New Scrub Forms by Judy
33
ST. ANTHONY COLLEGE OF ROXAS CITY, INC. SAN ROQUE EXTENSION, ROXAS CITY 5800 CAPIZ, PHILIPPINES Name of Student: BARGAS, JUDY CARATAO First Course (if any) N/A Name and Address of School: ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City School Graduated: N/A Recognition/ Accreditation Level Year of Admission in the BSN : 2007 Date School/ Program was Recognized: FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity) Year Graduated from the BSN Program 2011 MAJOR OPERATION ASSISTED NO . DATE OF OPERATION CASE NO. NAME OF PATIENT DIAGNOSIS OPERATION PERFORMED TYPE OF ANESTHESIA NAME OF SURGEON NAME OF HOSPITAL 1 JANUARY 19, 2010 11812700 OGPIMININA, MARJORIE TERM OF PREGNANCY PRIMIGRAVIDA, PREMATURE RUPTURE OF MEMEBRANE, CEPHALOPELVIC DISPROPORTION LOW CERVICAL CESAREAN SECTION SPINAL DR. HELEN BISNAR SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL) Prepared by: Noted by: Concurred by: Approved by: JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MAN Signature Over Printed Name of Student Signature Over Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221 FLORA MAY R. CORTEL, RN Valid Until: NOVEMBER 22, 2012 Valid Until: Valid Until: SEPTMBER 15, 2011 Signature Over Printed Name of Clinical Instructor b). PNA No.: Valid b). PNA No.: Valid b). PNA No.: Valid 8002 LIFETIME
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Transcript of New Scrub Forms by Judy
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MAJOR OPERATION ASSISTEDNO.
DATE OF OPERATION
C A S E N O .
NAME OF PATIENT
DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIA
NAME OF SURGEON
NAME OF HOSPITAL
1JANUARY 19,
201011812700
OGPIMININA, MARJORIE
TERM OF PREGNANCY PRIMIGRAVIDA, PREMATURE RUPTURE OF MEMEBRANE,
CEPHALOPELVIC DISPROPORTION
LOW CERVICAL CESAREAN SECTION
SPINALDR. HELEN
BISNARSAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
FLORA MAY R. CORTEL, RN Valid Until: NOVEMBER 22, 2012
Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0380456 Valid Until: MAY 31, 2011 Valid Until: MAY 17, 2014b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MAJOR OPERATION ASSISTEDNO.
DATE OF OPERATION
CASE NO.
NAME OF PATIENT
DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIANAME OF SURGEON
NAME OF HOSPITAL
1MARCH 29,
2010268006
VALENZUELA, CRISTINA
DISTAL ABDOMINAL BILE DUCT
OBSTRUCTION
CHOLEDOCHO- DUODENOSCOPY
SUBARACHNOID BLOCK AND
CONTINUOUS EPIDURAL
ANESTHESIA
DR. IGNACIO SAN GABRIEL
SAN JUAN DE DIOS EDUCATIONAL FOUNDATION,
INC. (HOSPITAL)
2MARCH 30,
2010218292
FERRER, JADID AMINAH
CHRONIC CALCULUS CHOLECYSTITIS
OPEN CHOLECYSTECTOMY
WITH INTRAOPERATIVE
CHOLANGIOGRAPHY
SUBARACHNOID BLOCK AND
CONTINUOUS EPIDURAL
ANESTHESIA
DR. ADELBERT SANTOS
SAN JUAN DE DIOS EDUCATIONAL FOUNDATION,
INC. (HOSPITAL)
3MARCH 31,
2010179795 ROBLES, JOSE
UPPER GASTRIC INTESTINAL BLEEDING
EXPLORATORY LAPAROTOMY
GENERAL ANESTHESIA AND CONTINUOUS
EPIDURAL ANESTHESIA
DR. DANIEL ADVINCULA
SAN JUAN DE DIOS EDUCATIONAL FOUNDATION,
INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN RODOLFO C. BORROMEO, RN, MAN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: BSN, MAN Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: 0232752 a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until: NOVEMBER 22, 2012
Valid Until:APRIL 9, 2014
Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
25315 b). PNA No.: Valid Until:
8002
LIFETIME LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011 Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MAJOR OPERATION ASSISTEDNO.
