) PNA No.: 049199
Valid Until: 12 – 10 - 2011 Valid Until: Lifetime Valid Until: 2011
c) ADCPN No.: 0799
Valid Until: 2011
Prepared by: First Course (If Any): None
Name of Student: Van Kristine Joy. Baluyut School Graduated From: Not Applicable Year: Not Applicable
Name & Address of School: Philippine Rehabilitation Institute Foundation, Inc.,
Olongapo Gapan Road San Matias, Guagua Pampanga
Accreditation Level (If Any): Not Applicable Year Granted: Not Applicable Year of Admission in the Bachelor of Science in Program: 2007
Date School / Program was Recognized: February 18, 2009 Number: 008 Year: 2011 Year Graduated: 2011
I. ACTUAL ASSISTED

Supervised by: Name

No. Case Number Diagnosis Name of Mother Age Date of Delivery Time of Delivery Gender of Baby Name of Hospital Type of Delivery & Signature of
Qualified C.I

Pregnancy Uterine 39th

Week Age of Gestation, Lyra Isip
1 15-64-60 Cephalic, in Beginning 29 years old August 5, 2010 5:35 p.m. Female Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
Labor District Hospital Delivery R.N., M.A.N.
Gravida1 Para0

Gravida1 Para0
2 15-65-96 Pregnancy Uterine Full Arceli Arlega 26 years old August 13, 2010 4:36 p.m. Female Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
Term District Hospital Delivery R.N., M.A.N.

Gravida2 Para1
3 15-64-68 Pregnancy Uterine Full Jacquilou Pitalino 27 years old August 5, 2010 6:35 p.m. Male Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
Term District Hospital Delivery R.N., M.A.N.

4 15-75-09 Emergency, Normal Jennie Pineda 23 years old October 7, 2010 11:45 a.m. Female Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
Spontaneous Delivery District Hospital Delivery R.N., M.A.N.

Gravida1 Para0
5 15-65-44 Pregnancy Uterine in Ronilla Dela Cruz 20 years old September 8, 2010 4:45 p.m. Female Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
Labor District Hospital Delivery R.N., M.A.N.

Noted by: Concurred by: Approved by:

Nancy M. Legaspi, BSN, RN, MAN Ester Mendiola, BSN, RN Maria Remedios S. Garcia, RN, MAN
Signature over Printed Name: Clinical Coordinator Signature over Printed Name: Chief Nurse Signature over Printed Name: Dean
Date Signed: ____________ Date Signed: _____________ Date Signed: _____________
Degree: Bachelor of Science in Nursing, Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing, Master of Arts in Nursing
a) PRC No.:0178352 a) PRC No.:0052065 a) PRC No.: 0102024
Valid Until. March 20 2012 Valid Until: Aug 21, 2012 Valid Until: 07/01/2012
PNA No. 0178352 b) PNA No.:11940 b) PNA No.: 049199
Valid Until: 12 – 10 - 2011 Valid Until: Lifetime Valid Until: 2011
c) ADCPN No.: 0799
Valid Until: 2011
Prepared by: First Course (If Any): None
Name of Student: Van Kristine Joy. Baluyut School Graduated From: Not Applicable Year: Not Applicable
Name & Address of School: Philippine Rehabilitation Institute Foundation, Inc.,
Olongapo Gapan Road San Matias, Guagua Pampanga
Accreditation Level (If Any): Not Applicable Year Granted: Not Applicable Year of Admission in the Bachelor of Science in Program: 2007
Date School / Program was Recognized: February 18, 2009 Number: 008 Year: 2011 Year Graduated: 2011
II. DELIVERIES ASSISTED

Supervised by: Name

No. Case Number Diagnosis Name of Mother Age Date of Delivery Time of Delivery Gender of Baby Name of Hospital Type of Delivery & Signature of
Qualified C.I

Romalyn Bato
1 15-27-62 Gravida1 Para0 24 years old November 19, 2009 6:60 a.m. Female Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
District Hospital Delivery R.N., M.A.N.

2 15-28-61 Gravida3 Para2 Vivian David 34 years old November 26, 2009 11:25 a.m. Male Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
District Hospital Delivery R.N., M.A.N.

