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ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
SURGICAL SCRUB (Major) in ______JOSE R. REYES MEMORIAL MEDICAL CENTER, STA.CRUZ MANILA, METRO MANILA_____ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student _______CHARIZE C. SANTIAGO_______
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number
SURGICAL PROCEDUREPERFORMED
O.R. Nurse On Duty(Name and Signature)
SUPERVISED BYClinical instructor
Name and Signature
September 8, 20119:20 a.m
A.O.D665171
Herniotomy of Left testes Grace A. Adaiao, RN Julita M. Talinio, RN MAN
September 7, 20111:25 p.m
A.W.C652134
T12 L3 Laminectomy Patrick T. Santiago, RN Julita M. Talinio, RN MAN
September 7, 20119:15 a.m
V.P.V668170
Exlaparotomy subtotal colectomy Dennis C. Valmores, RN Julita M. Talinio, RN MAN
September 1, 20117:30 a.m
A.G.P645372
Total Abdominal Hysterectomy Bilateral Salphingo Oophorectomy
Cristy V. Donquines, RN Julita M. Talinio, RN MAN
August 31, 20118:10 a.m
R.G.E648226
Modified Radical Mastectomy Grace A. Adaiao, RN Julita M. Talinio, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
SURGICAL SCRUB (Minor) in _________RIZAL PROVINCIAL HOSPITAL, MORONG, RIZAL________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student ________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number
SURGICAL PROCEDUREPERFORMED
O.R. Nurse On Duty(Name and Signature)
SUPERVISED BYClinical instructor
Name and Signature
July 7, 20118:45 p.m
J.S.R456
Episiorraphy Aileen M. Villones, RM Rosemarie M. Sasaki, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MAN Clinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
SURGICAL SCRUB (Minor) in _________MISSION HOSPITAL, PASIG CITY, METRO MANILA_______ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student ________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number
SURGICAL PROCEDUREPERFORMED
O.R. Nurse On Duty(Name and Signature)
SUPERVISED BYClinical instructor
Name and Signature
July 29, 20116:30 p.m
V.C.S834624
Wound suturing of Left middle finger
Kristian Noel T. Reyes, RN Earl Don B. De Castro, MD RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
SURGICAL SCRUB (Minor) in _________JOSE R. REYES MEMORIAL MEDICAL CENTER, STA.CRUZ MANILA, METRO MANILA________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student ________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number
SURGICAL PROCEDUREPERFORMED
O.R. Nurse On Duty(Name and Signature)
SUPERVISED BYClinical instructor
Name and Signature
September 8, 201112:45 p.m
H.T.V660372
Debridement of Right Leg Lorraine Claire P. Danipog, RN Julita M. Talinio, RN MAN
August 31, 201112:30 p.m
F.R.B656228
Trans Urethral Resection of Prostate
Edgardo L. Dulatas, RN Julita M. Talinio, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
SURGICAL SCRUB (Minor) in _________QUIRINO MEMORIAL MEDICAL CENTER, ANONAS QUEZON CITY, METRO MANILA________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student ________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number
SURGICAL PROCEDUREPERFORMED
O.R. Nurse On Duty(Name and Signature)
SUPERVISED BYClinical instructor
Name and Signature
October 24, 201110:05 a.m
J.P.C76198
Wound Debridement of Left Leg Richard L. Leonor, RN Marpaul M. Marica, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
ACTUAL DELIVERY in__________MAUWAY LYING-IN CLINIC, MANDALUYONG CITY, METRO MANILA_________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student __________CHARIZE C. SANTIAGO__________
Date Performedand
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
PROCEDUREPERFORMED
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BYClinical instructor
Name and Signature
April 27, 201112:53 p.m
J.G.V Normal Spontaneous Delivery Liezl B. Saluna, RM Mariflor N. Gariguez, RN MAN
April 26, 20117: 26 a.m
S.C.S Normal Spontaneous Delivery Zenaida A. Ricafranca, RM Mariflor N. Gariguez, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
ACTUAL DELIVERY in__________RIZAL PROVINCIAL HOSPITAL, MORONG, RIZAL__________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student __________CHARIZE C. SANTIAGO__________
Date Performedand
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
PROCEDUREPERFORMED
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BYClinical instructor
