St.

Scholastica’s College Tacloban

COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

CORD CARE in LEYTE PROVINCIAL HOSPITAL PALO LEYTE

Hospital, Municipality / City / Province
IMMEDIATE NEWBORN
Prepared by: CORD CARE FORM
Printed Name with Signature of Student: MAESTRE, RUSTOM JHON P.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required

February 10, 2019 Baby Girl C. Neonatal Intensive Care Unit – Essential MRS. JEAN A. PEÑARANDA, RN, MAN
7:44AM 210-41-74 Intrapartum Newborn Care MRS. VIOLA C. NOMBRE, RN PRC NO. : 0143733 VALID UNTIL: 05-30-19
Anthropometrics, Vaccines PNA NO. : 2242 VALID UNTIL: LIFETIME

February 07, 2019 Baby Boy Neonatal Intensive Care Unit – Essential MRS. JEAN A. PEÑARANDA, RN, MAN
1:14PM 208-89-81 Intrapartum Newborn Care MRS. IDERLINE T. BODO, RN PRC NO. : 0143733 VALID UNTIL: 05-30-19
Anthropometrics, Vaccines PNA NO. : 2242 VALID UNTIL: LIFETIME

February 15, 2019 Baby Boy Neonatal Intensive Care Unit – Essential MRS. JEAN A. PEÑARANDA, RN, MAN
8:03AM 210-46-01 Intrapartum Newborn Care MRS. VIOLA C. NOMBRE, RN PRC NO. : 0143733 VALID UNTIL: 05-30-19
Anthropometrics, Vaccines PNA NO. : 2242 VALID UNTIL: LIFETIME

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No. : 0252934 Valid Until: 08-28-19 PRC No. : 0133674 Valid Until: 09-21-20
PNA No. : 007717 Valid Until: 12-31-18 PNA No. : 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2019, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

ASSISSTED DELIVERY in LEYTE PROVINCIAL HOSPITAL PALO LEYTE

Hospital, Municipality / City / Province
ASSISSTED DELIVERY
Prepared by: FORM
Printed Name with Signature of Student: MAESTRE, RUSTOM JHON P.
Date Performed Patient’s Nurse On Duty SUPERVISED BY
and Time Started INITIALS PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required
Actual Delivery Assisted
February 03, 2019 P. D Pregnancy Uterine Full Term Gravida 2 Para 2 (2002) MRS. JEAN A. PEÑARANDA, RN, MAN
9:11AM 210-36-96 Delivered by Normal Spontaneous Vaginal MRS. IDERLINE T. BODO, RN PRC NO. : 0143733 VALID UNTIL: 05-30-19
Delivery to an alive Baby Boy, Term, Clear Amniotic PNA NO. : 2242 VALID UNTIL: LIFETIME
Fluid, Apgar Score of 8, 9
Actual Delivery Assisted
January 23, 2019 R. J Pregnancy Uterine Full Term Gravida 6 Para 6 (6006) MRS. JEAN A. PEÑARANDA, RN, MAN
9:25AM 205-26-90 Passed Urine, Alive term, Cephalic, Baby Boy, Apgar MRS. IDERLINE T. BODO, RN PRC NO. : 0143733 VALID UNTIL: 05-30-19
Score 8, 9, Clear Amniotic Fluid, Delivered by PNA NO. : 2242 VALID UNTIL: LIFETIME
Spontaneous Vaginal Delivery
Actual Delivery Assisted
February 07, 2019 L. C Pregnancy Uterine Full Term Gravida 2 Para 2 (2002) MRS. IDERLINE T. BODO, RN MRS. JEAN A. PEÑARANDA, RN, MAN
7:23AM 205-62-82 Passed Urine, Alive Term, Cephalic, Baby Girl, Apgar PRC NO. : 0143733 VALID UNTIL: 05-30-19
Score 9, Clear Amniotic Fluid, Delivered by Spontaneous PNA NO. : 2242 VALID UNTIL: LIFETIME
Vaginal Delivery

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No. : 0252934 Valid Until: 08-28-19 PRC No. : 0133674 Valid Until: 09-21-20
PNA No. : 007717 Valid Until: 12-31-18 PNA No. : 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province
O.R FORM 1A MAJOR
Prepared by:
SURGERY
Printed Name with Signature of Student: MAESTRE, RUSTOM JHON P.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Required
Number

September 06, 2018 N. Q Total Abdominal Hysterectomy Bilateral Salphingo MRS. ZUSIE B. ABUDA , RN, MAN
11:35am 262184 Oophorectomy (TABHSO) MR. MICHELSON GERARD A. TIU, PRC NO. :0194172 VALID UNTIL: 01-02-19
Diagnosis: Abdominal Uterine Bleeding due to RN PNA NO.: 2018-054903VALID UNTIL: 12-31-18
Endometrial Polyp R Dermoid Cyst

September 20,2018 M.A (Left) Parietal Craniectomy for Evacuation of Chronic MS. JOBETH M. CAVIO, RN MRS. ZUSIE B. ABUDA , RN, MAN
1:22PM 262812 Subdural Hematoma PRC NO. :0194172 VALID UNTIL: 01-02-19
Diagnosis: Chronic Subdural Hematoma (left) Fronto PNA NO.: 2018-054903VALID UNTIL: 12-31-18
Parietal

October 04, 2018 T.A Exploratomy Laparotomy, Total Abdominal, MS. KAREN MAE RAMBANO MRS. ZUSIE B. ABUDA , RN, MAN
9:45am 263022 Hysterectomy Salphingo Oophorectomy PRC NO. :0194172 VALID UNTIL: 01-02-19
Diagnosis: Ovarian New Growth, Probably Malignant PNA NO.: 2018-054903VALID UNTIL: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No. : 0252934 Valid Until: 08-28-19 PRC No. : 0133674 Valid Until: 09-21-20
PNA No. : 007717 Valid Until: 12-31-18 PNA No. : 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province

Prepared by: O.R FORM 1A MAJOR

SURGERY
Printed Name with Signature of Student: MAESTRE, RUSTOM JHON P.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required

August 21, 2018 S.M Laparoscopic Cholecystectomy MRS. ZUSIE B. ABUDA, RN, MRS. ZUSIE B. ABUDA , RN, MAN
9:05am 262168 Diagnosis: MAN PRC NO. :0194172 VALID UNTIL: 01-02-19
PNA NO.: 2018-054903VALID UNTIL: 12-31-18

September 22, 2018 E.L Ray Amputation MRS. ZUSIE B. ABUDA , RN, MAN
262801 Diagnosis Diabetic Gangrene 5th Toe (left) Foot MR. JOELU J. DIZON, RN PRC NO. :0194172 VALID UNTIL: 01-02-19
PNA NO.: 2018-054903VALID UNTIL: 12-31-18

October 04, 2018 R.D Exploratory Laparotomy, (left) Salpingectomy MS. JOBETH M. CAVIO, RN
209148 Diagnosis Tubal Pregnancy, Nearly Ruptured (left) MRS. ZUSIE B. ABUDA, RN, MAN
PRC NO. :0194172 VALID UNTIL: 01-02-19
PNA NO.: 2018-054903VALID UNTIL: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No. : 0252934 Valid Until: 08-28-19 PRC No. : 0133674 Valid Until: 09-21-20
PNA No. : 007717 Valid Until: 12-31-18 PNA No. : 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019