Republic of the Philippines NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Cabanatuan City College of Nursing

Name of Student: SAN PEDRO,NEZKA CAMILLE SAN PEDRO Name and Address of School: Nueva Ecija University of Science and Technology, General Tinio Street, Cabanatuan City Accreditation Level (if any): Not Applicale Date School/ Program was Recognized: December 2, 2003 Board Resolution 96 A Series of 2003 First Course (if any): Not Applicable Year of Admission in Bachelor of Science in Nursing Program: 2008 Year Graduated from Bachelor of Science in Nursing Program: 2012 I. MAJOR OPERATIONS No. 1. 2. 3. PREPARED BY: SUPERVISED BY: NOTED BY: MS. LUZVIMINDA I. DALLO RELATED LEARNING EXPERIENCE COORDINATOR, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0086572 Valid Until: August 19, 2013 PNA Number: 19755 Valid Until: Lifetime Member Date Signed: _______________ CONCURRED BY: _______________________ CHIEF NURSE APPROVED BY: MS. EPPIE DC. BUGARIN DEAN, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Registered Midwife Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0085974 Valid Until: April 3, 2014 PNA Number: 17977 Valid Until: Lifetime Member ADPCN Number: 0662 Valid Until: Date Signed: _______________ Date of Operation Case Number Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital

SAN PEDRO,NEZKA CAMILLE S.P. _____________________ NAME OF STUDENT CLINICAL INSTRUCTOR, COLLEGE OF NURSING, Date Signed: _______________ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse units Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Republic of the Philippines NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Cabanatuan City College of Nursing

Name of Student: SAN PEDRO,NEZKA CAMILLE SAN PEDRO Name and Address of School: Nueva Ecija University of Science and Technology, General Tinio Street, Cabanatuan City Accreditation Level (if any): Not Applicale Date School/ Program was Recognized: December 2, 2003 Board Resolution 96 A Series of 2003 First Course (if any): Not Applicable Year of Admission in Bachelor of Science in Nursing Program: 2008 Year Graduated from Bachelor of Science in Nursing Program: 2012 II. MINOR OPERATIONS No. 1. 2. 3. PREPARED BY: SUPERVISED BY: NOTED BY: MS. LUZVIMINDA I. DALLO RELATED LEARNING EXPERIENCE COORDINATOR, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0086572 Valid Until: August 19, 2013 PNA Number: 19755 Valid Until: Lifetime Member Date Signed: _______________ CONCURRED BY: _______________________ CHIEF NURSE APPROVED BY: MS. EPPIE DC. BUGARIN DEAN, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Registered Midwife Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0085974 Valid Until: April 3, 2014 PNA Number: 17977 Valid Until: Lifetime Member ADPCN Number: 0662 Valid Until: Date Signed: _______________ Date of Operation Case Number Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital

SAN PEDRO,NEZKA CAMILLE S.P _____________________ NAME OF STUDENT CLINICAL INSTRUCTOR, COLLEGE OF NURSING, Date Signed: _______________ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse units Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Republic of the Philippines NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Cabanatuan City College of Nursing

Name of Student SAN PEDRO,NEZKA CAMILLE SAN PEDRO Name and Address of School: Nueva Ecija University of Science and Technology, General Tinio Street, Cabanatuan City Accreditation Level (if any): Not Applicale Date School/ Program was Recognized: December 2, 2003 Board Resolution 96 A Series of 2003 First Course (if any): Not Applicable Year of Admission in Bachelor of Science in Nursing Program: 2008 Year Graduated from Bachelor of Science in Nursing Program: 2012 III. ACTUAL DELIVERIES Gender of the Baby

No. 1. 2. 3.

