REPUBLIC OF THE PHILIPPINES PROFESSIONAL REGULATION COMMISSION BOARD OF NURSING Adapted by: Far Eastern University Prepared by:

Name of Student: Tan, Andrea Camille Dela Pea ________ Name and Address of School : Far Eastern University, Nicanor Reyes Sr. Street Sampaloc Manila Accreditation Level : Level II PAASCU Accredited Date School / Program was Recognized : April 10, 1958 Number : 66 First Course (if any) : None Year of Admission in the Bachelor of Science in Nursing Program : Year Graduated (BSN Program) : 2011 I. No. Date of Operation
September 24, 2009 October 30, 2010 March 9, 2011 March 21, 2011 March 25, 2011

_____________________________________________ ___________________ Year Granted :March 31, 2001 ___________________ Year : 1958 _________________________ School Graduated from : Not Applicable __________________ ___________________ ___________________

MAJOR OPERATIONS Type of Anesthesia

Spinal Anesthesia General Endotracheal Anesthesia Spinal Anesthesia Spinal Anesthesia Spinal Anesthesia

Case No.
13857 8 39057

Name of Patient
Jennifer Oslucio Myrna del Carmen Datu, Cristina Tumambac Cielo, Petronio Suarez Guillermo, Imelda Santos

Diagnosis
Gravida 1, Para 0, Pregnancy Uterine 43 weeks Endometrial cyst, Right Gravida 2 Para 1 (1001) Tubal Pregnancy Left 6 to 7 weeks Age of Gestation Unruptured Acute Appendicitis Pregnancy Uterine 37 weeks and 2 days Age of Gestation Placenta Marginalis Gravida 10 Para 6 (6036)

Operation Performed
Cephalic in Labor Low Transverse Cesarean Section Primary Adhesiolysis Left Salphingectomy Acute Ruptured Appendicitis Cesarean Section and Bilateral Tubal Ligation

Name of Surgeon
Gregorgio L. Demifin, MD Raymund Andrew Ong, MD Dra. _______ Lavandero Buenvenido Tan, MD Arlyn Eming, MD

Name of Hospital
Valenzuela General Hospital Far Eastern University Nicanor Reyes Medical Foundation Antipolo City Medical Hospital Antipolo City Medical Hospital Antipolo City Medical Hospital

Name of O.R Scrub Nurse

Supervised by (Name & Signature of Qualified Clinical Instructor)

Vilma S. Vasquez, RN, MAN

1 2 3 4

Jeezel Tan, RN Rufino Forio, Jr., RN Irish Joy Lopez, RN Emily Sanoy, RN

Brenda Quimada, RN, MAN Fe Fatima Villamayor, RN, MAN Fe Fatima Villamayor, RN, MAN Fe Fatima Villamayor, RN, MAN

Noted by: Elizabeth F. Hacias, RN, RM, MAN___

Signature over printed Name of Clinical Coordinator

Concurred by: Dona D. Salmos, RN, MAN

Signature over printed Name of Chief Nurse

Concurred by: Mercedes E. Legarda, RN, PhD

Signature over printed Name of Chief Nurse

Concurred by:
Signature over printed Name of Chief Nurse

Approved by: Glenda S. Arquiza, RN, PhD

_________

Date Signed: Degree: Master of Arts in Nursing a.) PRC No.: 0101726 Valid until: July 1, 2011 b.) PNA No.: 4870 Valid until: Lifetime

Date Signed: ____ Degree: Master of Arts in Nursing_ a.) PRC No.: 0102232 ____ Valid until: December 2013 ____ b.) PNA No.: 19823 ____ Valid until: Lifetime ____

Date Signed: ____ Degree: Doctor of Philosophy____ a.) PRC No.: 054088 ____ Valid until: September 24, 2011___ b.) PNA No.: ____ Valid until: ____ c.) ANSAP No.:0271 ____ Valid until: Lifetime ____

Date Signed: Degree: a.) PRC No.: Valid until: b.) PNA No.: Valid until:

____ ____ ____ ____ ____ ____

Signature over printed Name of Dean

Date Signed: _________ Degree: Doctor of Philosophy Major in Education a.) PRC No.: 0043483 __ Valid until: December 31, 2014 __ b.) PNA No.: 19071 __ Valid until: Lifetime __ c.) ADPCN No.: 0786 __ Valid until: Lifetime __