Name and Signature
July 13, 20114: 10 p.m
R.D.V454
Normal Spontaneous Delivery Nelita Nilda A. Cenidoza, RM Rosemarie M. Sasaki, RN MAN
July 6,20117: 48 p.m
J.G.F212
Normal Spontaneous Delivery Rowena D. Eslava, RM Rosemarie M. Sasaki, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
ACTUAL DELIVERY in__________WELL-FAMILY CLINIC CATTLEYA, PEMBO, MAKATI CITY, METRO MANILA__________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by: Printed Name and Signature of Student __________CHARIZE C. SANTIAGO__________
Date Performedand
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
PROCEDUREPERFORMED
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BYClinical instructor
Name and Signature
August 11, 20113: 53 p.m
J.M.P Normal Spontaneous Delivery Caroliona E. Milan, RM April M. Moreno, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
ASSISTED DELIVERY in ___________RIZAL PROVICIAL HOSPITAL, MORONG, RIZAL_________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student _________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
PROCEDUREPERFORMED
ASSISTED DELIVERY
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BYClinical instructor
Name and Signature
July 7, 2011 3:50 p.m
S.D.S239
Normal Spontaneous Delivery Aileen M. Villones, RM Rosemarie M. Sasaki, RN MAN
July 6, 20119:10 p.m
S.J.Q208
Normal Spontaneous Delivery Rowena D. Eslava, RM Rosemarie M. Sasaki, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
ASSISTED DELIVERY in ___________TAGUIG PATEROS DISTRICT HOSPITAL, TAGUIG CITY, METRO MANILA ________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student _________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
PROCEDUREPERFORMED
ASSISTED DELIVERY
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BYClinical instructor
Name and Signature
October 27, 20118:02 p.m
A.H.D11-02966
Normal Spontaneous Delivery Marilyn T. Villadolid, RM Archimedes G. Balinas, RN RM MSN
October 26, 2011 2:52 p.m
C.G.B11-02956
Normal Spontaneous Delivery Vinamar Rafael M. Novejas, RM Archimedes G. Balinas, RN RM MSN
October 25, 20112:30 p.m
L.B.F11-02947
Normal Spontaneous Delivery Marilyn T. Villadolid, RM Archimedes G. Balinas, RN RM MSN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
IMMEDIATE NEWBORN CORD CARE in __________MAUWAY LYING-IN CLINIC, MANDALUYONG CITY, METRO MANILA_________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student _________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
Immediate Newborn Cord Care
PERFORMEDIndicate 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 instructorName and Signature
April 29, 20119:45 p.m
Baby Boy B. Delivery room Liezl B. Saluna, RM Mariflor N. Gariguez, RN MAN
April 25, 20116:15 p.m
Baby Boy C. Delivery room Zenaida A. Ricafranca, RM Mariflor N. Gariguez, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
ARELLANO UNIVERSITYCOLLEGE of NURSING
2600 Legarda St., Sampaloc, Manila7347371 LOC 222/210, 7353509 Fax, www.arellano.edu.ph
PACUCOA Level II Re-Accredited Status (February 2010 to February 2015)
IMMEDIATE NEWBORN CORD CARE in __________RIZAL PROVINCIAL HOSPITAL, MORONG, RIZAL_________ Hospital/Home/Lying-in Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student _________CHARIZE C. SANTIAGO_________
Date Performed and
Time Started
Patient’s INITIAL Only
Case Number(not applicable for Birthing/Lying-
in Clinic/Home)
Immediate Newborn Cord Care
PERFORMEDIndicate 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 instructorName and Signature
July 7, 20119:25 p.m
Baby Boy L.84
Delivery room Aileen M. Villones, RM Rosemarie M. Sasaki, RN MAN
July 7, 20118:05 p.m
Baby Girl S.74
Delivery room Aileen M. Villones, RM Rosemarie M. Sasaki, RN MAN
July 6, 20113:30 p.m
Baby Boy M.65
Delivery room Rowena D. Eslava, RM Rosemarie M. Sasaki, RN MAN
Noted by: EMILIE M. LOPEZ, RN MAN Approved by: NOLI V. PAGDANGANAN, RN MPA MANClinical Coordinator: PRC I.D. No. 0157036 Valid Until August 28, 2014 Dean: PRC I.D. No.025555 Valid Until October 16, 2013Date document is signed: ________________ Time: ______________ Date document is signed: ________________ Time: _____________Highest Nursing Degree Earned: BSN, MAN Highest Nursing Degree Earned: BSN, MPA, MAN
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