Case Number

Diagnosis

Name of Patient

Age

Date of Delivery

Time of Delivery

Name of Hospital

Type of Delivery

PREPARED BY:

SUPERVISED BY:

NOTED BY: MS. LUZVIMINDA I. DALLO RELATED LEARNING EXPERIENCE COORDINATOR, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0086572 Valid Until: August 19, 2013 PNA Number: 19755 Valid Until: Lifetime Member Date Signed: _______________

CONCURRED BY: _______________________ CHIEF NURSE

APPROVED BY: MS. EPPIE DC. BUGARIN DEAN, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Registered Midwife Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0085974 Valid Until: April 3, 2014 PNA Number: 17977 Valid Until: Lifetime Member ADPCN Number: 0662 Valid Until: Date Signed: _______________

SAN PEDRO,NEZKA CAMILLE S.P _____________________ NAME OF STUDENT CLINICAL INSTRUCTOR, COLLEGE OF NURSING, Date Signed: _______________ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse units Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Republic of the Philippines NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Cabanatuan City College of Nursing

Name of Student: SAN PEDRO,NEZKA CAMILLE SAN PEDRO Name and Address of School: Nueva Ecija University of Science and Technology, General Tinio Street, Cabanatuan City Accreditation Level (if any): Not Applicale Date School/ Program was Recognized: December 2, 2003 Board Resolution 96 A Series of 2003 First Course (if any): Not Applicable Year of Admission in Bachelor of Science in Nursing Program: 2008 Year Graduated from Bachelor of Science in Nursing Program: 2012 IV. ASSISTED DELIVERIES Gender of the Time of Delivery Baby

No. 1. 2. 3.

Case Number

Diagnosis

Name of Patient

Age

Date of Delivery

Name of Hospital

Type of Delivery

PREPARED BY:

SUPERVISED BY:

NOTED BY: MS. LUZVIMINDA I. DALLO RELATED LEARNING EXPERIENCE COORDINATOR, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0086572 Valid Until: August 19, 2013 PNA Number: 19755 Valid Until: Lifetime Member Date Signed: _______________

CONCURRED BY: _______________________ CHIEF NURSE

APPROVED BY: MS. EPPIE DC. BUGARIN DEAN, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Registered Midwife Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0085974 Valid Until: April 3, 2014 PNA Number: 17977 Valid Until: Lifetime Member ADPCN Number: 0662 Valid Until: Date Signed: _______________

SAN PEDRO,NEZKA CAMILLE S.P _____________________ NAME OF STUDENT CLINICAL INSTRUCTOR, COLLEGE OF NURSING, Date Signed: _______________ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse units Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Republic of the Philippines NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Cabanatuan City College of Nursing

Name of Student: SAN PEDRO,NEZKA CAMILLE SAN PEDRO Name and Address of School: Nueva Ecija University of Science and Technology, General Tinio Street, Cabanatuan City Accreditation Level (if any): Not Applicale Date School/ Program was Recognized: December 2, 2003 Board Resolution 96 A Series of 2003 First Course (if any): Not Applicable Year of Admission in Bachelor of Science in Nursing Program: 2008 Year Graduated from Bachelor of Science in Nursing Program: 2012 IV. ESSENTIAL NEWBORN CARE No. 1. 2. 3. PREPARED BY: SUPERVISED BY: NOTED BY: MS. LUZVIMINDA I. DALLO RELATED LEARNING EXPERIENCE COORDINATOR, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0086572 Valid Until: August 19, 2013 PNA Number: 19755 Valid Until: Lifetime Member Date Signed: _______________ CONCURRED BY: _______________________ CHIEF NURSE APPROVED BY: MS. EPPIE DC. BUGARIN DEAN, COLLEGE OF NURSING, NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Registered Midwife Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing Doctor of Philosophy PRC Number: 0085974 Valid Until: April 3, 2014 PNA Number: 17977 Valid Until: Lifetime Member ADPCN Number: 0662 Valid Until: Date Signed: _______________ Case Number Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital

SAN PEDRO,NEZKA CAMILLE S.P _____________________ NAME OF STUDENT CLINICAL INSTRUCTOR, COLLEGE OF NURSING, Date Signed: _______________ NUEVA ECIJA UNIVERSITY OF SCIENCE AND TECHNOLOGY Degree/s: Bachelor of Science in Nursing Registered Nurse units Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________

Degree/s: Bachelor of Science in Nursing Registered Nurse Master of Arts in Nursing PRC Number: Valid Until: PNA Number: Valid Until: Date Signed: _______________