DATE OF OPERATION
C A S E N O .
NAME OF PATIENT DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIA
NAME OF SURGEON
NAME OF HOSPITAL
1 MAY 6, 2010 11812965DE GUZMAN,
JAY-AN
GRAVIDA 1 PARA 1 PREGNANCY UTERINE, 41
WEEKS AGE OF GESTATION, FRANK BREECH IN LABOR
LOW CERVICAL CESAREAN SECTION,
SEPTATECTOMY WITH LIGATION OF
BLEEDERS
SPINALDR. LUCINO
DELFINSAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
ANDREW D. BELUSO, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until: SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002LIFETIME
Date signed: Degree:
BSNc). ADPCN No. :
427
a). PRC No.: 0106869 Valid Until: MAY 31, 2011 Valid Until: OCTOBER 17, 2011b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MINOR OPERATION ASSISTEDNO.
DATE OF OPERATION
CASE NO.
NAME OF PATIENT
DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIA
NAME OF SURGEON
NAME OF HOSPITAL
1FEBRUARY
3, 201011812736
GALERA, ANALYN
ABORTION 7-8 WEEKS AGE OF GESTATION, NON
INDUCED NON SEPTIC
COMPLETION CURETTAGE
INTRAVENOUS SEDATION
DR. HELEN BISNAR
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
2 JULY 9, 201011812112
6
FERNANDO, MATTHEW
JAMES
SOLID MASS 10 CENTIMETERS LEFT
UPPER ARM TO CONSIDER LIPOSARCOMA
EXCISION OF SOLID MASS, LEFT UPPER
ARMGENERAL
DR. MA. MERCEDES ALTAVAS
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
FLORA MAY R. CORTEL, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until: SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002LIFETIME
Date signed: Degree: BSN c). ADPCN
No. :427
a). PRC No.: 0380456 Valid Until: MAY 31, 2011 Valid Until: MAY 17, 2014b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MINOR OPERATION ASSISTEDNO.
DATE OF OPERATION
C A S E N O .
NAME OF PATIENT DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIA
NAME OF SURGEON
NAME OF HOSPITAL
1MAY 12,
201042419 FUNDAR, ELSA MASS, LEFT BREAST INCISIONAL BIOPSY LOCAL
DR. MA. MERCEDES ALTAVAS
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
ANDREW D. BELUSO, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until: SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002LIFETIME
Date signed: Degree:
BSNc). ADPCN No. :
427
a). PRC No.: 0106869 Valid Until: MAY 31, 2011 Valid Until: OCTOBER 17, 2011b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MINOR OPERATION ASSISTEDNO.
DATE OF OPERATION
CASE NO.
NAME OF PATIENT DIAGNOSISOPERATION PERFORMED
TYPE OF ANESTHESIA
NAME OF SURGEON
NAME OF HOSPITAL
1APRIL 19,
201008069
ARNAIZ, KEITH IRVINE
LACERATED WOUND FRONTAL AREA
SECONDARY TO HEAD TRAUMA
SUTURING OF LACERATED WOUND,
FRONTAL AREALOCAL
DR. GEMMA PATRICIA TACACA
SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN RODOLFO C. BORROMEO, RN, MAN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: BSN, MAN Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: 0232752 a). PRC No.: 0074221
MARK ALVIN A. ALISASIS, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: APRIL 9, 2014 Valid Until: SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
25315 b). PNA No.: Valid Until:
8002LIFETIME LIFETIME
Date signed: Degree:
BSNc). ADPCN No. :
427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until:b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
MINOR OPERATION ASSISTEDNO.