REPUBLIC OF THE PHILIPPINES PROFESSIONAL REGULATION COMMISSION BOARD OF NURSING Adapted by: Far Eastern University Prepared by: Name of Student: Tan, Andrea Camille Dela Pea ________ Name and Address of School : Far Eastern University, Nicanor Reyes Sr. Street Sampaloc Manila Accreditation Level : Level II PAASCU Accredited Date School / Program was Recognized : April 10, 1958 Number : 66 First Course (if any) : None Year of Admission in the Bachelor of Science in Nursing Program : Year Graduated (BSN Program) : 2011 _____________________________________________ ___________________ Year Granted :March 31, 2001 ___________________ Year : 1958 _________________________ School Graduated from : Not Applicable __________________ ___________________ ___________________

II. MINOR OPERATIONS

No. Date of Operation
September. 2, 2009 March 23, 2011 March 23, 2011 March 9, 2011 March 9, 2011

Case No.

Name of Patient

Diagnosis

Operation Performed

Type of Anesthesia
Intravenous Sedation Local Anesthesia Local Anesthesia Intravenous Sedation

Name of Surgeon
Fortunato Boto Jr., MD Dr. Aquino Mae Anne Claire Saloma, MD Dr. ________ Lavandero Winston Cornel, MD

Name of Hospital
Jose Rodriguez Memorial Medical Hospital and Sanitarium Jose R. Reyes Memorial Medical Center Jose R. Reyes Memorial Medical Center Antipolo City Medical Hospital Antipolo City Medical Hospital

Name of O.R Scrub Nurse

Luciana .M Dolorito, RN Jennibeth Pascual, RN Saturnina Niles, RN Emily Sanoy, RN Emily Sanoy, RN

Supervised by (Name & Signature of Qualified Clinical Instructor)

Renville M. Ladera, RN, MAN Joyce Acena, RN, MAN Joyce Acena, RN, MAN Fe Fatima Villamayor, RN, MAN Fe Fatima Villamayor, RN, MAN

38485 41627 7 62444 8

Lindsay Love Andres

Incomplete Abortion

Dilatation and Curettage

2 3 4 5

Barretto, Reynaldo O. Etoc, Ronadel B. Evangelista, Anne Villanueva, John Paul Azeliz

Foreign body penile shaft Breast mass Left to consider Fibroadenoma Incomplete abortion 10-12 weeks completed by curettage Gravida 2 Para 1 (1002) Mass Nape

Removal of foreign body Excision Biopsy Dilatation and Curettage Concurred by:

Elsie I. Sarabia, RN, MAN

Excision Biopsy, Nape Date Signed:

Signature over printed Name GeneralNurse of Chief Anesthesia

Noted by: Elizabeth F. Hacias, RN, RM, MAN___

Signature over printed Name of Clinical Coordinator

Concurred by: SAMUEL C. SUMILANG, RN, MAN, EMR-B

Signature over printed Name of Chief Nurse

Date Signed: Degree: Master of Arts in Nursing a.) PRC No.: 0101726 Valid until: July 1, 2011 b.) PNA No.: 4870 Valid until: Lifetime

Date Signed: ____ Degree: Master of Arts in Nursing a.) PRC No.: 0214460 Valid until: July 11, 2011 b.) PNA No.: 2011-041456 Valid until: October 31, 2011 c.) ANSAP No.: 09-0405 Valid until: December 13, 2011

___ ___ ___ ___ ___ ___ ___

Degree: Master of Arts in Nursing_ a.) PRC No.: 0051967 ____ Valid until: October 2012 ____ b.) PNA No.: 14415 ____ Valid until: Lifetime ____ c.) ANSAP No.: 0164 ____ Valid until: March 20110_in Nursingor in_

____ through Intravenous

Concurred by:
Signature over printed Name of Chief Nurse

Approved by: Glenda S. Arquiza, RN, PhD

_________

Date Signed: Degree: a.) PRC No.: Valid until: b.) PNA No.: Valid until:

____ ____ ____ ____ ____ ____

Signature over printed Name of Dean

Date Signed: _________ Degree: Doctor of Philosophy Major in Education a.) PRC No.: 0043483 __ Valid until: December 31, 2014 __ b.) PNA No.: 19071 __ Valid until: Lifetime __ c.) ADPCN No.: 0786 __ Valid until: Lifetime __

