St.

Scholastica’s College Tacloban

COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

CORD CARE in LEYTE PROVINCIAL HOSPITAL PALO LEYTE

Hospital, Municipality / City / Province
IMMEDIATE NEWBORN
Prepared by: CORD CARE FORM
Printed Name with Signature of Student: MUYALDE, PATRISHA ISABEL M.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required

MR. GERRYDEL A. CORRES, RN,MAN

PRC NO. :0372249VALID UNTIL: 10-03-20
PNA NO. :2018-007707VALID UNTIL:12-31-
18

MRS. JEAN A. PEÑARANDA, RN,MAN

PRC NO. :0143733 VALID UNTIL: 05-30-19
PNA NO. 2442 VALID UNTIL: LIFETIME

MRS. JEAN A. PEÑARANDA, RN,MAN

PRC NO. : 0143733 VALID UNTIL: 05-30-19
PNA NO. : 2442 VALID UNTIL: LIFETIME

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

ASSISSTED DELIVERY in LEYTE PROVINCIAL HOSPITAL PALO LEYTE

Hospital, Municipality / City / Province
ASSISSTED DELIVERY
Prepared by: FORM
Printed Name with Signature of Student: MUYALDE, PATRISHA ISABEL M.
Date Performed Patient’s Nurse On Duty SUPERVISED BY
and Time Started INITIALS PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required

MRS. JEAN A. PEÑARANDA, RN,MAN

PRC NO. :0143733 VALID UNTIL: 05-30-19
PNA NO. :2442 VALID UNTIL: LIFETIME

MRS. JEAN A. PEÑARANDA, RN,MAN

PRC NO. :0143733VALID UNTIL: 05-30-19
PNA NO. :2442 VALID UNTIL: LIFETIME

MRS. JEAN A. PEÑARANDA, RN,MAN

PRC NO. :0143733 VALID UNTIL: 05-30-19
PNA NO. :2442 VALID UNTIL: LIFETIME

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province
O.R FORM 1A MAJOR
Prepared by: SURGERY
Printed Name with Signature of Student: MUYALDE, PATRISHA ISABEL M.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Required
Number

September 09, 2018 J.B MRS. ZUSIE B. ABUDA, RN, MAN

11:50 am 262530 Caesarean Section, Primary Low Transverse Ms. Jean Salvacion, RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

J.E Removal of Implant Right Callide and Right Mr. Mel Benedict Abing, RN MRS. ZUSIE B. ABUDA, RN, MAN
10:20am 215458 Femur PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 12,2018 A.T MRS. ZUSIE B. ABUDA, RN, MAN

9:05 am 239953 Laparoscopic Cholecystectomy Ms. Liza Joy Abantao, RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province
O.R FORM 1A MAJOR
Prepared by: SURGERY
Printed Name with Signature of Student: MUYALDE, PATRISHA ISABEL M.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required
August 06, 2018
3:22pm Y.M. Vaginal hysterectomy with McCall Culdoplasty MR. REY IAN CASTANOS, MRS. ZUSIE B. ABUDA, RN, MAN
22839 Antero-posterior Repair RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 11,2018 D.F Emergency Tracheostomy Tube Insertion MS. CARMILINE PORTA, RN MRS. ZUSIE B. ABUDA, RN, MAN
10:12am 262654 PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 12,2018 Y.J Cystoscopy, Cystolithotomy, Tube Cyst ostomy MS. LIZA JOY ABANTAO, MRS. ZUSIE B. ABUDA, RN, MAN
7:15pm 262460 RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

CIRCULATING NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province
O.R FORM 1A MAJOR
Prepared by: SURGERY
Printed Name with Signature of Student: PEGON, MIKKI L.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Number Required
August 06, 2018
3:22pm Y.M. Vaginal hysterectomy with McCall Culdoplasty MS. KAREN MAE RAMBANO, MRS. ZUSIE B. ABUDA, RN, MAN
22839 Antero-posterior Repair RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 11,2018 D.F Emergency Tracheostomy Tube Insertion MR. MEL BENEDICT S. ABING, MRS. ZUSIE B. ABUDA, RN, MAN
10:12am 262654 RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 12,2018 Y.J Cystoscopy, Cystolithotomy, Tube Cyst ostomy MR. VALERIANO PRINCILLO MRS. ZUSIE B. ABUDA, RN, MAN
7:15pm 262460 III, RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019
 St. Scholastica’s College Tacloban
COLLEGE OF NURSING
Maharlika Highway, Brgy. Campetic, Palo, Leyte

SCRUB NURSE in DIVINE WORD HOSPITAL, TACLOBAN CITY

Hospital, Municipality / City / Province
O.R FORM 1A MAJOR
Prepared by: SURGERY
Printed Name with Signature of Student: PEGON, MIKKI L.
Date Performed and Patient’s Nurse On Duty SUPERVISED BY
Time Started INITIALS SURGICAL PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
If Midwife On Duty, Signature not (Name and Signature)
Case Required
Number

September 09, 2018 J.B Caesarean Section, Primary Low Transverse MS. JENNY G. DEGORIO, RN MRS. ZUSIE B. ABUDA, RN, MAN
11:50 am 262530 PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

J.E Removal of Implant Right Clavicle and Right MR. MICHELSON GERARD A. MRS. ZUSIE B. ABUDA, RN, MAN
10:20am 215458 Femur TIU, RN PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

September 12,2018 A.T Laparoscopic Cholecystectomy MRS. ZUSIE B. ABUDA, RN, MAN MRS. ZUSIE B. ABUDA, RN, MAN
9:05 am 239953 PRC No.: 0194172 Valid Until: 01-02-19
PNA No.: 2018-00772 Valid Until: 12-31-18

MRS. WILMA M. RUIZ, RN, MAN DR. CAROLINA D. BARROT, RN, MAN
Over-all Clinical Coordinator DEAN COLLEGE OF NURSING
PRC No.: 0252934 Valid Until: 08-28-19 PRC No.: 0133674 Valid Until: 09-21-20
PNA No.: 007717 Valid Until: 12-31-18 PNA No.: 007706 Valid Until: 12-31-18

I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct and
complete statement pursuant to the provisions, laws, rules and regulation of the Republic of the Philippines,
Subscribed and sworn to before this ______________________ day of ___________________________, 2018, Tacloban City, Philippines.
Doc. No.
Page No.
Book No.
Series of 2019