URDANETA CITY UNIVERSITY

(formerly City Colleges of Urdaneta)

Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004
Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: Montano, Cesar T. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2009___ Year of Admission in the Bachelor of Science in Nursing Program: _2007_
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): APRIL 2011_______________________
Recognition Number: 054 Year: 1985

I. Major Operations
Signature
Name of Signature
of Name of
No Date of Case Type of Name of Qualified of O.R.
Name of Patient Diagnosis Operation Performed Name of Hospital Qualified O.R. Scrub
. Operation No. Anesthesia Surgeon Clinical Scrub
Clinical Nurse
Instructor Nurse
Instructor
Gravida 5 Urdaneta Sacred Loida dela
Para 4 Dr. Heart Hospital Cruz
August Low Transverse Caesarean Spinal Michael Alvin
1. 809 Annalisa Gonzales Frank Gladys
24, 2010 Section I (Pfannensteil) Anesthesia T. Regis
Breech Palagud
Presentation
Cholelithiasi Urdaneta Sacred Mylene de
Total Abdominal Hysterectomy Dr.
August s and Spinal Heart Hospital Michael Alvin Guzman
2. 781 Annette Garcia Salpingo Oophoprectomy, Evalinda
16, 2010 Myoma Anesthesia T. Regis
Partial Omenectomy Guevarra
Uteri
Gravida Urdaneta Sacred Mylene de
Dr.
August 5,Para 4, Emergency Low Cervical Spinal Heart Hospital Michael Alvin Guzman
3. 722 Abigail Corpuz Cecilia
03, 2010 Meconium Caesarean Section Anesthesia T. Regis
Tolete
Stain
Emergency Exploratory Loida dela
Intestinal
Laparatomy; insertion of closed Cruz
Obstruction
tube thoracostomy,
December due to General Dr.Luz Urdaneta Sacred Michael T.
4. 1360 Cecille de Castro hepatorrhaphy, repair of
14, 2009 bands, Anesthesia Gandia Heart Hospital Regis
peritoneal and diaphragmatic
Ileoceccal
rent, incidental appendectomy,
area
peritoneal lavage
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MICHAEL T. REGIS Concurred by: BELEN T. OLIGORES Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: ___________________ Date Signed: _______________ Date Signed: ______________
Degree: __________________________ Degree: _______________________ Degree: BSN, RN, MAN Degree: MAN, Ed.D .
a). PRC No.: ______________________ a). PRC No.: ___________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ____________________ Valid Until: March 24, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: __________________ b). PNA No.: _______________ b). PNA No.: 12163
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004
Valid Until: _____________________ Valid Until: ____________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. ________________ c). ADPCN No.: ______________
Valid until: ___________________ Valid Until: December 2011

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2009___ Year of Admission in the Bachelor of Science in Nursing Program: 2007__
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985

I. Major Operations
Signature
Name of Signature
of Name of
No Date of Case Type of Name of Qualified of O.R.
Name of Patient Diagnosis Operation Performed Name of Hospital Qualified O.R. Scrub
. Operation No. Anesthesia Surgeon Clinical Scrub
Clinical Nurse
Instructor Nurse
Instructor
Decembe Multiple Beatriz
1122 Spinal Dr. John Urdaneta District Marc Darwin
5. . r 09, Marlon Olimpo Choledoch Cholecystectomy Mercado
0 Anesthesia Mina Hospital L. Ragojos
2010 al Stones
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: Marc Darwin L. Ragojos Concurred by: MARY ELEANOR B. MAYO Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: BSN RN, MAN Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MAN, Ed.D.
a). PRC No.: 0536521 a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: March 22, 2011 Valid Until: ______________________ Valid Until: March 24, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.:
Valid until: ______________________ Valid Until: December 2011
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2011___ Year of Admission in the Bachelor of Science in Nursing Program: _2007_
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985

II. Minor Operations

Name of Signature of
Name of Signature of
Date of Case Name of Operation Type of Name of Name of Qualified Qualified
No. Diagnosis O.R. Scrub O.R. Scrub
Operation No. Patient Performed Anesthesia Surgeon Hospital Clinical Clinical
Nurse Nurse
Instructor Instructor
1. Augist 037259 Mark Steven Circumcision IV Sedation Dr. Darius Urdaneta Christina
Michael T.
11, 2010 Obiano Parinas Scared Heart Diana B.
Regis
Hospital Miclat
2. August 789 Teodora Percutaneous IV Sedation Urdaneta Joseph
18, Apostol Esophageal Dr. Arsenio Scared Heart Michael T. Caliboso
20010 Gastrectomy Reyes Hospital Regis
Insertion

Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MICHAEL T. REGIS Concurred by: BELEN T. OLIGORES Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: __________________________ Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, MAN, Ed.D.
a). PRC No.: ______________________ a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ______________________ Valid Until: March 24, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2011___ Year of Admission in the Bachelor of Science in Nursing Program: _2007_
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985

II. Minor Operations

Signature
Name of Name of Signatur
Date of Cas Type of of
No Name of Qualified O.R. e of O.R.
Operatio e Name of Patient Diagnosis Operation Performed Anesthesi Name of Hospital Qualified
. Surgeon Clinical Scrub Scrub
n No. a Clinical
Instructor Nurse Nurse
Instructor
Right Joanne
Local Dr.
August 511 Mediolater Urdaneta District Marc Darwin Estanilla
3. Joan M. Dial Episiorrhaphy Anesthesi Cristina
06, 2010 6 al Hospital L. Ragojos
a Fajardo
Episiotomy
Incomplete Joanne
Dr.
August 492 Abortion, IV Urdaneta District Marc Darwin Estanilla
4. Natividad Luna Dilatation and Curettage Josephin
06, 2010 4 Gravida 1, Sedation Hospital L. Ragojos
e Guiang
Para 0
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MARC DARWIN L. RAGOJOS Concurred by: MARY ELEANOR B. MAYO Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: BSN, RN, MAN Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MaED, MAN, Ed.D.
a). PRC No.: 0536521 a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004
Valid Until: March 22, 2012 Valid Until: ______________________ Valid Until: March 23, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2011___ Year of Admission in the Bachelor of Science in Nursing Program: _2007_
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985

II. Minor Operations

Signature
Name of Name of Signatur
Date of Cas Type of of
No Operation Name of Qualified O.R. e of O.R.
Operatio e Name of Patient Diagnosis Anesthesi Name of Hospital Qualified
. Performed Surgeon Clinical Scrub Scrub
n No. a Clinical
Instructor Nurse Nurse
Instructor
Lacerated wound at Dr. Mary
Local Dr. Laureano S.
July 07, 285 the right cheek with Suturing 4 Jo S. Glenda B.
5. Bobby Soriano Anesthesi Perez Memorial
2010 8 hematoma secondary centimeters Matusale Tadena
a Clinic
to mauling m
Prepared by:
Name of Student: Fred G. Aqui_
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004

Supervised by: MICHAEL T. REGIS Concurred by: MARY JO S. MATUSALEM Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: __________________________ Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MaED, MAN, Ed.D.
a). PRC No.: ______________________ a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ______________________ Valid Until: March 23, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2011___ Year of Admission in the Bachelor of Science in Nursing Program: ______
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985
III. Actual Deliveries
No. Case Diagnosis Name of Age Date Of Delivery Time of Gender Of Baby Name of Type Of Delivery Supervised By: Name &
No. Patient Delivery Hospital Signature of Qualified
CI
1. 5505 Pregnancy Uterine Full Urdaneta District Normal
Term Gravida 1, Para 0 Irish Arciaga 20 June 28, 2010 9:45 pm Female Hospital Spontaneous Marc Darwin L. Ragojos
Delivery
2. 4079 Pregnancy Uterine Full Urdaneta District Normal
Term Gravida 2, Para 1 Jocelyn 25 June 07, 2010 8:29 pm Male Hospital Spontaneous Marc Darwin L. Ragojos
Cabuslay Delivery
3. 2488 Pregnancy Uterine Full Urdaneta District Normal
Term Gravida 2, Para 1 Jessica 18 July 06, 2010 10:45 am Male Hospital Spontaneous Marc Darwin L. Ragojos
Bermudez Delivery
4. 4880 Pregnancy Uterine Full Urdaneta District Normal
Term Gravida 2, Para 1 Jocelyn 30 June 07, 2010 6:08 pm Male Hospital Spontaneous Marc Darwin L. Ragojos
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004
Fernandez Delivery
5. 4921 Pregnancy Uterine Full Urdaneta District Normal
Term Gravida 1, Para 0 Orange 23 June 08, 2010 9:40 pm Female Hospital Spontaneous Marc Darwin L. Ragojos
Adviento Delivery
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MARC DARWIN L. RAGOJOS Concurred by: MARY ELEANOR B. MAYO Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: __________________________ Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MaED, MAN, Ed.D.
a). PRC No.: ______________________ a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ______________________ Valid Until: March 23, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2010___ Year of Admission in the Bachelor of Science in Nursing Program: ______
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985
IV. Assisted Deliveries
No. Case Diagnosis Name of Patient Age Date Of Time of Gender Of Name of Type Of Supervised By:
No. Delivery Delivery Baby Hospital Delivery Name & Signature of
Qualified CI
1. 5530 Pregnancy Uterine Edelma 42 June 29, 10:30 pm Male Urdaneta Normal
Full Term Gravida 3, Zarasate 2010 District Spontaneous Marc Darwin L.
Para 2 Hospital Delivery Ragojos
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004