____

REPUBLIC OF THE PHILIPPINES PROFESSIONAL REGULATION COMMISSION BOARD OF NURSING Adapted by: Far Eastern University Prepared by: Name of Student: Tan, Andrea Camille Dela Pea ________ Name and Address of School : Far Eastern University, Nicanor Reyes Sr. Street Sampaloc Manila Accreditation Level : Level II PAASCU Accredited Date School / Program was Recognized : April 10, 1958 Number : 66 First Course (if any) : None Year of Admission in the Bachelor of Science in Nursing Program : Year Graduated (BSN Program) : 2011 III. ACTUAL DELIVERIES No. 1 2 3 4 5 Case No. 10-094 10-097 10-098 10-099 10-100 Diagnosis Gravida 3 Parity 2 Pregancy Uterine, 39 Weeks Age of Gestation, Cephalic in Labor Gravida 1 Parity 0 Pregancy Uterine, 41 Weeks Age of Gestation, Cephalic in Labor Gravida 2 Parity 1 Pregancy Uterine, 37 Weeks Age of Gestation, Cephalic in Labor Gravida 3 Parity 2 Pregancy Uterine, 41 Weeks Age of Gestation, Cephalic in Labor Gravida 3 Parity 2 Pregancy Uterine, 39 Weeks Age of Gestation, Cephalic in Labor Name of Mother Mariane Tena Angeline Reyes Eden Bert Suarez Marilyn Dela Cruz Mary Jean Amante Age 25 19 16 28 25 Date of Delivery March 13, 2010 March 15, 2010 March 16, 2010 March 17, 2010 March 18, 2010 Time of Delivery 4:10 AM 8: 59 AM 5:02 AM 9:10 PM 9:15 AM Gender of Baby Male Male Male Female Male Name of Hospital Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Type of Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Supervised by (Name & Signature of Qualified Clinical Instructor) Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Approved by: Glenda S. Arquiza, RN, PhD _____________________________________________ ___________________ Year Granted :March 31, 2001 ___________________ Year : 1958 _________________________ School Graduated from : Not Applicable __________________ ___________________ ___________________

Noted by: Elizabeth F. Hacias, RN, RM, MAN___

Signature over printed Name of Clinical Coordinator

Concurred by: BENJAMIN A. DE GUZMAN, RN, RM, MAN_

Signature over printed Name of Chief Nurse

_________

Date Signed: Degree: Master of Arts in Nursing a.) PRC No.: 0101726 Valid until: July 1, 2011 b.) PNA No.: 4870 Valid until: Lifetime

Date Signed: __________ Degree: Master of Arts in Nursing ____ a.) PRC No.: 100631 ____ Valid until: January 28, 2012 ____ b.) PNA No.: 18088 ____ Valid until: Lifetime ____

Signature over printed Name of Dean

Date Signed: _________ Degree: Doctor of Philosophy Major in Education a.) PRC No.: 0043483 __ Valid until: December 31, 2014 __ b.) PNA No.: 19071 __ Valid until: Lifetime __ c.) ADPCN No.: 0786 __ Valid until: Lifetime __

REPUBLIC OF THE PHILIPPINES PROFESSIONAL REGULATION COMMISSION BOARD OF NURSING Adapted by: Far Eastern University Prepared by: Name of Student: Tan, Andrea Camille Dela Pea ________ Name and Address of School : Far Eastern University, Nicanor Reyes Sr. Street Sampaloc Manila Accreditation Level : Level II PAASCU Accredited Date School / Program was Recognized : April 10, 1958 Number : 66 First Course (if any) : None Year of Admission in the Bachelor of Science in Nursing Program : Year Graduated (BSN Program) : 2011 IV. DELIVERIES ASSISTED No. 1 2 3 4 5 Case No. 10-095 10-101 10-104 10-108 10-112 Diagnosis Gravida 2 Parity 1 Pregancy Uterine, 36 Weeks Age of Gestation, Cephalic in Labor Gravida 1 Parity 0 Pregancy Uterine, 39 Weeks Age of Gestation, Cephalic in Labor Gravida 6 Parity 4 Pregancy Uterine, 42 Weeks Age of Gestation, Cephalic in Labor Gravida 3 Parity 1 Pregancy Uterine, 39 Weeks Age of Gestation, Cephalic in Labor Gravida 2 Parity 1 Pregancy Uterine, 39 Weeks Age of Gestation, Cephalic in Labor Name of Mother Jonalyn Estorque Cristy JeanPamatian Melissa Gono Jocelyn Frivaldo Zorina Diesta Age 29 23 28 29 23 Date of Delivery March 15, 2010 March 20, 2010 March 25, 2010 March 28, 2010 March 31, 2010 Time of Delivery 9:25 AM 11:12 PM 3:39 AM 11:18 PM 2:08 PM Gender of Baby Male Female Female Female Male Name of Hospital Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Type of Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Supervised by (Name & Signature of Qualified Clinical Instructor) Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN _____________________________________________ ___________________ Year Granted :March 31, 2001 ___________________ Year : 1958 _________________________ School Graduated from : Not Applicable __________________ ___________________ ___________________

