UNIVERSITY OF PANGASINAN

COLLEGE OF NURSING
DAGUPAN CITY
University Seal

NAME OF STUDENT: SANTOS, Paul Christian Padama First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year:
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: June 2007
Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

I. MAJOR OPERATIONS
TIME OF NAME OF PATIENT
DATE of OPERATION OPERATION TYPE of NAME of NAME of Name and Signature of Qualified
No.
OPERATION STARTED- DIAGNOSIS
CASE NO. PERFORMED ANESTHESIA SURGEON HOSPITAL Clinical Instructor
ENDED

3
4
5
LEGEND:

Prepared by: Concurred by:

PAUL CHRISTIAN P. SANTOS

Student _____,Chief Nurse
Date Signed:
Degree:
a). PRC No.: Valid Until:
b). PNA No.: Valid Until:
c). ANSAP No.: Valid Until:

Supervised by: Noted by: Approved by:

ZENAIDA M. BAUTISTA MELANIA C. CENON

Clinical Instructor Clinical Coordinator Dean
Date Signed: Date Signed: Date Signed:
Degree: Degree: BSN-RN, MAN Degree: BSN-RN, MAN, MAEd, PhD
a). PRC No.: Valid Until: a). PRC No.: 0133422 Valid Until: July 27, 2011 a). PRC No.: 0100236 Valid Until: January 06, 2012
b). PNA No.: Valid Until: b). PNA No.: 029069 Valid Until: December 31, 2009 b). PNA No.: 17978 Valid Until: Lifetime Member
c). ANSAP No.: 09-0054 Valid Until: December 31, 2009 c). ADPCN No.: 0185 Valid Until: December 31, 2009
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
DAGUPAN CITY
University Seal

NAME OF STUDENT: SANTOS, Paul Christian Padama First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year:
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: June 2007
Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

II. MINOR OPERATIONS

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

3
4
5
LEGEND:

Prepared by: Concurred by:

PAUL CHRISTIAN P. SANTOS

Student _____,Chief Nurse
Date Signed:
Degree:
a). PRC No.: Valid Until:
b). PNA No.: Valid Until:
c). ANSAP No.: Valid Until:

Supervised by: Noted by: Approved by:

ZENAIDA M. BAUTISTA MELANIA C. CENON

Clinical Instructor Clinical Coordinator Dean
Date Signed: Date Signed: Date Signed:
Degree: Degree: BSN-RN, MAN Degree: BSN-RN, MAN, MAEd, PhD
a). PRC No.: Valid Until: a). PRC No.: 0133422 Valid Until: July 27, 2011 a). PRC No.: 0100236 Valid Until: January 06, 2012
b). PNA No.: Valid Until: b). PNA No.: 029069 Valid Until: December 31, 2009 b). PNA No.: 17978 Valid Until: Lifetime Member
c). ANSAP No.: 09-0054 Valid Until: December 31, 2009 c). ADPCN No.: 0185 Valid Until: December 31, 2009
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
DAGUPAN CITY
University Seal

NAME OF STUDENT: SANTOS, Paul Christian Padama First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year:
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: June 2007
Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

III. ACTUAL DELIVERIES

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

LEGEND:

Prepared by: Concurred by:

PAUL CHRISTIAN P. SANTOS

Student _____,Chief Nurse
Date Signed:
Degree:
a). PRC No.: Valid Until:
b). PNA No.: Valid Until:
c). ANSAP No.: Valid Until:

Supervised by: Noted by: Approved by:

ZENAIDA M. BAUTISTA MELANIA C. CENON

Clinical Instructor Clinical Coordinator Dean
Date Signed: Date Signed: Date Signed:
Degree: Degree: BSN-RN, MAN Degree: BSN-RN, MAN, MAEd, PhD
a). PRC No.: Valid Until: a). PRC No.: 0133422 Valid Until: July 27, 2011 a). PRC No.: 0100236 Valid Until: January 06, 2012
b). PNA No.: Valid Until: b). PNA No.: 029069 Valid Until: December 31, 2009 b). PNA No.: 17978 Valid Until: Lifetime Member
c). ANSAP No.: 09-0054 Valid Until: December 31, 2009 c). ADPCN No.: 0185 Valid Until: December 31, 2009
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
DAGUPAN CITY
University Seal

NAME OF STUDENT: SANTOS, Paul Christian Padama First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year:
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: June 2007
Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

IV. DELIVERIES ASSISSTED

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

LEGEND:

Prepared by: Concurred by:

PAUL CHRISTIAN P. SANTOS

Student _____,Chief Nurse
Date Signed:
Degree:
a). PRC No.: Valid Until:
b). PNA No.: Valid Until:
c). ANSAP No.: Valid Until:

Supervised by: Noted by: Approved by:

ZENAIDA M. BAUTISTA MELANIA C. CENON

Clinical Instructor Clinical Coordinator Dean
Date Signed: Date Signed: Date Signed:
Degree: Degree: BSN-RN, MAN Degree: BSN-RN, MAN, MAEd, PhD
a). PRC No.: Valid Until: a). PRC No.: 0133422 Valid Until: July 27, 2011 a). PRC No.: 0100236 Valid Until: January 06, 2012
b). PNA No.: Valid Until: b). PNA No.: 029069 Valid Until: December 31, 2009 b). PNA No.: 17978 Valid Until: Lifetime Member
c). ANSAP No.: 09-0054 Valid Until: December 31, 2009 c). ADPCN No.: 0185 Valid Until: December 31, 2009
 UNIVERSITY OF PANGASINAN
COLLEGE OF NURSING
DAGUPAN CITY
University Seal

NAME OF STUDENT: SANTOS, Paul Christian Padama First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year:
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: June 2007
Date School / Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

V. CORD DRESSING
DATE TIME of GENDER of NAME of Name and Signature of Qualified
No. Case No. NAME of BABY AGE NAME of HOSPITAL
PERFORMED DELIVERY BABY MOTHER Clinical Instructor
1

LEGEND:

Prepared by: Concurred by:

PAUL CHRISTIAN P. SANTOS

Student _____,Chief Nurse
Date Signed:
Degree:
a). PRC No.: Valid Until:
b). PNA No.: Valid Until:
c). ANSAP No.: Valid Until:

Supervised by: Noted by: Approved by:

ZENAIDA M. BAUTISTA MELANIA C. CENON

Clinical Instructor Clinical Coordinator Dean
Date Signed: Date Signed: Date Signed:
Degree: Degree: BSN-RN, MAN Degree: BSN-RN, MAN, MAEd, PhD
a). PRC No.: Valid Until: a). PRC No.: 0133422 Valid Until: July 27, 2011 a). PRC No.: 0100236 Valid Until: January 06, 2012
b). PNA No.: Valid Until: b). PNA No.: 029069 Valid Until: December 31, 2009 b). PNA No.: 17978 Valid Until: Lifetime Member
c). ANSAP No.: 09-0054 Valid Until: December 31, 2009 c). ADPCN No.: 0185 Valid Until: December 31, 2009