Name of Student : Farillas, Roxanne Algo First Course (if any) : N/A

Name and Address of School : Gordon College - College of Nursing School Graduated From : N/A Year:
Old Hospital Road, East Tapinac, Olongapo City Year of Admission in the BSN Program : 2006
Recognition and Accreditation Level (if any) : Year Granted 2004 Year Graduated from the BSN Program : 2010
Date School/ Program Recognized : Number 3 Year 2004

I. Major Operation
Signature of O.R. Scrub
No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Types of Anesthesia Name of Surgeon Name of Hospital Name of O.R. Scrub Nurse
Nurse
Federico Santos James L. Gordon Graciosa R. Perea, RN
1. November 28, 2008 454-163 Calculous Cholecystitis Open Cholecystectomy Spinal Anesthesia Arnildo C. Tamayo, MD
Ladiero Memorial Hospital License No. 0150559
Rommel Jay Serrano James L. Gordon Graciosa R. Perea, RN
2. November 29, 2008 454-135 Calculous Cholecystitis Laparoscopic Cholecystectomy General Anesthesia Arturo E. Mendoza, MD
Panlilio Memorial Hospital License No. 0150559
Jodielyn Romanban Gravida 2 Para 1 James L. Gordon Graciosa R. Perea, RN
3. December 6, 2008 454-491 Emergency Caesarian Section Spinal Anesthesia Joan C. Fermantez, MD
Ladon (1001), 39 2/7 weeks Memorial Hospital License No. 0150559
Emergency Exploratory Laparotomy, James L. Gordon Graciosa R. Perea, RN
4. May 8, 2009 460-476 Norilyn T. Bautista Ectopic Pregnancy Spinal Anesthesia Paolo C. Lizarondo, MD
Left Salphingectomy Memorial Hospital License No. 0150559
Hydradenitis James L. Gordon Charito B. Mista, RN
5. October 9, 2009 467-071 Princess L. Jimenez Wide Excision of Axillary Mass General Anesthesia Karen C. Romero, MD
Suppuritiva, Left Axilla Memorial Hospital License No. 0344193

Noted by: Concurred by: Approved by:

Rebecca M. Llabres, RN, MAN Ligaya P. Paragas, BSN, RN, MAN Victor C. Quimen, Jr., RN, MAN, Ph.D.
Signature and Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean

Date Signed : Date Signed : Date Signed :

Degree : Bachelor of Science in Nursing, Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing
: Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing
a) PRC No. : 0055326 a) PRC No. : 0129700 : Doctor of Philosophy
Valid until : July 31, 2010 Valid until : July 6, 2010 a) PRC No. : 0328797
b) PNA No. : 057101 b) PNA No. : 026616 Valid until : February 22, 2011
Valid until : October 2010 Valid until : October 2010 b) PNA No. : 057102
Valid until : October 2010
c) ADPCN No. : 0802
Valid until : Decemcer 2011 .
PREPARED BY : ROXANNE ALGO FARILLAS
Signature Over Name of Student
Name of Student : Farillas, Roxanne Algo First Course (if any) : N/A
Name and Address of School : Gordon College - College of Nursing School Graduated From : N/A Year:
Old Hospital Road, East Tapinac, Olongapo City Year of Admission in the BSN Program : 2006
Recognition and Accreditation Level (if any) : Year Granted 2004 Year Graduated from the BSN Program : 2010
Date School/ Program Recognized : Number 3 Year 2004

II. Minor Operation

Signature of
Types of Name of O.R. Scrub
No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Name of Surgeon Name of Hospital O.R. Scrub
Anesthesia Nurse
Nurse
Emergency Wound
Stabbed Wound Left Lumbar 1- Local Anesthesia, IV James L. Gordon Graciosa R. Perea, RN
1. December 4, 2008 452-408 Elpidio Cruz Montanas Exploration, Ligation of Lawrence R. Salazar, MD
Lumbar 2 Level Mid-scapular Line Sedation Memorial Hospital License No. 0150559
Bleeding
Marc Joseph James L. Gordon Graciosa R. Perea, RN
2. December 5, 2008 454-432 Acute Appendicitis Emergency Appendectomy Spinal Anesthesia Laurice C. Guillen, MD
Mirabuenos Amponin Memorial Hospital License No. 0150559
Bataan General Violeta Y. Garcia, RN
3. March 7, 2009 13-12-31 April Joy Madanang Missed Abortion Dilatation and Curettage IV Sedation Alma Madayag, MD
Hospital License No. 025849
Ome Francisco Cambe James L. Gordon Eloisa R. Rosapapan, RN,
4. April 29, 2009 642-921 Mild Head Injury Secondary to Fall Wound Suturing Local Anesthesia Lizette C. Refuerzo, MD
Jr. Memorial Hospital MAN-License No. 0062875
Foreign Body Impaled Second James L. Gordon Eloisa R. Rosapapan, RN,
5. July 2, 2009 644-502 Adolfo Donoso Cupo Wound Exploration Local Anesthesia Bonifacio P. Floreza, MD
Digit (Needle) Memorial Hospital MAN-License No. 0062875

Noted by: Concurred by: Concurred by: Approved by:

Rebecca M. Llabres, RN, MAN Ligaya P. Paragas, BSN, RN, MAN Evelyn R. Rubia, RN, MAN, PhD Victor C. Quimen, Jr., RN, MAN, Ph.D.
Signature and Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean

Date Signed : Date Signed : Date Signed : Date Signed :

Degree : Bachelor of Science in Nursing, Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing,
: Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing,

a) PRC No. : 0055326 a) PRC No. : 0129700 . : Doctor of Philosophy : Doctor of Philosophy
Valid until : July 31, 2010 Valid until : July 6, 2010 a) PRC No. : 0098006 a) PRC No. : 0328797

b) PNA No. : 057101 b) PNA No. : 026616 Valid until : October 22, 2011 Valid until : February 22, 2011
Valid until : October 2010 Valid until : October 2010 b) PNA No. : 7845 b) PNA No. : 057102
Valid until : Lifetime Valid until : October 2010

c) ADPCN No. : 0802

Valid until : Decemcer 2011 .

PREPARED BY : ROXANNE ALGO FARILLAS

Signature Over Name of Student
Name of Student : Farillas, Roxanne Algo First Course (if any) : N/A
Name and Address of School : Gordon College - College of Nursing School Graduated From : N/A Year:
Old Hospital Road, East Tapinac, Olongapo City Year of Admission in the BSN Program : 2006
Recognition and Accreditation Level (if any) : Year Granted 2004 Year Graduated from the BSN Program : 2010
Date School/ Program Recognized : Number 3 Year 2004

III. Actual Deliveries

Gender of Time of
No. Case No. Date Performed Diagnosis Name of Mother Age Type of Delivery Name of Hospital Supervised by: Name and Signature of Qualified C. I.
Baby Delivery
Gravida 1 Para 0, Pregnancy Uterine,
Normal Spontaneous Bataan General Violeta Y. Garcia, RN
1. March 7, 2009 39 weeks Age of Gestation, Cephalic Marian Yumul 15 Male 9:49 AM
13-12-35 Delivery Hospital License No. 025849
in Labor
Gravida 3 Para 2, Pregnancy Uterine,
Normal Spontaneous Bataan General Violeta Y. Garcia, RN
2. March 12, 2009 36 weeks Age of Gestation, Cephalic Daniela Iso 42 Female 11:25 AM
13-14-81 Delivery Hospital License No. 025849
in Labor
Gravida 1 Para 0, Pregnancy Uterine,
Normal Spontaneous Bataan General Sheila Marie P. Oconer, RN
3. 13-32-75 April 21, 2009 38 weeks Age of Gestation, Cephalic Michelle Laylo 25 Female 12:01 AM
Delivery Hospital License No. 0374931
in Labor
Gravida 1 Para 0, Pregnancy Uterine,
Normal Spontaneous Bataan General Sheila Marie P. Oconer, RN
4. 13-33-20 April 21, 2009 38 weeks Age of Gestation, Cephalic Melanie Manuel 17 Female 4:51 AM
Delivery Hospital License No. 0374931
in Labor
Gravida 1 Para 0, Pregnancy Uterine,
Normal Spontaneous James L. Gordon Noreen Espedido, RN, MAN
5. 461-948 August 15, 2009 39 weeks Age of Gestation, Cephalic Veronica Calingasan 18 Male 7:35 AM
Delivery Memorial Hospital License No. 0231056
in Labor

Noted by: Concurred by: Concurred by: Approved by:

Rebecca M. Llabres, RN, MAN Ligaya P. Paragas, BSN, RN, MAN Evelyn R. Rubia, RN, MAN, PhD Victor C. Quimen, Jr., RN, MAN, Ph.D.
Signature and Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean

Date Signed : Date Signed : Date Signed : Date Signed :

Degree : Bachelor of Science in Nursing, Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing,
: Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing,

a) PRC No. : 0055326 a) PRC No. : 0129700 . : Doctor of Philosophy : Doctor of Philosophy
Valid until : July 31, 2010 Valid until : July 6, 2010 a) PRC No. : 0098006 a) PRC No. : 0328797

b) PNA No. : 057101 b) PNA No. : 026616 Valid until : October 22, 2011 Valid until : February 22, 2011
Valid until : October 2010 Valid until : October 2010 b) PNA No. : 7845 b) PNA No. : 057102
Valid until : Lifetime Valid until : October 2010
 c) ADPCN No. : 0802
Valid until : Decemcer 2011 .

PREPARED BY : ROXANNE ALGO FARILLAS

Signature Over Name of Student

Name of Student : Farillas, Roxanne Algo First Course (if any) : N/A
Name and Address of School : Gordon College - College of Nursing School Graduated From : N/A Year:
Old Hospital Road, East Tapinac, Olongapo City Year of Admission in the BSN Program : 2006
Recognition and Accreditation Level (if any) : Year Granted 2004 Year Graduated from the BSN Program : 2010
Date School/ Program Recognized : Number 3 Year 2004

IV. Deliveries Assisted

Time of Gender of
No. Case No. Diagnosis Name of Patient Age Date of Delivery Name of Hospital Type of Delivery Supervised by: Name and Signature of Qualified C. I.
Delivery Baby
Gravida 2 Para 1, Pregnancy Uterine, Bataan General Normal Spontaneous Violeta Y. Garcia, RN
1. 13-12-01 Analyn Orpiada 19 March 6, 2009 9:36 AM Male
37 weeks Age of Gestation Hospital Delivery License No. 025849
Gravida 1 Para 0, Pregnancy Uterine, Bataan General Normal Spontaneous Violeta Y. Garcia, RN
2. 13-12-38 Jenelyn Santiago 18 March 7, 2009 12:40 PM Male
39 weeks Age of Gestation Hospital Delivery License No. 025849
Gravida 1 Para 0, Pregnancy Uterine, Mary Grace de Bataan General Normal Spontaneous Violeta Y. Garcia, RN
3. 13-15-17 24 March 13, 2009 10:30 AM Male
38 weeks Age of Gestation Jesus Hospital Delivery License No. 025849
Gravida 2 Para 1, Pregnancy Uterine, Bataan General Normal Spontaneous Violeta Y. Garcia, RN
4. 13-15-49 Rowena Galura 38 March 14, 2009 10:47 AM Male
40 weeks Age of Gestation Hospital Delivery License No. 025849
Gravida 3 Para 2, Pregnancy Uterine, Bataan General Normal Spontaneous Violeta Y. Garcia, RN
5. 13-15-44 Evylinda Doronio 36 March 14, 2009 3:03 PM Male
37 weeks Age of Gestation Hospital Delivery License No. 025849

