[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.

]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

ACTUAL DELIVERY in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

City of Batac, Ilocos Norte

Prepared by: D.R. Form

Printed Name and Signature of Student: VAN HALEN S. LLANES___ ACTUAL DELIVERY FORM

Patients INITIAL Only

D.R. Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PROCEDURE (Name and Signature)
And (Not Applicable for Clinical Instructor
PERFORMED (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In (Name and Signature
required)
Clinic)
Normal Spontaneous Delivery with
July 28, 2014 M.R.T
Right Medio-Lateral Episiotomy and JULIE C. DAMASO, RN, MAN
(8:35 am) 678048 ERWIN G. GARVIDA, RN, RM
Repair
Normal Spontaneous Vaginal
December 26, 2016, R.M MARIA SOCORRO T. MACADANGDANG, RN,
Delivery with Right Medio-Lateral
(3:46 pm) 535362 LEONILA B. BARADI, RM MAN
Episiotomy and Repair
Normal Spontaneous Delivery with
December 26, 2016, F.R.M
Right Medio-Lateral Episiotomy and MARIA SOCORRO T. MACADANGDANG, RN,
(7:40 pm) 734419 LANI R. NALUPTA, RM
Repair MAN

Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

ASSIST DELIVERY in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

City of Batac, Ilocos Norte

Prepared by: D.R. Form

Printed Name and Signature of Student: VAN HALEN S. LLANES__ ASSIST DELIVERY FORM

Patients INITIAL Only

D.R. Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PROCEDURE (Name and Signature)
And (Not Applicable for Clinical Instructor
PERFORMED (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In (Name and Signature
required)
Clinic)
January 29, 2015, Normal Spontaneous Delivery with
A.D.P
(3:10 pm) Right Medio-Lateral Episiotomy and PRECY G. ODUCAYEN, RN, MAN
688805 ERWIN G. GARVIDA, RN, RM
Repair
December 26, 2016, Normal Spontaneous Delivery with
A.G.R MARIA SOCORRO T. MACADANGDANG, RN,
(1:30 pm) Right Medio-Lateral Episiotomy and
737792 LANI R. NALUPTA, RM MAN
Repair
May 17, 2017 Normal Spontaneous Delivery with
J.C.M MARIA SOCORRO T. MACADANGDANG, RN,
( 9:23 pm) Right Medio-Lateral Episiotomy and
739867 LANI R. NALUPTA, RM MAN
Repair

Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

IMMEDIATE NEWBORN CARE in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER
City of Batac, Ilocos Norte

Prepared by: D.R. Form

Printed Name and Signature of Student: VAN HALEN S. LLANES__ IMMEDIATE CARE OF THE NEWBORN

Patients INITIAL Only

Immediate Newborn Cord Care D.R. Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PERFORMED (Name and Signature)
And (Not Applicable for Clinical Instructor
Indicate where performed e.g. D.R., (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In Nursery, NICU, or Home (Name and Signature
required)
Clinic)
December 26, 2016,
B.B.S Immediate Newborn Care
(7:15 pm) MARIA SOCORRO T. MACADANGDANG, RN,
741602 Delivery Room LEONILA B. BARADI, RM
MAN
February 4, 2017 B.G.D Immediate Newborn Care
(10:12 pm) 744033 Delivery Room LANI R. NALUPTA, RM PRECY G. ODUCAYEN, RN, MAN
May 17, 2017
B.G.A Immediate Newborn Care
(7:00 pm) MARIA SOCORRO T. MACADANGDANG, RN,
751067 Delivery Room LANI R. NALUPTA, RM
MAN

Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

SURGICAL SCRUB in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

City of Batac, Ilocos Norte

Prepared by: O.R. Form 1A

Printed Name and Signature of Student: VAN HALEN S. LLANES__ O.R. SCRUB FORM Major

