St.

Rita Hospital College of Nursing and Midwifery 2047 T Earnshaw Street Gagalangin Tondo Manila
Prepared by: NAME of STUDENT: ELIZON, ARIANE FAITH C. Accreditation Level: (if any) Date School/ Program was Recognized: BSN July 2, 1992 First Course: (if any ) Year of Admission in the Bachelor of Science in Nursing Program: Year Graduated (BSN Program): 2012 Date of operation
September 14, 2011

. Number: C 030 2005 I. MAJOR OPERATION . Year Granted: Series: 1992 School Graduated From: Year: July 2, 1992 Year: . . . . . Type of Anesthesia
Subarachnoid Block Subarachnoid Block/ Continuous Lumbar Epidural Anesthesia/ General Endotracheal Anesthesia

Case No
082640

Name of Patient
R. Z.

Diagnosis
Recurrent direct inguinal right

Operation Performed
Mesh Herniorrhaphy Right

Name of Surgeon
Dr. Min F. Fernandez

Name of Hospital
Tondo Medical Center

Name of O.R. Scrub Nurse

Lourdes L. Bonifacio RN, MAN

Supervised by: Name and Signature of Qualified C.I.

Carmen B. Estigoy RN, MAN

September 16, 2011

011739

M. J.

Gravida 2 Para 2 (1001) Pregnancy Uterine 38 1/7 weeks Age of Gestation cephalic in labor previous low transverse cesarean section secondary to breech

Low Transverse Cesarean Section

Dr. Jillian Marie G. Diaz

Tondo Medical Center

Larena V. Hernandez RN, MAN

Lourdes L. Bonifacio RN, MAN

September 19, 2011

379049

C. V.

Gravida 2 Para 1 (1001) Pregnancy Uterine 42 5/7 weeks Age of Gestation, cephalic in labor previous cesarean section 1 secondary to unknown indication.

Low Transverse Cesarean Section

Subarachnoid Block

Dr. Jay-Lanie D. Co

Tondo Medical Center

Larena V. Hernandez RN, MAN

Carmen B. Estigoy RN, MAN

September 20, 2011

047866

E. D.

Perforated Peptic Ulcer 1cm.

Exploratory Laparotomy, Gastrorrhaphy, Omental Patching, Placement of drain Total Lobectomy Right Isthmusectomy Subtotal Lobectomy Left

General Endotracheal Anesthesia General Endotracheal Anesthesia

Dr. Min F. Fernandez

Tondo Medical Center

Maria Teresa M. Fraga RN, MAN, Ed.D Lourdes L. Bonifacio RN, MAN

Carmen B. Estigoy RN, MAN

September 21, 2011

155429

B. M.

Colloid Adenomatus Goiter Right

Dr. Min F. Fernandez

Tondo Medical Center

Carmen B. Estigoy RN, MAN

Concurred by: RHODORA A. QUILANTIP, RN., MAN. . Signature over printed Name of Chief Nurse Date Signed: Degree: M.A.N.

Approved by: MARIA CLAUDIA A. MARQUEZ, RN. MAN. Signature over printed Name of Dean Date Signed: Degree: M.A.N. a.) PRC NO.: Valid Until: 0149796 April 2, 2014 b.) PNA NO.:

Noted by: CARMEN B ESTIGOY, RN. MAN Signature over printed Name of Clinical Instructor Date Signed: . Degree: M.A.N. . a.) PRC NO.: Valid Until: 17905 . Valid Until: 0067396 July 28, 2014 . . . .

a.)

PRC NO.: 0097511 Valid Until: July 8, 2012

b.)

PNA NO.: 18651 Valid Until: Life time Member

b.) PNA NO.: 8435 Valid Until: Lifetime Member c.) ADCPN NO.: 429

Life time Member

Valid Until:

December. 31, 2012

St. Rita Hospital College of Nursing and Midwifery 2047 T Earnshaw Street Gagalangin Tondo Manila

Prepared by: NAME of STUDENT: ELIZON, ARIANE FAITH C. Accreditation Level: (if any) Date School/ Program was Recognized: BSN July 2, 1992 First Course: (if any ) Year of Admission in the Bachelor of Science in Nursing Program: Year Graduated (BSN Program): Date of operation February 08, 2011 Name of Patient B. E.

. Number: C 030 2005 2012 II. MINOR OPERATION Type of Anesthesia Local Anesthesia . Year Granted: Series: 1992 School Graduated From: Year: July 2, 1992 Year: . . . . . Supervised by: Name and Signature of Qualified C.I. Hermina M. Protacio RN, MAN

Case No

Diagnosis

Operation Performed

Name of Surgeon Dr. Darwin U. Oandasan

Name of Hospital Tondo Medical Center

Name of O.R. Scrub Nurse

552871

Tendon Cyst Wrist Right

Excision of Tendon Cyst

Alicia F. Barrientos RN.