DATE OF OPERATION
C A S E N O .
NAME OF PATIENT DIAGNOSIS OPERATION PERFORMEDTYPE OF
ANESTHESIANAME OF SURGEON
NAME OF HOSPITAL
1 JULY 3, 2010 60733DECLARO, STEPHENE
SEBACEOUS CYST AT THE POSTERIOR EAR
EXCISION OF SEBACEOUS CYST AT THE POSTERIOR EAR
LOCALDR. MA.
MERCEDES ALTAVAS
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
RUBILYN B. SUMAYLO, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until: APRIL 8,b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
ACTUAL DELIVERIESNO.
CASE NO.
DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERYTIME OF
DELIVERYGENDER OF
BABYNAME OF HOSPITAL TYPE OF DELIVERY
100-56-
47
PREGNANCY UTERINE FULLTERM GRAVIDA 2
PARA 2
ANTIQUERA, CHRISTINE
27SEPTEMBER 3,
201010:19 AM FEMALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
200-56-
66
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1GARCIA, FATIMA 20
SEPTEMBER 11, 2010
8:25 PM MALESAINT ANTHONY COLLEGE
OF ROXAS CITY, INC. (HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
300-54-
91
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1
PAGAYON, GLADYS
26SEPTEMBER 19,
20101:25 PM FEMALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011
Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
ACTUAL DELIVERIESNO.
CASE NO.
DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERYTIME OF
DELIVERYGENDER OF
BABYNAME OF HOSPITAL TYPE OF DELIVERY
100-59-
86
PREGNANCY UTERINE FULLTERM GRAVIDA 5
PARA 2
BERMUDO, KAREEN
33DECEMBER 20,
20104:27 PM MALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
200-59-
83
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1
TRINIDAD, RHODORA
36DECEMBER 31,
20102:32 AM MALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MARK ALVIN A. ALISASIS, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until:b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
DELIVERIES ASSISTEDNO.
CASE NO.
DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERYTIME OF
DELIVERYGENDER OF
BABYNAME OF HOSPITAL TYPE OF DELIVERY
100-56-
94
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1
SENOPE, MA. ATHELA
23SEPTEMBER 4,
20109:10 PM MALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
200-57-
03
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1
DORDAS, MICHELLE
22SEPTEMBER 5,
201012:50 PM MALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011 Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
DELIVERIES ASSISTEDNO.
CASE NO.
DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERYTIME OF
DELIVERYGENDER OF
BABYNAME OF HOSPITAL TYPE OF DELIVERY
100-59-
30
PREGNANCY UTERINE FULLTERM GRAVIDA 1
PARA 1
MAGBANUA, SHARON
25DECEMBER 29,
201012:15 PM MALE
SAINT ANTHONY COLLEGE OF ROXAS CITY, INC.
(HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
200-59-
59
PREGNANCY UTERINE FULLTERM GRAVIDA 3
PARA 2FERRER, EDELPA 25
FEBRUARY 16, 2011
12:49 AM FEMALESAINT ANTHONY COLLEGE
OF ROXAS CITY, INC. (HOSPITAL)- COMMUNITY
NORMAL SPONTANEOUS
VAGINAL DELIVERY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MARK ALVIN A. ALISASIS, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until:b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
DELIVERIES ASSISTEDNO.
CASE NO.
DIAGNOSIS NAME OF MOTHER AGE DATE OF DELIVERYTIME OF
DELIVERYGENDER OF
BABYNAME OF HOSPITAL TYPE OF DELIVERY
1 269670
PREGNANCY UTERINE 39 1/7 WEEKS OF
GESTATION GRAVIDA 1 PARA 1
DOMINGO, AIREN 23 MARCH 29, 2010 9:52 AM MALE
SAN JUAN DE DIOS EDUCATIONAL
FOUNDATION, INC. (HOSPITAL)
NORMAL SPONTANEOUS
VAGINAL DELIVERY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN RODOLFO C. BORROMEO, RN, MAN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: BSN, MAN Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: 0232752 a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: APRIL 9, 2014 Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
25315 b). PNA No.: Valid Until:
8002LIFETIME
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011 Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
CORD DRESSINGNO.