Patients INITIAL Only

O.R. Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PROCEDURE (Name and Signature)
And (Not Applicable for Clinical Instructor
PERFORMED (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In (Name and Signature
required)
Clinic)
L.A
July 31, 2015 Nephrectomy Lef
703720 PHILIP ROMELE J. TOLENTINO, RN NORMAL L. ECLARIN, RN, MAN
(10:00 am)
January 14, 2015, J,J
Plating and Screwing
(8:05 am) 716977 EDGAR S. CERENADO, RN FLORDELIZA I. TABANIAG, RN, MAN
May 10, 2016, S.M.P.D Emergency Low Transverse
(5:20 pm) 667869 Caesarean Section ARLENE A. BATTULAYAN, RN PRECY G. ODUCAYEN, RN, MAN

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

O.R. CIRCULATING in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

City of Batac, Ilocos Norte

Prepared by: O.R. Form 1B

Printed Name and Signature of Student: VAN HALEN S. LLANES__ O.R. CIRCULATING FORM Major

Patients INITIAL Only

O.R Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PROCEDURE (Name and Signature)
And (Not Applicable for Clinical Instructor
PERFORMED (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In (Name and Signature
required)
Clinic)
July 24, 2015,
R.T
(11:55 am) Transurethral Resection of Prostate
665468 CHARINA V. ACDAL, RN NORMAL L. ECLARIN, RN, MAN
January 28, 2016, M.S
5th Ray Amputation Foot Lef
(3:18 pm) 718320 OSCAR S. SADORRA, RN FLORDELIZA I. TABANIAG, RN, MAN
May 12, 2016, M.S Vaginal Hysterectomy
(2:05 pm) 722794 BRYANT TABIJE, RN FLORDELIZA I. TABANIAG, RN, MAN

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

[Accrediting Agency of Chartered Colleges and Universities in the Philippines (AACCUP), INC.]
Level III Re-Accredited; Inclusive Date of Accreditation: September 2015 August 2017

SURGICAL SCRUB in MARIANO MARCOS MEMORIAL HOSPITAL AND MEDICAL CENTER

City of Batac, Ilocos Norte

Prepared by: O.R. Form

Printed Name and Signature of Student: VAN HALEN S. LLANES__ O.R. SCRUB FORM Minor

Patients INITIAL Only

O.R. Nurse on Duty
Dated Performed Case Number SUPERVISED BY
PROCEDURE (Name and Signature)
And (Not Applicable for Clinical Instructor
PERFORMED (If Midwife on Duty, Signature not
Time Started Birthing/Home/Lying-In (Name and Signature
required)
Clinic)
October 9, 2015,
(8:55 am) B.R
Transurethral Resection of Prostate EDGAR S. CERENADO, RN
621243 NORMAL L. ECLARIN, RN, MAN

July 24, 2015, J.S Cervical Lymph node Biopsy

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
(8:14 am)
731138 CHARINA V. ACDAL, RN NORMAL L. ECLARIN, RN, MAN
September 11, 2015,
I.G
(3:18 pm) Dilatation and Curettage
569860 REYNALDO U. SANTOS, RN NORMAL L. ECLARIN, RN, MAN

Noted by: NORMA L. ECLARIN, R.N.,M.A.N Approved by: MANOLITA S. CRISOSTOMO, R.N.,M.A.N, EdD
Clinical Coordinator, PRC I.D. No. 0054871 Valid Until 09/02/2019 Dean, PRC I.D. No. 0121749 Valid Until ______________
PNA No. 17665 Valid Until Lifetime Member PNA No. 19854 Valid Until Lifetime Member
Date document is signed Time ADPCN No.11-546 Valid Until ______________
Date document is signed: Time
Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing Please Specify Highest Nursing Degree Earned: Master of Arts in Nursing

Brgy. 16-S Quiling Sur, Batac City

(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph
 Brgy. 16-S Quiling Sur, Batac City
(077) 670-1920; mmsu_chs@yahoo.com.ph; www.mmsu.edu.ph