March 07, 2011

352518

J. G.

Incomplete Abortion Pregnancy Uterine 13-14 weeks Age of Gestation Gravida 2 Para 1 Incomplete Abortion Pregnancy Uterine 13 weeks Age of Gestation Gravida 2 Para 1 Lipoma at Clavicular Area

Completion Curettage

Intravenous Sedation

Dr. Marietess F. Ramos

Tondo Medical Center

Virginia A. Flores RN.

Donna Lynne T. Lopez RN, MAN

March 08, 2011 August 24, 2011 August 25, 2011

358610

L. R.

Completion Curettage

Intravenous Sedation

Dr. Jillian Marie G. Diaz Dr. Solna Minerva A. Decena Dr. Reynaldo Puig

Tondo Medical Center Tondo Medical Center Tondo Medical Center

Jane R. De Jesus RN, MAN

Donna Lynne T. Lopez RN, MAN Ricardo M. Binuya RN, MAN Ricardo M. Binuya RN, MAN

336571

V. E

Excision of Lipoma

Local Anesthesia

Alicia F. Barrientos RN.

372798

A. T.

Breast Mass at Right

Lumpectomy

Local Anesthesia

Alicia F. Barrientos RN.

Concurred by: RHODORA A. QUILANTIP, RN., MAN. . Signature over printed Name of Chief Nurse Date Signed: Degree: M.A.N.

Approved by: MARIA CLAUDIA A. MARQUEZ, RN. MAN. Signature over printed Name of Dean Date Signed: Degree: M.A.N. a.) PRC NO.: Valid Until: 0149796 April 2, 2014 b.) PNA NO.:

Noted by: CARMEN B ESTIGOY, RN. MAN Signature over printed Name of Clinical Instructor Date Signed: . Degree: M.A.N. . a.) PRC NO.: Valid Until: 17905 . Valid Until: 0067396 July 28, 2014 . . . .

a.) b.)

PRC NO.: Valid Until: PNA NO.: Valid Until:

0097511 July 8, 2012 18651 Life time Member

b.) PNA NO.: 8435 Valid Until: Lifetime Member c.) ADCPN NO.: 429

Life time Member

Valid Until:

December. 31, 2012

St. Rita Hospital College of Nursing and Midwifery 2047 T Earnshaw Street Gagalangin Tondo Manila

Prepared by: NAME of STUDENT: ELIZON, ARIANE FAITH C. Accreditation Level: (if any) Date School/ Program was Recognized: BSN July 2, 1992 First Course: (if any ) Year of Admission in the Bachelor of Science in Nursing Program: Year Graduated (BSN Program):

. Number: C 030 2005 2012 III. DELIVERIES HANDLED . Year Granted: Series: 1992 School Graduated From: Year: July 2, 1992 Year: . . . . .

No

Case No.

Diagnosis Pregnancy Uterine 38 weeks Age of Gestation Gravida 3 Para 3 Pregnancy Uterine 40 weeks Age of Gestation Gravida 1 Para 1 Pregnancy Uterine 38 weeks Age of Gestation Gravida 2 Para 2 Pregnancy Uterine 38 weeks Age of Gestation Gravida 1 Para 1 Pregnancy Uterine 38 weeks Age of Gestation Gravida 3 Para 3

Name of Mother R. C.

Age

Date of Delivery

Time of Delivery 09:50 am

Gender of Baby Male

Name of Hospital

Type of Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery

Supervised by: Name and Signature of Qualified C.I. Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN

358860

34

March 09, 2011

Tondo Medical Center

373378

L. L

23

August 02, 2011

12:10pm

Female

Tondo Medical Center

354621

A. T.

26

August 03, 2011

09:55 am

Male

Tondo Medical Center

360850

C. F.

26

August 08, 2011

11:54 am

Male

Tondo Medical Center

355586

V. G.

24

August 10, 2011

09:38 am

Male

Tondo Medical Center

Concurred by: RHODORA A. QUILANTIP, RN., MAN. . Signature over printed Name of Chief Nurse Date Signed: Degree: M.A.N.

Approved by: MARIA CLAUDIA A. MARQUEZ, RN. MAN. Signature over printed Name of Dean Date Signed: Degree: M.A.N. a.) PRC NO.: Valid Until: b.) PNA NO.: Valid Until: 0149796 April 2, 2014 8435 Lifetime Member b.) PNA NO.:

Noted by: CARMEN B ESTIGOY, RN. MAN Signature over printed Name of Clinical Instructor Date Signed: . Degree: M.A.N. . a.) PRC NO.: Valid Until: 17905 . Valid Until: 0067396 July 28, 2014 . . . .

a.) b.)