2. 5386 Pregnancy Uterine Analisa de 25 June 23, 10:32 pm Male Urdaneta Normal
Full Term Gravida 3, Vera 2010 District Spontaneous Marc Darwin L.
Para 2 Hospital Delivery Ragojos
3. 5316 Pregnancy Uterine Maricel 24 June 21, 9:30 pm Female Urdaneta Normal
Full Term Gravida 3, Saculles 2010 District Spontaneous Marc Darwin L.
Para 2 Hospital Delivery Ragojos

4. 5164 Pregnancy Uterine Joanne dela 20 June 16, 7:21 pm Female Urdaneta Normal
Full Term Gravida 1, Cruz 2010 District Spontaneous Marc Darwin L.
Para 0 Hospital Delivery Ragojos
5. 4949 Pregnancy Uterine Cindy Joy 23 June 09, 6:49 pm Female Urdaneta Normal
Full Term Gravida 1, Macanyayon 2010 District Spontaneous Marc Darwin L.
Para 0 Hospital Delivery Ragojos
g
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MARC DARWIN L. RAGOJOS Concurred by: MARY ELEANOR B. MAYO Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: __________________________ Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MaED, MAN, Ed.D.
a). PRC No.: ______________________ a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ______________________ Valid Until: March 23, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011

Name & Address of College of Nursing: San Vicente West, Urdaneta City, Pangasinan
Name of Student: AQUI, FRED G. _______ Last Course (if any): Not Applicable_______________________________
Status of Accreditation (if any): Level I ______ Date Granted: 2010___ Year of Admission in the Bachelor of Science in Nursing Program: ______
Date Nursing Program/College of Nursing was Recognized: June 17, 1985 Year Graduated (BSN Program): _________________________________
Recognition Number: 054 Year: 1985

V. Cord Care
No. Case Diagnosis Name of Age Date Of Time of Gender Of Name of Hospital Type Of Supervised By:
No. Patient Delivery Delivery Baby Delivery Name & Signature
of Qualified CI
1. 5507 Pregnancy Uterine Jean Rillera 37 June 28, 6:45 pm Male Urdaneta District Normal
Full Term Gravida 2010 Hospital Spontaneous Marc Darwin L.
1, Para 0 Delivery Ragojos
 URDANETA CITY UNIVERSITY
(formerly City Colleges of Urdaneta)
Urdaneta City, Philippines-2428
Tel No. (075) 568-2475
Adopted from BON Resolution No. 357
Series of 2004

2. 5174 Pregnancy Uterine Perlita Mateo 35 June 16, 8:38 pm Male Urdaneta District Normal
Full Term Gravida 2010 Hospital Spontaneous Marc Darwin L.
1, Para 0 Delivery Ragojos

3. 5168 Pregnancy Uterine Jovelyn Baylon 27 June 16, 5:42 pm Female Urdaneta District Normal
Full Term Gravida 2010 Hospital Spontaneous Marc Darwin L.
3, Para 2 Delivery Ragojos

4. 5138 Pregnancy Uterine Sherryle Monje 33 June 15, 5:24 pm Female Urdaneta District Normal
Full Term Gravida 2010 Hospital Spontaneous Marc Darwin L.
2, Para 1 Delivery Ragojos
5. 4923 Pregnancy Uterine Jeanie May 19 June 08, 7:04 pm Female Urdaneta District Normal
Full Term Gravida Locquiao 2010 Hospital Spontaneous Marc Darwin L.
1, Para 0 Delivery Ragojos
Prepared by:
Name of Student: Fred G. Aqui_

Supervised by: MARC DARWIN L. RAGOJOS Concurred by: MARY ELEANOR B. MAYO Noted by: ANNALISA A. TELLES Approved by: ZOSIMA C. GARIN
Name of Clinical Instructor Chief Nurse Clinical Coordinator Dean
Date Signed: ______________________ Date Signed: _______________________ Date Signed: ________________ Date Signed: ________________
Degree: __________________________ Degree: ___________________________ Degree: BSN, RN, MAN Degree: RN, BSN, MaED, MAN, Ed.D.
a). PRC No.: ______________________ a). PRC No.: _______________________ a). PRC No.: 0201496 a). PRC No.: 0075349
Valid Until: _____________________ Valid Until: ______________________ Valid Until: March 23, 2013 Valid Until: December 18, 2013
b). PNA No.: ______________________ b). PNA No.: _______________________ b). PNA No.: ________________ b). PNA No.: 12163
Valid Until: _____________________ Valid Until: ______________________ Valid Until: _______________ Valid Until: Life Member
c). ANSAP No. _____________________ c). ADPCN No.: ______________
Valid until: ______________________ Valid Until: December 2011