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Mindanao Sanitarium & Hospital College

School of Nursing Barangay San Miguel, Iligan City 9200 Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated Accreditation Level: Level II, April 29, 2011 April 2014 Accredited By: Adventist Accrediting Association Accreditation Level: Level II, October 4, 2010-December 31, 2012 IMMEDIATE NEWBORN CORD CARE in:Adventist Medical Center, Barangay San Miguel, Iligan City Lanao del Norte Provincial Hospital, Baroy, Lanao del Norte Hospital/Home/Lying-in, Municipality/City/Province Prepared by: Printed name and Signature of Student: CRISTINA L. JAYSON Date Performed and Time Started Patients INITIAL Only Case Number (not applicable for Birthing/Lying-in Clinics/Homes) Baby Boy M 199353 Immediate Newborn Cord Care PERFORMED Indicate where performed e.g. D.R., Nursery, Nicu, or Home Nurse on Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

INCB Form IMMEDIATE CARE OF THE NEWBORN FORM

SUPERVISED BY Clinical Instructor Name and Signature

September 21, 2011 12:09 AM

Cord Care Neonatal Intensive Care Unit

Cristine Faith G. Damas, RN PRC Number: 0441143 Valid Until: July 7, 2016 Eunice Lan S. Ardiente, RN PRC Number: 0714486 Valid Until: October 19, 2017 Nia Mae D. Abarquez, RN PRC Number: 0651914 Valid Until: January 1, 2016

Lucy May L. Bucayan, MN, RN PRC Number: 0193232 Valid Until: May 25, 2016 Lucy May L. Bucayan, MN, RN PRC Number: 0193232 Valid Until: May 25, 2016 Daverly M. Caeda, MN, RN PRC Number: 0364265 Valid Until: April 28, 2016

September 26, 2012 10:00 AM

Baby Boy L 211834

Cord Care Neonatal Intensive Care Unit

October 2, 2013 9:46 PM

Baby Girl F 074557

Cord Care Neonatal Intensive Care Unit

Noted by: EVALYN M. LECCIONES, MN, RN (Print Name and Signature) Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Date document is signed: ________ Time:______________ Please specify Highest Nursing Degree Earned: Master in Nursing

Approved by: GTER G, GAID, PhD, MAN, RN (Print Name and Signature) Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015 Date document is signed: Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Mindanao Sanitarium & Hospital College


School of Nursing Barangay San Miguel, Iligan City 9200 Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated Accreditation Level: Level II, April 29, 2011 April 2014 Accredited By: Adventist Accrediting Association Accreditation Level: Level II, October 4, 2010-December 31, 2012

D.R. Form ACTUAL DELIVERY FORM

ACTUAL DELIVERY in: Adventist Medical Center, Barangay San Miguel, Iligan City Gregorio T. Lluch Memorial Hospital, Palao, Iligan City Hospital/Home/Lying-in, Municipality/City/Province Prepared by: Printed name and Signature of Student: CRISTINA L. JAYSON Patients INITIAL Only Case Number (not applicable for Birthing/Lying-in Clinics/Homes) ND 203287 Normal Spontaneous Vaginal Delivery

Date Performed and Time Started

Type of Delivery

D. R. Nurse on Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor Name and Signature

January 6, 2012 4:09 AM

Dyan Marie L. Villaver, RN PRC Number: 0411677 Valid Until: November 1, 2015 Cheryl S. Epe, RN PRC Number: 0318137 Valid Until: September 10, 2016 Merlita B. Omlero, RM PRC Number: 0101442 Valid Until: June 5, 2015

Lucy May L. Bucayan, MN, RN PRC Number: 0193232 Valid Until: May 25, 2016 Daverly M. Caeda, MN, RN PRC Number: 0364265 Valid Until: April 28, 2016 Daverly M. Caeda, MN, RN PRC Number: 0364265 Valid Until: April 28, 2016

October 12, 2012 7: 25 AM

EG 154393

Normal Spontaneous Vaginal Delivery

July 19, 2013 6:00 PM

JT 79256

Normal Spontaneous Vaginal Delivery

Noted by: EVALYN M. LECCIONES, MN, RN (Print Name and Signature) Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Date document is signed: ________ Time:______________ Please specify Highest Nursing Degree Earned: Master in Nursing

Approved by: GTER G, GAID, PhD, MAN, RN (Print Name and Signature) Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015 Date document is signed: Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Mindanao Sanitarium & Hospital College