3 15-50-05 Gravida3 Para2 Mylene Matitu 31 years old April 23, 2010 9:35 a.m. Male Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
District Hospital Delivery R.N., M.A.N.

Romana Pangan Normal Spontaneous

4 15-55-72 Gravida1 Para1 Sheryl Magmay 20 years old June 4, 2010 7:46 p.m. Female District Hospital Delivery
Ms. Henlyn L. Enriquez,
R.N., M.A.N.

Juanita Occenia
5 15-64-65 Gravida4 Para3 36 years old August 5, 2010 6:15 p.m. Male Romana Pangan Normal Spontaneous Ms. Henlyn L. Enriquez,
District Hospital Delivery R.N., M.A.N.

Noted by: Concurred by: Approved by:

Nancy M. Legaspi, BSN, RN, MAN Ester Mendiola, BSN, RN Maria Remedios S. Garcia, RN, MAN
Signature over Printed Name: Clinical Coordinator Signature over Printed Name: Chief Nurse Signature over Printed Name: Dean
Date Signed: ____________ Date Signed: _____________ Date Signed: _____________
Degree: Bachelor of Science in Nursing, Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing, Master of Arts in Nursing
a) PRC No.:0178352 a) PRC No.:0052065 a) PRC No.: 0102024
Valid Until. March 20 2012 Valid Until: Aug 21, 2012 Valid Until: 07/01/2012
PNA No. 0178352 b) PNA No.:11940 b) PNA No.: 049199
Valid Until: 12 – 10 - 2011 Valid Until: Lifetime Valid Until: 2011
c) ADCPN No.: 0799
Valid Until: 2011
Prepared by: First Course (If Any): None
Name of Student: Van Kristine Joy. Baluyut School Graduated From: Not Applicable Year: Not Applicable
Name & Address of School: Philippine Rehabilitation Institute Foundation, Inc.,
Olongapo Gapan Road San Matias, Guagua Pampanga
Accreditation Level (If Any): Not Applicable Year Granted: Not Applicable Year of Admission in the Bachelor of Science in Program: 2007
Date School / Program was Recognized: February 18, 2009 Number: 008 Year: 2011 Year Graduated: 2011
III. CORD DRESSING

Supervised by: Name &

No. Case Number Date of Operation Gender of Baby Name of Mother Age Name of Hospital
Signature of Qualified C.I

1 15-18-13 September 18, 2009 Male Eliza Apostol 28 years old Romana Pangan District Hospital Ms. Henlyn L. Enriquez, R.N.,
M.A.N.

2 15-51-63 August 4, 2010 Male Jenifer Cirujales 20 years old Romana Pangan District Hospital Ms. Henlyn L. Enriquez, R.N.,
M.A.N.

3 15-91-13 January 19, 2011 Female Glaiza Francisco 23 years old Romana Pangan District Hospital Ms. Henlyn L. Enriquez, R.N.,
M.A.N.

4 15-91-26 January 19,2011 Female Mary Jane Simon 20 years old Romana Pangan District Hospital Ms. Henlyn L. Enriquez, R.N.,
M.A.N.

5
Romana Pangan District Hospital Ms. Henlyn L. Enriquez, R.N.,
M.A.N.

Noted by: Concurred by: Approved by:

Nancy M. Legaspi, BSN, RN, MAN Ester Mendiola, BSN, RN Maria Remedios S. Garcia, RN, MAN
Signature over Printed Name: Clinical Coordinator Signature over Printed Name: Chief Nurse Signature over Printed Name: Dean
Date Signed: ____________ Date Signed: _____________ Date Signed: _____________
Degree: Bachelor of Science in Nursing, Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing, Master of Arts in Nursing
a) PRC No.:0178352 a) PRC No.:0052065 a) PRC No.: 0102024
Valid Until. March 20 2012 Valid Until: Aug 21, 2012 Valid Until: 07/01/2012
PNA No. 0178352 b) PNA No.:11940 b) PNA No.: 049199
Valid Until: 12 – 10 - 2011 Valid Until: Lifetime Valid Until: 2011
c) ADCPN No.: 0799
Valid Until: 2011