Noted by: Elizabeth F. Hacias, RN, RM, MAN___

Signature over printed Name of Clinical Coordinator

Concurred by: BENJAMIN A. DE GUZMAN, RN, RM, MAN_

Signature over printed Name of Chief Nurse

Approved by: Glenda S. Arquiza, RN, PhD

_________

Date Signed: Degree: Master of Arts in Nursing a.) PRC No.: 0101726 Valid until: July 1, 2011 b.) PNA No.: 4870 Valid until: Lifetime

Date Signed: __________ Degree: Master of Arts in Nursing ____ a.) PRC No.: 100631 ____ Valid until: January 28, 2012 ____ b.) PNA No.: 18088 ____ Valid until: Lifetime ____

Signature over printed Name of Dean

Date Signed: _________ Degree: Doctor of Philosophy Major in Education a.) PRC No.: 0043483 __ Valid until: December 31, 2014 __ b.) PNA No.: 19071 __ Valid until: Lifetime __ c.) ADPCN No.: 0786 __ Valid until: Lifetime __

REPUBLIC OF THE PHILIPPINES PROFESSIONAL REGULATION COMMISSION BOARD OF NURSING Adapted by: Far Eastern University Prepared by: Name of Student: Tan, Andrea Camille Dela Pea ________ Name and Address of School : Far Eastern University, Nicanor Reyes Sr. Street Sampaloc Manila Accreditation Level : Level II PAASCU Accredited Date School / Program was Recognized : April 10, 1958 Number : 66 First Course (if any) : None Year of Admission in the Bachelor of Science in Nursing Program : Year Graduated (BSN Program) : 2011 I. No. Case No. Date Performed Name of Baby Gender of Baby CORD DRESSING Name of Mother Age Name of Hospital Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Sta. Peregrina Maternity House Supervised by (Name & Signature of Qualified Clinical Instructor) Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Dennis V. Sevilla, RN, MAN Approved by: Glenda S. Arquiza, RN, PhD _____________________________________________ ___________________ Year Granted :March 31, 2001 ___________________ Year : 1958 _________________________ School Graduated from : Not Applicable __________________ ___________________ ___________________

1 2 3 4 5

10-092 10-093 10-096 10-105 10-107

March 11, 2010 March 12, 2010 March 15, 2010 March 25, 2010 March 28, 2010

Baby Girl Uy Baby Boy Cruz Baby Boy Elunio Baby Boy Gellan Baby Boy Into

Female Male Male Male Male

Annabel Uy Rosalina Cruz Maricar Elunio Jean Gellan Rose Ann Into

22 34 29 22 18

Noted by: Elizabeth F. Hacias, RN, RM, MAN___

Signature over printed Name of Clinical Coordinator

Concurred by: BENJAMIN A. DE GUZMAN, RN, RM, MAN_

Signature over printed Name of Chief Nurse

_________

Date Signed: Degree: Master of Arts in Nursing a.) PRC No.: 0101726 Valid until: July 1, 2011 b.) PNA No.: 4870 Valid until: Lifetime

Date Signed: __________ Degree: Master of Arts in Nursing ____ a.) PRC No.: 100631 ____ Valid until: January 28, 2012 ____ b.) PNA No.: 18088 ____ Valid until: Lifetime ____

Signature over printed Name of Dean

Date Signed: _________ Degree: Doctor of Philosophy Major in Education a.) PRC No.: 0043483 __ Valid until: December 31, 2014 __ b.) PNA No.: 19071 __ Valid until: Lifetime __ c.) ADPCN No.: 0786 __ Valid until: Lifetime __