OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway, Valenzuela City

Tel. 292-1124
PACUCOA Level III. Granted 2010
SURGICAL SCRUB in VALENZUELA MEDICAL CENTER

Prepared by:
Printed Name and Signature of Student: TUBAA, BERNARDINO GALANZA____________________________________________

Date Performed and

Time Started

PROCEDURE PERFORMED

D.R. Nurse On Duty

(Name and Signature)
(If Midwife on duty,
Signature Not Required)

SUPERVISED BY
Clinical Instructor
Name and Signature

Patient's INITIAL Only

Case Number

August 6, 2010 4:30 pm

D.L 72775

Oophorocystectomy

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

August 6, 2010 6:00 pm

G.O 173055

Salpingectomy Right

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

September 16, 2010 7:50 am

M.A 167165

Appendectomy

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

Noted by: ____________________________________________________________

Aida V. Garcia, RN MAN
Clinical Coordinator, PRC I.D. No. 0196716 Valid Until: MARCH 30, 2014
Date document is signed: _________________________________________
Degree Earned: Master of Arts in Nursing____________________________

Approved by: ___________________________________________________________

Lurceli L. Santos, RN RM MAN
Dean, PRC I.D. No. 0010878____ Valid Until: SEPTEMBER, 2014_____
Date document is signed: _______________________________________
Degree Earned: Master of Arts in Nursing__________________________

OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway, Valenzuela City
Tel. 292-1124
PACUCOA Level III. Granted 2010
SURGICAL CIRCULATING in VALENZUELA MEDICAL CENTER

Prepared by:
Printed Name and Signature of Student: TUBAA, BERNARDINO GALANZA ___________________________________________

Patient's INITIAL Only

Date Performed and Time Started

PROCEDURE PERFORMED

O.R. Nurse On Duty

(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

Case Number
August 28, 2010 5:00 pm

A.T 97922

Bilateral Tubal Ligation

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

February 15, 2011 3:00 pm

K.T 1782688

Elective Caesarean Section

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

Noted by: ____________________________________________________________

Aida V. Garcia, RN MAN
Clinical Coordinator, PRC I.D. No. 0196716 Valid Until: MARCH 30, 2014
Date document is signed: _________________________________________
Degree Earned: Master of Arts in Nursing____________________________

Approved by: ___________________________________________________________

Lurceli L. Santos, RN RM MAN
Dean, PRC I.D. No. 0010878____ Valid Until: SEPTEMBER, 2014_____
Date document is signed: _______________________________________
Degree Earned: Master of Arts in Nursing__________________________

OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway, Valenzuela City
Tel. 292-1124
PACUCOA Level III. Granted 2010
ACTUAL DELIVERY in VALENZUELA MEDICAL CENTER

Prepared by:
Printed Name and Signature of Student: TUBAA, BERNARDINO GALANZA ___________________________________________

Date Performed and

Time Started

Patient's INITIAL Only

Case Number

PROCEDURE
PERFORMED
ASSISTED DELIVERY

D.R. Nurse On Duty

(Name and Signature)
(If Midwife on Duty,
Signature Not Required)

SUPERVISED BY
Clinical Instructor
Name and Signature

August 24, 2010 4:00 pm

SG 95708

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

August 26, 2010 2:45 pm

EO 170721

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

September 16, 2010 8:30 pm

AC 1476459

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

Noted by: ____________________________________________________________

Aida V. Garcia, RN MAN
Clinical Coordinator, PRC I.D. No. 0196716 Valid Until: MARCH 30, 2014
Date document is signed: _________________________________________
Degree Earned: Master of Arts in Nursing____________________________

Approved by: ___________________________________________________________

Lurceli L. Santos, RN RM MAN
Dean, PRC I.D. No. 0010878____ Valid Until: SEPTEMBER, 2014_____
Date document is signed: _______________________________________
Degree Earned: Master of Arts in Nursing__________________________

OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway, Valenzuela City
Tel. 292-1124
PACUCOA Level III. Granted 2010
DELIVERIES ASSISTED in VALENZUELA MEDICAL CENTER

Prepared by:
Printed Name and Signature of Student: TUBAA, BERNARDINO GALANZA ___________________________________________

Date Performed and

Time Started

Patient's INITIAL Only

SURGICAL PROCEDURE
PERFORMED

Case Number

O.R. Nurse On Duty

(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

October 18, 2009 5:40 pm

E.L 144541

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

August 26, 2010 8:19 pm

M.V 82948

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

August 28, 2010 2:26 pm

A.T 97922

Normal Spontaneous Delivery

Bernadette V. Antonio, RN MAN

Jocelyn C. Tebrero, RN RM MAN

Noted by: ____________________________________________________________

Aida V. Garcia, RN MAN
Clinical Coordinator, PRC I.D. No. 0196716 Valid Until: MARCH 30, 2014
Date document is signed: _________________________________________
Degree Earned: Master of Arts in Nursing____________________________

Approved by: ___________________________________________________________

Lurceli L. Santos, RN RM MAN
Dean, PRC I.D. No. 0010878____ Valid Until: SEPTEMBER, 2014_____
Date document is signed: _______________________________________
Degree Earned: Master of Arts in Nursing__________________________

OUR LADY OF FATIMA UNIVERSITY

120 McArthur Highway, Valenzuela City
Tel. 292-1124
PACUCOA Level III. Granted 2010
IMMEDIATE NEWBORN CARE in VALENZUELA MEDICAL CENTER

Prepared by:
Printed Name and Signature of Student: TUBAA, BERNARDINO GALANZA ___________________________________________

Date Performed and

Time Started

Patient's INITIAL Only

Case Number

Immediate Newborn Cord Care

PERFORMED
Indicate where performed e.g. D.R.,
Nursery, NICU or Home

D.R. Nurse On Duty

(Name and Signature)
(If Midwife on Duty, Signature not
required)

SUPERVISED BY
Clinical Instructor
Name and Signature

October 18, 2009 7:30 pm

M.A 133983

Delivery Room

Lorna Ruanto, RN MAN

Jocelyn C. Tebrero, RN RM MAN

July 29, 2010 7:00 am

BL 174367

Delivery Room

Lorna Ruanto, RN MAN

Jocelyn C. Tebrero, RN RM MAN

September 16, 2010 3:00pm

CB 1479359

Delivery Room

Lorna Ruanto, RN MAN

Jocelyn C. Tebrero, RN RM MAN

Noted by: ____________________________________________________________

Aida V. Garcia, RN MAN
Clinical Coordinator, PRC I.D. No. 0196716 Valid Until: MARCH 30, 2014
Date document is signed: _________________________________________
Degree Earned: Master of Arts in Nursing____________________________

Approved by: ___________________________________________________________

Lurceli L. Santos, RN RM MAN
Dean, PRC I.D. No. 0010878____ Valid Until: SEPTEMBER, 2014_____
Date document is signed: _______________________________________
Degree Earned: Master of Arts in Nursing__________________________