CASE NO. DATE PERFORMED NAME OF BABY GENDER OF BABY NAME OF MOTHER AGE NAME OF HOSPITAL
1 00-57-17 SEPTEMBER 12, 2010 CURATCHO, BABY BOY MALE CURATCHO, RIZALLY 33SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)-
COMMUNITY
2 00-57-32 SEPTEMBER 20, 2010 OPOLENCIA, BABY BOY MALE OPOLENCIA, MARY ANN 18SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)-
COMMUNITY
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011 Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
CORD DRESSINGNO.
CASE NO. DATE PERFORMED NAME OF BABY GENDER OF BABY NAME OF MOTHER AGE NAME OF HOSPITAL
1 61654 NOVEMBER 17, 2010 GUZMAN, BABY BOY MALE GUZMAN, AILEEN 35SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
MERIAM D. FLORES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: 0153798 Valid Until: MAY 31, 2011 Valid Until: JUNE 25, 2012b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
CORD DRESSINGNO.
CASE NO. DATE PERFORMED NAME OF BABY GENDER OF BABY NAME OF MOTHER AGE NAME OF HOSPITAL
1 269966 APRIL 16, 2010 SUMERA, BABY GIRL FEMALE SUMERA, MELANIE 29SAN JUAN DE DIOS EDUCATIONAL FOUNDATION, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN RODOLFO C. BORROMEO, RN, MAN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: BSN, MAN Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: 0232752 a). PRC No.: 0074221
WILA C. VALLES, RN Valid Until:
NOVEMBER 22, 2012 Valid Until:APRIL 9, 2014
Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
25315 b). PNA No.: Valid Until:
8002
LIFETIME LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until:b). PNA No.: Valid Until:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC.SAN ROQUE EXTENSION, ROXAS CITY
5800 CAPIZ, PHILIPPINES
Name of Student: BARGAS, JUDY CARATAO
First Course (if any) N/A
Name and Address of School:
ST. ANTHONY COLLEGE OF ROXAS CITY, INC., San Roque Extension, Roxas City
School Graduated: N/A
Recognition/Accreditation Level
Year of Admission in the BSN : 2007
Date School/ Program was Recognized:
FEBRUARY 08, 1982 Number 012 Year 1981 (Effectivity)
Year Graduated from the BSN Program 2011
CORD DRESSINGNO.
CASE NO. DATE PERFORMED NAME OF BABY GENDER OF BABY NAME OF MOTHER AGE NAME OF HOSPITAL
1 59495 JULY 10, 2010 BENLIRO, BABY GIRL FEMALE BENLIRO, RUTH 28SAINT ANTHONY COLLEGE OF ROXAS CITY, INC. (HOSPITAL)
Prepared by: Noted by: Concurred by: Approved by:
JUDY C. BARGAS KATHERINE C. BENGAN, RN, MSN SR. EDITHA A. BAGAYAUA, DC, RN, MANSignature Over Printed Name of Student Signature Over Printed Name of Clinical
CoordinatorSignature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed: Date Signed: Date Signed: Supervised by: Degree: BSN, MSN Degree: Degree: BSN, MAN
a). PRC No.: 0295743 a). PRC No.: a). PRC No.: 0074221
RUBILYN B. SUMAYLO, RN Valid Until:
NOVEMBER 22, 2012 Valid Until: Valid Until:SEPTMBER 15, 2011
Signature Over Printed Name of Clinical Instructor
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
b). PNA No.: Valid Until:
8002
LIFETIMEDate signed: Degree:
BSNc). ADPCN No. : 427
a). PRC No.: Valid Until: MAY 31, 2011 Valid Until:b). PNA No.: Valid Until:
