PRC FORM CVMC - Edited

UNIVERSITY OF SAINT LOUIS
TUGUEGARAO CITY, CAGAYAN

COLLEGE OF HEALTH AND ALLIED SCIENCES
BACHELOR OF SCIENCE IN NURSING
Name of Student:___MANAUIS, KRISTINE ALLA_________________________________________________________________________________________________________________________________

Name and Address of School:__UNIVERSITY OF SAINT LOUIS , MABINI STREET, TUGUEGARAO CITY___________________________________________________________
Accreditation Level (if any):__GRANTED AUTONOMOUS STATUS_____________ Valid Until:___2012______________________Year Granted: 2007_________________
Date School/ Program was Recognized:_DECEMBER 17, 2007 Number: ____053___________________________Year:__2007__________________________________
Year of Admission in the Bachelor of Science in Nursing Program:__2007__________________________________________________________________________________________
Year Graduated (BSN Program):__2011______________________________________________________________________________________________________________________
I. MAJOR OPERATION
No. Date of Operation Case Name of Diagnosis Operation Performed Type of Name of Name of Name and Signature
No. Patient Anesthesia Surgeon Hospital of O.R. Scrub Nurse
April 23, 2010 Acute Abdomen Secondary To Stab General
1. 6:22 am 64940 M. D. F Wound, Hemiperitoneum, Pancreatic Emergency Exploratory Endotracheal Dr. Odessa Cagayan Valley Manuel S. Cortez III,
Injury Distal third Laparotomy Anesthesia Tiangco Medical Center RN
April 23, 2010 Abnormal Uterine Bleeding Status Total Abdominal Continuous
2. 8:50 am 64507 N. T. B Post Fractional Curettage, Hysterectomy Bilateral Lumbar Epidural Dr. Jose Dante Cagayan Valley Christopher D. Javier,
Endometrial Polyp, Myoma Uterine Salphingo Oophorectomy Anesthesia Marcos Medical Center RN
November 24, 2010 Open Reduction Internal General
3. 8:42 am 86901 J. D. R Fracture, Close Complete, Fixation, Application of Anesthesia Dr. Nicolo Cagayan Valley
Comminuted, Displaced Middle Roger Anderson External Endotracheal Mamba Medical Center Christopher D. Javier,
Third Tibia- Fibula Left Fixation Tibia- Fibula Left Tube RN
November 24, 2010 Pregnancy Uterine 38 1/7 weeks Age
4. 11:03 am 78684 M. J. E of Gestation, Footling Breech Emergency Primary Low Sub Arachnoid Dr. Marianne Cagayan Valley
Gravida 1 Para 1, Delivered Segment Cesarean Section Block Diasen Medical Center Manuel S. Cortez III,
Operatively to a Live Baby Girl at RN
11:10am
December 7, 2010 Genaral
5. 7:15 am 85668 G. R. P Multiple Goiter Total Thyroidectomy Endotracheal Dr. Enouel Cagayan Valley Manuel S. Cortez III,
Anesthesia Steve Battung Medical Center RN
Prepared by: Noted by: Approved by: Concurred by:
KRISTINE A. MANAUIS ROSARIO R. CAÑAZARES, RN,MSN DINDO V. ASUNCION, RPh, RN, MSN, PhD OLIVIA SB. GONZALES, RN, MAN, MSN
Signature Over Printed Name Of Student Signature Over Printed Name Of Clinical Coordinator Signature Over Printed Name Of Dean Signature Over Printed Name Of Chief Nurse
Date Signed: ______________________ Date Signed: _____________________________ Date Signed:_____________________ Date Signed:__________________________
Degree: Bachelor of Science in Nursing Degree: Master of Science in Nursing Degree: Doctor of Philosophy Degree: Master of Science in Nursing
a.) PRC No.: 0109691 a.) PRC No.: 0248760 a.) PRC No.: 0132834
Valid Until: October 6, 2014 _ Valid Until: October 2, 2013 Valid Until: October 3, 2012 __
b.) PNA No.: 9384 __ b.) PNA No.: 2011- 061652 b.) PNA No.: 402_______ ___
Valid Until: LIFETIME MEMBER Valid Until: October 31, 2011 Valid Until: LIFETIME MEMBER
c.) ADPCN No.: _0837 ____
Valid Until:__ December 2011___
Name of Student:__ _ MANAUIS, KRISTINE ALLA________________________________________________________________________________________________________________________________

Name and Address of School:__UNIVERSITY OF SAINT LOUIS , MABINI STREET, TUGUEGARAO CITY___________________________________________________________
Accreditation Level (if any):_GRANTED AUTONOMOUS STATUS _____________ Valid Until: ______2012________Year Granted: ___ 2007__________________
Date School/ Program was Recognized: DECEMBER 17, 2007_________ Number:_ 053_______________________Year:__ 2007__________________________
Year of Admission in the Bachelor of Science in Nursing Program:__2007__________________________________________________________________________________________
Year Graduated (BSN Program):__20011_____________________________________________________________________________________________________________________
II. MINOR OPERATION

No. Date of Operation Case Name of Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital Name and Signature
No. Patient of O.R. Scrub Nurse
June 28, 2010 Lacerated Wound, 2cm Left Ear
1. 9:40 am 71039 R. T. M Secondary To Vehicular Wound Suturing Local Anesthesia Dr. Paul Balisi Cagayan Valley
Accident Medical Center Carol Guillermo, RN
June 30, 2010 Open Fracture, Complete,
2. 10:10 am 71261 J. A. B Oblique Displace, Distal Wound Debridement Local Anesthesia Dr. Rickson Cagayan Valley
Phalanges and Shaft Index and Wound Suturing Tolentino Medical Center
Finger Left Shandee Sabio, RN
August 11, 2010
3. 11:30 pm 75990 F. D. A Partially Avulsed Lower Lid Emergency Repair of General Anesthesia Cagayan Valley
Right Partially Avulsed Laryngeal Mask Medical Center Richelle Llyn Tallow,
Lower Lid Right Airway RN, MSN
September 15, 2010 Abortion, Incomplete,
4. 12:10 am 80335 I. C. O Spontaneous, Non- Septic Dilatation and Intravenous Dr. Marianne Cagayan Valley
Gravida 3 Para 2 (2012) Curettage Sedation Diasen Medical Center Abigail Soriano, RN
5. December 1, 2010 Closed Reduction with General Anesthesia
2:10 pm 88494 S. E. T Radial Head Fracture Close Left Roger Anderson Laryngeal Mask Dr. Marco Paolo Cagayan Valley
External Fixation Airway Lasam Medical Center Jambo Delmendo, RN
Date Signed: ______________________ Date Signed: _____________________________ Date Signed:_____________________ Date Signed:__________________________
c.) ADPCN No.: _0837 ____

Name and Address of School:__UNIVERSITY OF SAINT LOUIS , MABINI STREET, TUGUEGARAO CITY_______________________________________________________
Accreditation Level (if any):__GRANTED AUTONOMOUS STATUS____________ Valid Until:___2012_____________________Year Granted: 2007________________
Date School/ Program was Recognized:_DECEMBER 17, 2007 Number: ____053___________________________Year:__2007________________________________
Year of Admission in the Bachelor of Science in Nursing Program:__2007_______________________________________________________________________________________
Year Graduated (BSN Program):_20011___________________________________________________________________________________________________________________
III. ACTUAL DELIVERIES

Supervised by Name
No. Case No. Diagnosis Name of Age Date of Time of Gender of Name of Hospital Type of Delivery and Signature of
Mother Delivery Delivery Baby Qualified C.I.
Pregnancy Uterine Full Term 39-40
1. 45226 Weeks Age of Gestation, Gravida 1 M. L. L 21 April 19, 10: 06 pm Female Cagayan Valley Normal Spontaneous Rosemarie Tadena,
Para 1 (1001) 2010 Medical Center Delivery RN, MSN
Pregnancy Uterine Full Term 40 Weeks
2. 51487 Age of Gestation, Gravida 3 Para 3 C. V. B 38 July 28, 12: 58 am Female Cagayan Valley Normal Spontaneous Helen P. Agustin,
(3003) 2010 Medical Center Delivery RN, MSN, MAN
Pregnancy Uterine Full Term 39 3/7
3. 80848 Weeks Age of Gestation, Gravida 2 E. G. L 31 September 4: 53 am Female Cagayan Valley Normal Spontaneous Helen P. Agustin,
Para 1 (1011) 18, 2010 Medical Center Delivery RN, MSN, MAN
Pregnancy Uterine Full Term 40 Weeks
4. 92832 Age of Gestation, Gravida 2 Para 2 S. A. P 31 January 16, 4: 32 pm Male Cagayan Valley Normal Spontaneous Helen P. Agustin,
(2002) 2011 Medical Center Delivery RN, MSN, MAN
5. 94159 Weeks Age of Gestation, Gravida 3 J. E. J 35 February 1, 9: 53 am Male Cagayan Valley Normal Spontaneous Helen P. Agustin,
Para 3 (3003) 2011 Medical Center Delivery RN, MSN, MAN
Date Signed: __February 28, 2011 Date Signed: _____________________________ Date Signed:_____________________ Date Signed:__________________________
c.) ADPCN No.: _0837 ____

Name and Address of School:__UNIVERSITY OF SAINT LOUIS , MABINI STREET, TUGUEGARAO CITY_______________________________________________________
Accreditation Level (if any):__GRANTED AUTONOMOUS STATUS_____________ Valid Until:___2012______________________Year Granted: 2007______________
Date School/ Program was Recognized: DECEMBER 17, 2007 Number: ____053___________________________Year:__2007________________________________
Year of Admission in the Bachelor of Science in Nursing Program:__2007______________________________________________________________________________________
IV. ASSISTED DELIVERIES

Supervised by Name
No. Case Diagnosis Name of Age Date of Time of Gender of Name of Hospital Type of Delivery and Signature of
No. Mother Delivery Delivery Baby Qualified C.I.
Pregnancy Uterine Full Term 40
1. 78214 Weeks Age of Gestation, Gravida 1 M. H. M 17 August 29, 6: 32 am Male Cagayan Valley Normal Spontaneous Helen P. Agustin,
Pregnancy Uterine Full Term 38
2. 79054 Weeks Age of Gestation, Gravida 1 P. I. C 26 September 5, 4: 13 pm Male Cagayan Valley Normal Spontaneous Helen P. Agustin,
3. 79080 Weeks Age of Gestation, Gravida 1 M. D. B 22 September 5, 1: 02 am Female Cagayan Valley Normal Spontaneous Helen P. Agustin,
4. 89039 Weeks Age of Gestation, Gravida 4 S. C. N 30 December 6, 10: 04 am Male Cagayan Valley Normal Spontaneous Helen P. Agustin,
5. 32161 Weeks Age of Gestation, Gravida 1 M. J. M 21 December 7, 11: 13 am Female Cagayan Valley Normal Spontaneous Helen P. Agustin,
Date Signed: February 28, 2011 Date Signed: _____________________________ Date Signed:_____________________ Date Signed:__________________________
c.) ADPCN No.: _0837 ____

Name and Address of School:__UNIVERSITY OF SAINT LOUIS , MABINI STREET, TUGUEGARAO CITY______________________________________________________
Accreditation Level (if any):__GRANTED AUTONOMOUS STATUS_____________ Valid Until:___2012______________________Year Granted: 2007_____________
Date School/ Program was Recognized:_DECEMBER 17, 2007 Number: ____053___________________________Year:__2007___________________________________
Year of Admission in the Bachelor of Science in Nursing Program:__2007______________________________________________________________________________________
V. CORD DRESSING
Supervised by Name and
No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Signature of Qualified C. I.
1. 71273 June 30, 2010 Baby Girl Calibag Female A. P. C 28 Cagayan Valley Brian Jaron Hingco, RN, MSN
9: 15 am Medical Center
2. 73387 September 13, 2010 Baby Girl Mangligot Female E. B. M 35 Cagayan Valley Helen P. Agustin,
10: 53 pm Medical Center RN, MSN, MAN
3. 89044 December 6, 2010 Baby Girl Angoluan Female J. F. A 24 Cagayan Valley Helen P. Agustin,
11: 11 am Medical Center RN, MSN, MAN
4. 72645 July 13, 2010 Baby Boy Ubiña Male M. B. U 20 Cagayan Valley Helen P. Agustin,
5. 92803 January 15, 2011 Baby Girl Mabborang Female J. A. M 19 Cagayan Valley Helen P. Agustin,
Date Signed: February 28, 2011 Date Signed: _____________________________ Date Signed:_____________________ Date Signed:__________________________
c.) ADPCN No.: _0837 ____

PRC FORM CVMC - Edited

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

PRC FORM CVMC - Edited

Uploaded by

Copyright:

Available Formats

UNIVERSITY OF SAINT LOUIS

TUGUEGARAO CITY, CAGAYAN

Name of Student:_MANAUIS, KRISTINE ALLA_______________________________________________________________________________________________________________________________

Name of Student:__ _ MANAUIS, KRISTINE ALLA________________________________________________________________________________________________________________________________

II. MINOR OPERATION

Name of Student:_MANAUIS, KRISTINE ALLA_______________________________________________________________________________________________________________________________

III. ACTUAL DELIVERIES

Name of Student:_MANAUIS, KRISTINE ALLA_______________________________________________________________________________________________________________________________

IV. ASSISTED DELIVERIES

Name of Student:_MANAUIS, KRISTINE ALLA_______________________________________________________________________________________________________________________________

You might also like