PRC NO.: Valid Until: PNA NO.: Valid Until:

0097511 July 8, 2012 18651 Life time Member

Life time Member

c.) ADCPN NO.: 429 Valid Until: December. 31, 2012

St. Rita Hospital College of Nursing and Midwifery 2047 T Earnshaw Street Gagalangin Tondo Manila

Prepared by: NAME of STUDENT: ELIZON, ARIANE FAITH C. Accreditation Level: (if any) Date School/ Program was Recognized: BSN July 2, 1992 First Course: (if any ) Year of Admission in the Bachelor of Science in Nursing Program: Year Graduated (BSN Program):

. Number: C 030 2005 2012 IV. DELIVERIES ASSISSTED . Year Granted: Series: 1992 School Graduated From: Year: July 2, 1992 Year: . . . . .

No

Case No.

Diagnosis Pregnancy Uterine 39 weeks age of gestation Gravida 1 Para 1 Pregnancy Uterine 41 weeks Age of Gestation Gravida 5 Para 3 Pregnancy Uterine 41 weeks Age of Gestation Gravida 1 Para 1 Pregnancy Uterine 38 weeks Age of Gestation Gravida 1 Para 1 Pregnancy Uterine 40 weeks Age of Gestation Gravida 1 Para 1

Name of Mother

Age

Date of Delivery

Time of Delivery

Gender of Baby Male

Name of Hospital

Type of Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery Normal Spontaneous Delivery
Noted by:

Supervised by: Name and Signature of Qualified C.I. Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN

354519

M. Z.

37

March 09, 2011

11:45 am

Tondo Medical Center

336873

J. B.

31

August 01, 2011

11:00 am

Female

Tondo Medical Center

373015

M. M.

20

August 09, 2011

10:52 am

Male

Tondo Medical Center

365028

R. E.

16

August 10, 2011

07:52 am

Male

Tondo Medical Center

355263

M. M.

32

August 10, 2011

10:45 am

Female

Tondo Medical Center

Concurred by: RHODORA A. QUILANTIP, RN., MAN. . Signature over printed Name of Chief Nurse Date Signed: Degree: M.A.N.

Approved by: MARIA CLAUDIA A. MARQUEZ, RN. MAN. Signature over printed Name of Dean Date Signed: Degree: M.A.N. a.) PRC NO.: Valid Until: 0149796 April 2, 2014 8435 b.) PNA NO.:

CARMEN B ESTIGOY, RN. MAN Signature over printed Name of Clinical Instructor Date Signed: . Degree: M.A.N. . a.) PRC NO.: Valid Until: 17905 . 0067396 July 28, 2014 . .

a.) b.)

PRC NO.: Valid Until: PNA NO.:

0097511 July 8, 2012 18651

b.) PNA NO.:

Valid Until:

Life time Member

Valid Until: Lifetime Member c.) ADCPN NO.: 429 Valid Until: December. 31, 2012

Valid Until:

Life time Member

St. Rita Hospital College of Nursing and Midwifery 2047 T Earnshaw Street Gagalangin Tondo Manila
Prepared by: NAME of STUDENT: ELIZON, ARIANE FAITH C. Accreditation Level: (if any) Date School/ Program was Recognized: BSN July 2, 1992 First Course: (if any ) Year of Admission in the Bachelor of Science in Nursing Program: Year Graduated (BSN Program):

. Number: C 030 2005 2012 V. CORD DRESSING . Year Granted: Series: 1992 School Graduated From: Year: July 2, 1992 Year: . . . . .

No

Case No.

Date of Delivery

Name of Baby

Gender of Baby

Name of Mother

Age

Name of Hospital

Supervised by: Name and Signature of Qualified C.I. Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN Donna Lynne T. Lopez RN, MAN
Noted by: CARMEN B ESTIGOY, RN. MAN Signature over printed Name of Clinical Instructor Date Signed: . Degree: M.A.N. . a.) PRC NO.: Valid Until: 0067396 July 28, 2014 . . . .

1 2 3 4 5

362070 361583 373469 374099 140513

August 01, 2011 August 01, 2011 August 03, 2011 August 09, 2011 August 09, 2011

Baby girl Baby girl Baby girl Baby girl Baby boy

Female Female Female Female Male

M. R. M. R. A. C. M. A. R. P.

Newborn Newborn Newborn Newborn Newborn

Tondo Medical Center Tondo Medical Center Tondo Medical Center Tondo Medical Center Tondo Medical Center

Concurred by: RHODORA A. QUILANTIP, RN., MAN. . Signature over printed Name of Chief Nurse Date Signed: Degree: M.A.N.

Approved by: MARIA CLAUDIA A. MARQUEZ, RN. MAN. Signature over printed Name of Dean Date Signed: Degree: M.A.N. a.) PRC NO.: Valid Until: 0149796 April 2, 2014 b.) PNA NO.:

a.) b.)

PRC NO.: Valid Until: PNA NO.: Valid Until:

0097511 July 8, 2012 18651 Life time Member

b.) PNA NO.: 8435 Valid Until: Lifetime Member c.) ADCPN NO.: 429

17905

. Valid Until:

Life time Member

Valid Until:

December. 31, 2012