Noted by: Concurred by: Approved by:

Rebecca M. Llabres, RN, MAN Evelyn R. Rubia, RN, MAN, Ph.D. Victor C. Quimen Jr., RN, MAN, Ph.D.
Signature and Printed Name of Clinical Coordinator Signature over Printed Name of Chief Nurse Signature over Printed Name of Dean

Date Signed : Date Signed : Date Signed :

Degree : Bachelor of Science in Nursing, Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing,
: Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing
a) PRC No. : 0055326 : Doctor of Philosophy : Doctor of Philosophy
Valid until : July 31, 2010 a) PRC No. : 0098006 a) PRC No. : 0328797
b) PNA No. : 057101 Valid until : October 22, 2011 Valid until : February 22, 2011
Valid until : October 2010 b) PNA No. : 7845 b) PNA No. : 057102
Valid until : Lifetime Valid until : October 2010
c) ADPCN No. : 0802
 Valid until : Decemcer 2011 .

PREPARED BY : ROXANNE ALGO FARILLAS

Signature Over Name of Student

Name of Student : Farillas, Roxanne Algo First Course (if any) : N/A
Name and Address of School : Gordon College - College of Nursing School Graduated From : N/A Year:
Old Hospital Road, East Tapinac, Olongapo City Year of Admission in the BSN Program : 2006
Recognition and Accreditation Level (if any) : Year Granted 2004 Year Graduated from the BSN Program : 2010
Date School/ Program Recognized : Number 3 Year 2004

V. Cord Dressings
No. Case No. Date Performed Name of Baby Gender of baby Name of Mother Age Name of Hospital Supervised by: Name and Signature of Qualified C. I.
James L. Gordon Memorial Yvonne Pedroso, RN
1. 453-553-33139 November 14, 2008 Baby Girl Cayanong Female Marilou Belleza Cayanong 22
Hospital License No. 0360520
James L. Gordon Memorial Yvonne Pedroso, RN
2. 453-193-33189 November 15, 2008 Baby Girl Tabornal Female Mary Rose Tabornal 20
Hospital License No. 0360520
James L. Gordon Memorial Yvonne Pedroso, RN
3. 815-453-915 November 21, 2008 Baby Boy Olan-Olan Male Leslie Lagrimas Olan-Olan 24
Hospital License No. 0360520
James L. Gordon Memorial Arnaldo Daroy Jr., RN, MAN
4. July 10, 2009 Baby Boy Santos Male Hilda Santos 36
463-378 Hospital License No. 0320824
James L. Gordon Memorial Arnaldo Daroy Jr., RN, MAN
5. 464-489-48504 July 24, 2009 Baby Girl Acayan Female Mary Rezel Acayan 27
Hospital License No. 0320824

Noted by: Concurred by: Approved by:

Rebecca M. Llabres, RN, MAN Ligaya P. Paragas, BSN, RN, MAN Victor C. Quimen, Jr., RN, MAN, Ph.D.
Signature and Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean

Date Signed : Date Signed : Date Signed :

Degree : Bachelor of Science in Nursing, Degree : Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing
: Master of Arts in Nursing : Master of Arts in Nursing : Master of Arts in Nursing
a) PRC No. : 0055326 a) PRC No. : 0129700 : Doctor of Philosophy
Valid until : July 31, 2010 Valid until : July 6, 2010 a) PRC No. : 0328797
b) PNA No. : 057101 b) PNA No. : 026616 Valid until : February 22, 2011
 Valid until : October 2010 Valid until : October 2010 b) PNA No. : 057102
Valid until : October 2010
c) ADPCN No. : 0802
Valid until : Decemcer 2011 ..
PREPARED BY : ROXANNE ALGO FARILLAS
Signature Over Name of Student