UNIVERSITY OF PANGASINAN COLLEGE OF NURSING Arellano St., Dagupan City Phone No.: (075)522-5635-37; Fax No.: (075)522-2496; E-mail: r egistrar@up ang.edu.ph; Website: http://www.upang.edu.ph(Level I PACUCOA; Year Granted: March 05, 2007) (Date School / Program was recognized: May 19, 1976; Number: 44; Year: 1976) I.MAJOR OPERATION No. DATE ofOPERATIO N TIME ofOPERATION STARTED- ENDED PATIENT¶S INITIALS DIAGNOSISOPERATION PERFORMED TYPE ofANESTHESI A NAME of SURGEON NAME ofHOSPITAL Name & Signature of Qualified Clinical Instructor CASE NO. 1 May 5, 2010 12:25 pm-12:50 pm M.J.C Status Post Partum, Normal Spontaneous Delivery, With Vaginal Laceration, Gravid 2 Para 2 (1-0-0-1) Perineorrhaphy Local Dr. Frederick G. Lalas MapCH Maria Leah G. Barangan, RN 00894 LEGEND: MapCH ± Mapandan Community HospitalNoted by: ZENAIDA M. BAUTISTAClinical Coordinator PRC I.D. No.: 0133422 Valid Until: July 27, 2011 PNA No.: 029069 Valid Until: October 31, 2010_______Date document is signed: Time: Please specify Highest Nursing Degree Earned: Concurred by: GRACE Z. JOVELIANOS Chief Nurse PRC I.D. No.: 0064042 Valid Until: September 16, 2011 PNA No.: 029073 Valid Until: October 31,2010 Date document is signed: Time: Please specify Highest Nursing Degree Earned: BSN-RN Approved by: MARIA TERESA R. FAJARDO Dean PRC I.D. No.: 0160104 Valid Until: September 9, 2010 PNA No.: 013739 ________ Valid Until: October 31, 2010 ADPCN No.: Valid Until: Date document is signed: Time: Please specify Highest Nursing Degree Earned: Supervised by: MARIA LEAH G. BARANGANClinical Instructor Date signed: Degree: BSN-RN PRC I.D. No.: 0392061 Valid Until: September 27, 2012 PNA No.: 031851 Valid Until: October 31, 2010 NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical Therapy School graduated from: Lyceun Northwestern University, Dagupan City, Pangasinan Year: 2002 Year of admission in the BSN Program: June 2006 Year graduated from BSN Program: 2011 Universi ty Seal Prepared by: JOAN T. OVIEDOStudent
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Supervised by: MARIA LEAH G. BARANGAN Clinical Instructor
Date signed:
Degree: BSN-RNPRC I.D. No.: 0392061 Valid Until: September 27, 2012PNA No.: 031851 Valid Until: October 31, 2010
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
Date signed:Degree:PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: OVIEDO, Joan Ticsay First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011
Date signed:Degree:PRC I.D. No.: Valid Until:PNA No.: Valid Until:
NAME OF STUDENT: First course (if any): Bachelor of Science in Physical TherapySchool graduated from: Lyceun Northwestern University,Dagupan City, Pangasinan
Year: 2002Year of admission in the BSN Program: June 2006Year graduated from BSN Program: 2011