School of Nursing Barangay San Miguel, Iligan City 9200 Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated Accreditation Level: Level II, April 29, 2011 April 2014 Accredited By: Adventist Accrediting Association Accreditation Level: Level II, October 4, 2010-December 31, 2012 SURGICAL SCRUB in: Gregorio T. Lluch Memorial Hospital, Palao, Iligan City Adventist Medical Center, Barangay San Miguel, Iligan City Hospital/Home/Lying-in, Municipality/City/Province Prepared by: Printed name and Signature of Student: CRISTINA L. JAYSON Patients INITIAL Only Case Number (not applicable for Birthing/Lying-in Clinics/Homes) O.R. Form 1A O.R. SCRUB FORM MAJOR

Date Performed and Time Started

SURGICAL PROCEDURE PERFORMED

O.R. Nurse on Duty (Name and Signature)

SUPERVISED BY Clinical Instructor Name and Signature

August 9, 2012 11:30 PM

RB 147899

Appendectomy

Jed R. Santos, RN, CRN PRC Number: 0660385 Valid Until: July 14, 2016 Wendy Mar S. Rodrigo, RN PRC Number: 0313886 Valid Until: March 3, 2015

Darilyn G. Literatus, MN, RN PRC Number: 0301632 Valid Until: November 25, 2016 Sheilma Dreamy G. Manata, MN,RN PRC Number: 0173264 Valid Until: May 28, 2017

September 13, 2012 11:32 AM

SB 130179

Pelvic Laparotomy

December 6, 2012 1:40 PM

JG 062232

First Repeat Low Segment Transverse Cesarean Section

Belen Joy C. Patindol, RN PRC Number: 0306764 Valid Until: December 20, 2015

Sheilma Dreamy G. Manata,MN, RN PRC Number: 0173264 Valid Until: May 28, 2017

Noted by: EVALYN M. LECCIONES, MN, RN (Print Name and Signature) Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Date document is signed: ________ Time:______________ Please specify Highest Nursing Degree Earned: Master in Nursing

Approved by: GTER G, GAID, PhD, MAN, RN (Print Name and Signature) Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015 Date document is signed: Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Mindanao Sanitarium & Hospital College


School of Nursing Barangay San Miguel, Iligan City 9200 Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated Accreditation Level: Level II, April 29, 2011 April 2014 Accredited By: Adventist Accrediting Association Accreditation Level: Level II, October 4, 2010-December 31, 2012 CIRCULATING NURSE in: Gregorio T. Lluch Memorial Hospital, Palao, Iligan City Adventist Medical Center, Barangay San Miguel, Iligan City Hospital/Home/Lying-in, Municipality/City/Province Prepared by: Printed name and Signature of Student: CRISTINA L. JAYSON Patients INITIAL Only Case Number (not applicable for Birthing/Lying-in Clinics/Homes)

O.R. Form 1A O.R. CIRCULATING FORM MAJOR

Date Performed and Time Started

PROCEDURE PERFORMED

O.R. Nurse on Duty (Name and Signature)

SUPERVISED BY Clinical Instructor Name and Signature

August 7, 2012 11:51 PM

RB 148071

Primary Low Segment Ceasarean Section

Deardrie Rofany P. Dumadag, RN PRC Number: 0582588 Valid Until: July 15, 2015

Darilyn G. Literatus, MN, RN PRC Number: 0301632 Valid Until: November 25, 2016

December 7, 2012 1:30 PM

RV 157535

Open Cholecystectomy with Intraoperative Cholangiogram, Common Bile Duct Exploration, Ttube Cholangiogram, Choledochodudenostomy Drain Herniorrhaphy with Right Lichenstein Mesh

Belen Joy C. Patindol, RN PRC Number: 0306764 Valid Until: December 20, 2015

Sheilma Dreamy G. Manata, MN, RN PRC Number: 0173264 Valid Until: May 28, 2017

March 25, 2013 11:53 AM

RE 173629

Jan Michael B. Labuga,MN, RN PRC Number: 0390113 Valid Until: January 9, 2015

Darilyn G. Literatus, MN, RN PRC Number: 0301632 Valid Until: November 25, 2016

Noted by: EVALYN M. LECCIONES, MN, RN (Print Name and Signature) Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Date document is signed: ________ Time:______________ Please specify Highest Nursing Degree Earned: Master in Nursing

Approved by: GTER G, GAID, PhD, MAN, RN (Print Name and Signature) Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015 Date document is signed: Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing