Chief Nurses Updated (2011)

QCGHNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until : Lifetime

c). ANSAP Until: 3271 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until: 2010

FABELLANoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP Until: 257 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until: 2010

QMMCNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime

c). ADPCN No.: 0815 Valid until: 2011

AFPNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0059003 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 1050016 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ADPCN No.: 0815 Valid until : July 28, 2011 Valid until: 2010

EAMC Noted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN NORA L. DIAZ RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: November 06, 2011 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14597 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime


CASAULNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0083576 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 19, 2010 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: b). PNA No.: 15980 Valid until: Lifetime Valid until : Valid until : Lifetime


LYING-INNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE RN, MPH NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0089902 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime


PNPNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until : December 31, 2010 Valid until : Lifetime

c). ANSAP No.: 090275 c). ADPCN No.: 0815 Valid until : December 31, 2010 Valid until: 2010

PCMCNoted by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN AMELINDA S. MAGNO RN, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No: _ 0156074___ a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: _ June 03, 2011 __ Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No. _ 15963 b). PNA No.: 15980 Valid until: Lifetime Valid until: __ Lifetime___ Valid until : Lifetime


FABELLA / PNPGH Noted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN PSUPT. NORMITA O. CO RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0039563 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: October 12, 2012 Valid until: August 11, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 18153 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid Until: December 31, 2010 Valid until: Lifetime

c). ANSAP No. : 257 c). ANSAP No. : 090275 c). ADPCN No.: 0815 Valid Until: Lifetime Valid Until: December 31, 2010 Valid until: 2010

FABELLA / AFPNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0039563 a). PRC No.: 0059003 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: October 12, 2012 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 18153 b). PNA No.: 010516 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime

c). ANSAP No. : 257 c). ANSAP No. : 000206 c). ADPCN No.: 0815 Valid Until: Lifetime Valid Until : July 28, 2011 Valid until: 2010

QCGH / FABELLANoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No. : 257 c). ADPCN No.: 0815 Valid Until : Lifetime Valid Until : Lifetime Valid until: 2010

QCGH / PNPGHNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN PSUPT. NORMITA O. CO RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: August 11, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: December 31, 2010 Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No. : 090275 c). ADPCN No.: 0815 Valid Until: Lifetime Valid Until: July 24, 2010 Valid until: 2010

QMMC/ FABELLANoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ANSAP No. : 257 c). ADPCN No.: 0815 Valid Until: Lifetime Valid until: 2010

LYING-IN / FABELLANoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE RN, MPH MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0089902 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ANSAP No. : 257 c). ADPCN No.: 0815 Valid until: Lifetime Valid until: 2010

LYING-IN / QCGHNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE RN, MPH MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0089902 a). PRC No.: 0118849 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: February 10, 2011 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 18459 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ANSAP No. : 3271 c). ADPCN No.: 0815 Valid until : Lifetime Valid until: 2010

AFP / PNPGHNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN COL EVELYN B BAUTISTA NC (GSC) PSUPT. NORMITA O. CO RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0059003 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: January 04, 2012 Valid until: August 11, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 10516 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: December 31, 2010 Valid until : Lifetime

c). ANSAP No. : 000206 c). ANSAP No. : 090275 c). ADPCN No.: 0815 Valid Until : July 28, 2011 Valid Until : July 24, 2010 Valid until: 2010

QCGH / AFPNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN COL EVELYN B BAUTISTA NC (GSC) MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0059003 a). PRC No.: 0118849 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: January 04, 2012 Valid until: February 10, 2011 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 10516 b). PNA No.: 18459 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No. : 000206 c). ANSAP No. : 3271 c). ADPCN No.: 0815 Valid Until : July 28, 2011 Valid Until : Lifetime Valid until: 2010

QCGH/ EAST AVE.Noted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN NORA L. DIAZ RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: November 06, 2011 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 14597 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime


QCGH/ NOVA DISTRICTNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN JOSEPHINE B. LEONARDO, RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 81174 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: April 03, 2011 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 15614 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until : Lifetime Valid until : Lifetime

c). ANSAP No. : 3271 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until: 2010

CASAUL / AFPNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0083576 a). PRC No.: 00590043 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 19, 2012 Valid until: January 04, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: b). PNA No.: 10516 b). PNA No.: 15980 Valid until: Lifetime Valid until : Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ADPCN No.: 0815 Valid until: Jully 28, 2011 Valid until: 2010

CASAUL/ EAST AVE Noted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN NORA L. DIAZ RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0083576 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 19, 2012 Valid until: November 06, 2011 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: b). PNA No.: 14597 b). PNA No.: 15980 Valid until: Lifetime Valid until : Valid until : Lifetime Valid until : Lifetime


QMMC / CASAULNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 19, 2012 Valid until: July 25, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: b). PNA No.: 11959 b). PNA No.: 15980 Valid until: Lifetime Valid until : Valid until : Lifetime Valid until : Lifetime

c). ADPCN No.: 0815

PNPGH / QMMCNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD PSUPT. NORMITA O. CO RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: August 11, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid Until: December 31, 2010 Valid until : Lifetime

c). ANSAP No.: 090275 c). ADPCN No.: 0815 Valid Until: December 31, 2010 Valid until: 2010

QMMC/ AFPNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 00590043 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: January 04, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: 10516 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ADPCN No.: 0815 Valid until: Jully 28, 2011 Valid until: 2010

CGH/ FABELLANoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0083576 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 19, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Valid Until: Lifetime Valid until : Lifetime


LYING-IN / QMMCNoted by : Concurred by : Concurred by : Approved by :

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE, RN, MPH LUZ P. PADUA, RN, MAN, PhD. NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 a). PRC No.: 0089902 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: July 25, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 11959 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ADPCN : 0815

LYING-IN / EAMCNoted by : Concurred by : Concurred by : Approved by :

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE, RN, MPH NORA L. DIAZ RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 a). PRC No.: 0089902 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: November 06, 2011 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 14597 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ADPCN : 0815 Valid Until: 2011-05-03

CASAUL / QCGHNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0083576 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: February 19, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until: Valid until: Lifetime


QMMC / QCGHNoted by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0118849 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: February 10, 2011 Valid until: July 25, 2012 Valid until: February 12, 201 b). PNA No.: 15981 b). PNA No.: 18459 b). PNA No.: 11959 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime Valid until: Lifetime


PNPGH / FABELLA / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791_________

Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____ February 12, 2012_

b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: ____ 15980___________

Valid until: Lifetime___ Valid until: Dec. 31, 2010 Valid Until: Lifetime Valid until : __ Lifetime_______ _ Valid until : Lifetime

c). ANSAP No. : 090275 c). ANSAP No: 257 c). ADPCN No.: ___0815 Valid until: Dec. 31, 2010 Valid until : Lifetime Valid until: 2010

Valid until: ____ 2010 ________

CASAUL / FABELLA / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN TERESITA A. ROBENIOL, RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing


Valid until: September 23, 2012 Valid until: February 19, 2012 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____ February 12, 2012_

b). PNA No.: 15981 b). PNA No.: b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: ____ 15980___________

Valid until: Lifetime___ Valid until : Valid Until: Lifetime Valid until : __ Lifetime_______ _ Valid until : Lifetime

c). ANSAP No: 257 c). ADPCN No.: ___0815 Valid until : Lifetime Valid until: 2010

Valid until: ____ 2010 ________

PNP / FABELLA / CASAULNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN TERESITA A. ROBENIOL RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing


Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: October 12, 2012 Valid until: February 19, 2012 Valid until: ____ February 12, 2012_

b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 18153 b). PNA No.: b). PNA No.: ____ 15980___________

Valid until: Lifetime___ Valid until : Dec. 31, 2010 Valid Until: Lifetime Valid until : Valid until : Lifetime c). ANSAP No. : 090275 c). ANSAP No: 257 c). ADPCN No.: ___0815

Valid until : Dec. 31, 2010 Valid until : Lifetime Valid until: 2010 Valid until: ____ 2010 ________

PNPGH / FABELLA / QCGHNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0039563 a). PRC No.: 0118849 a). PRC No.: 0210791___________ Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: October 12, 2012 Valid until: February 10, 2011 Valid until: ____February 12, 2012___ b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 18153 b). PNA No.: 18459 b). PNA No.: __ 15980____________ Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No. : 090275 c). ANSAP No: 257 c). ANSAP No. : 3271 c). ADPCN No.: __ 0815 Valid Until : December 31, 2010 Valid until : Lifetime Valid Until : Lifetime Valid until: ___ 2010__________ ____

PNPGH / FABELLA / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN MARIE THERESE A. PACABIS RN, RM, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____February 12, 2012___ b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: __ 15980____________ Valid until: Lifetime___ Valid until: December 31, 2010 Valid Until: Lifetime Valid until: __ Lifetime__________ Valid until: Lifetime

c). ANSAP No. : 090275 c). ANSAP No: 257 c). ADPCN No.: __ 0815 Valid Until: December 31, 2010 Valid until : Lifetime Valid until: ___ 2010_________ _ ___

PNPGH / CASAUL / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: September 23, 2012 Valid until: August 11, 2009 Valid until: February 19, 2012 Valid until: July 25, 2012 Valid until: ____February 12, 2012___ b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: b). PNA No.: 11959 b). PNA No.: __ 15980____________ Valid until: Lifetime___ Valid until: December 31, 2010 Valid Until: Valid until: __ Lifetime__________ Valid until: Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: __ 0815 Valid Until: December 31, 2010 Valid until: ___ 2010__________ ___

PNP / EAST AVE / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN NORA L. DIAZ RN, MAN LUZ P. PADUA RN, MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0045102 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: November 06, 2011 Valid until: July 25, 2012 Valid until: ____February 12, 2012___ b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 14597 b). PNA No.: 11959 b). PNA No.: __ 15980____________ Valid until: Lifetime___ Valid until: December 31, 2010 Valid Until: Lifetime Valid until: __ Lifetime__________ Valid until: Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: 0815 Valid Until: December 31, 2010 Valid until: ___ 2010_______ _ __ ___

PNPGH / EAST AVE/ CASAULNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN NORA L. DIAZ RN, MAN TERESITA A. ROBENIOL RN, MaEd, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0045102 a). PRC No.: 0083576 a). PRC No.: 0210791___________

Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: November 06, 2011 Valid until: February 19, 2012 Valid until: ____February 12, 2012__ _ b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 14597 b). PNA No.: b). PNA No.: __ 15980____________

Valid until: Lifetime___ Valid until: December 31, 2010 Valid Until: Lifetime Valid until: __ __________ Valid until: Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: 0815 Valid Until: December 31, 2010 Valid until: ___ 2010_______ _ __ ___

PNP/ LYING-IN/ QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN FE M. JUSTIMBASTE RN, MPH LUZ P. PADUA RN MAN, PhD NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0089902 a). PRC No.: 0187428 a). PRC No.: 0210791___________

Valid until: September 23, 2012 Valid until: August 11, 2009 Valid until: December 04, 2012 Valid until: July 25, 2012 Valid until: ____February 12, 2012___

b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 14184 b). PNA No.: 11959 b). PNA No.: __ 15980____________

Valid until: Lifetime___ Valid until: December 31, 2010 Valid until: Lifetime Valid until: __ Lifetime_________ Valid until: Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: __ 0815 Valid Until: December 31, 2010 Valid until: ___ 2010__________ ___

QMMC / CASAUL / QCGHNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA, RN, MAN, PhD. TERESITA A. ROBENIOL RN, MaEd, MAN MARILOU GUILLERMINA JUAN-PALAFOX RN, MAN NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: __ Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0083576 a). PRC No.: 0118849 a). PRC No.: 0210791 __ Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: February 19, 2012 Valid until: February 10, 2011 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: b). PNA No.: 18459 b). PNA No.: 15980 Valid Until: Lifetime Valid Until: Lifetime Valid until: Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 3271_______ _ c). ADPCN No.: 0815_____ _ _ Valid until: Lifetime Valid until: 2010

QMMC / CGH / AFPNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD TERESITA A. ROBENIOL RN, MaEd, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD, R.N., M.A.N. Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: __ Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0083576 a). PRC No.: 0059003 a). PRC No.: 0210791 __ Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: February 19, 2012 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: b). PNA No.: 10516 b). PNA No.: 15980 Valid Until: Lifetime Valid Until: Lifetime Valid until: Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 000206_______ _ c). ADPCN No.: 0815_____ _ _ Valid until: July 28, 2011 Valid until: 2010

PNP / CGH / AFPNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN TERESITA A. ROBENIOL RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0059003 a). PRC No.: 0210791 __ Valid until: September 23, 2012 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 42646 b). PNA No.: 10516 b). PNA No.: 15980 Valid Until: Lifetime Valid Until: December 31, 2010 Valid until: December 09, 2009 Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 015334 c). ANSAP No.: 000206_______ _ c). ADPCN No.: 0815_____ Valid until: December 31, 2010 Valid until: July 28, 2011 Valid until: 2010

QMMC / EAST AVE. / AFPNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN LUZ P. PADUA RN, MAN, PhD NORA L. DIAZ RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0059003 a). PRC No.: 0210791 __ Valid until: September 23, 2012 Valid until: July 25, 2012 Valid until: November 06, 2011 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: 10516 b). PNA No.: 15980 Valid Until: Lifetime Valid Until: Lifetime Valid until: Lifetime Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 000206_______ _ c). ADPCN No.: 0815_____ _ _ Valid until: July 28, 2011 Valid until: 2010

PNPGH/ EAST AVE. / AFPNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN PSUPT. NORMITA O. CO RN, MAN NORA L. DIAZ, RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: __ Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 ______ a). PRC No.: 0109984 a). PRC No.: 0045102 a). PRC No.: 0059003 a). PRC No.: 0210791 __ Valid until: September 23, 2012 Valid until: August 11, 2009 Valid until: November 06, 2011 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 002947 b). PNA No.: 14597 b). PNA No.: 10516 b). PNA No.: 15980 Valid Until: Lifetime Valid Until: December 31, 2010 Valid until: Lifetime Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 015334 c). ANSAP No.: 000206_______ _ c). ADPCN No.: 0815_____ Valid Until: December 31, 2010 Valid until: July 28, 2011 Valid until: 2010

LYING-IN / CASAUL / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN FE M. JUSTIMBASTE, RN, MPH TERESITA A. ROBENIOL RN, MaEd, MAN LUZ P. PADUA RN, MAN, PhD MARIE THERESE A. PACABIS RN, RM, MAN NORA VELMA M. GAYOD RN, MAN

Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 a). PRC No.: 0089902 a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791

Valid until: September 23, 2012 Valid until: December 04, 2012 Valid until: February 19, 2012 Valid until: July 25, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012

b). PNA No.: 15981 b). PNA No.: 14184 b). PNA No.: 42646 b). PNA No.: 11959 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 257 c). ANSAP No.: 0815 Valid until: Lifetime Valid until : 2010

AFP / PNP / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DANIEL H. GAYOD RN, MAN COL EVELYN B BAUTISTA NC (GSC) PSUPT NORMITA O CO , RN, MAN LUZ P. PADUA, R.N.,MAN., PhD MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0335718 a). PRC No.: 0059003 a). PRC No.: 0109984 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: September 23, 2012 Valid until: January 04, 2012 Valid until: August 11, 2012 Valid until: July 25, 2012 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15981 b). PNA No.: 10516 b). PNA No.: 002947 b). PNA No.: 11959 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Dec. 31, 2010 Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ANSAP No.: 090275 c). ANSAP No.: 257 c). ANSAP No.: 0815 Valid until : July 28, 2011 Valid until : Dec. 31, 2010 Valid until: Lifetime Valid until : 2010

AFP / QCGH / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N COL EVELYN B BAUTISTA NC (GSC) MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN LUZ P. PADUA, R.N.,MAN., PhD MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0059003 a). PRC No.: 0118849 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid until: February 10, 2011 Valid until: July 25, 2012 Valid until: ___ _ October 12, 2012 Valid until: _ _ February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 18459 b). PNA No.: 11959 b). PNA No.: _____ 18153____________ b). PNA No.: ____15980_ Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ANSAP No.: 3271 c). ANSAP No.: ___ 257 c). ANSAP No.: 0815 Valid until : July 28, 2011 Valid until : Lifetime Valid until: ____ Lifetime________ ____ Valid until : 2010

PNP/ CASAUL / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT NORMITA O CO RN MAN TERESITA A. ROBENIOL , RN, Maed, MAN LUZ P. PADUA, R.N.,MAN., PhD MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN

Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: August 11, 2010 Valid until: February 19, 2010 Valid until: July 25, 2012 Valid until: ___ _ October 12, 2012 Valid until: _ _ February 12, 2012 b). PNA No.: 15979 b). PNA No.: 002947 b). PNA No.: 42646 b). PNA No.: 11959 b). PNA No.: _____ 18153____________ b). PNA No.: ____15980_ Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 090275 c). ANSAP No.: ___ 257 c). ANSAP No.: 0815 Valid until : December 31, 2010 Valid until: ____ Lifetime________ ____ Valid until : 2010

AFP / CASAUL / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N COL EVELYN B BAUTISTA NC (GSC) TERESITA A. ROBENIOL , RN, Maed, MAN LUZ P. PADUA, R.N.,MAN., PhD MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0059003 a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid until: February 19, 2010 Valid until: July 25, 2012 Valid until: ___ _ October 12, 2009 Valid until: _ _ February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 42646 b). PNA No.: 11959 b). PNA No.: _____ 18153____________ b). PNA No.: ____15980_ Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ANSAP No.: ___ 257 c). ANSAP No.: 0799 Valid until : July 28, 2011 Valid until: ____ Lifetime________ ____ Valid until : 2009

AFP / QMMC / EAST AVE / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N COL EVELYN B BAUTISTA NC (GSC) LUZ P. PADUA , RN, MAN NORA L. DIAZ, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 a). PRC No.: 0059003 a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid until: July 25, 2012 Valid until: November 06, 2011 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 000206 c). ANSAP No.: 257 c). ANSAP No.: 0815 Valid until : July 28, 2011 Valid until: Lifetime Valid until : 2010

PNP / QMMC / EAST AVE / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT NORMITA O. CO R.N, MAN LUZ P. PADUA , RN, MAN NORA L. DIAZ, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 a). PRC No.: 0109984 a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: July 25, 2012 Valid until: November 06, 2011 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 002947 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : December 31, 2010 Valid Until: Lifetime Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 090275 c). ANSAP No.: 257 c). ANSAP No.: 0815 Valid until : December 31, 2010 Valid until: Lifetime Valid until : 2010

LYIING-IN/ QMMC / EAST AVE / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by: DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH LUZ P. PADUA, RN, MAN NORA L. DIAZ, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 a). PRC No.: 0089902 a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0039563 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: July 25, 2012 Valid until: November 06, 2011 Valid until: October 12, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: 18153 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 257 c). ANSAP No.: 0815 Valid until: Lifetime Valid until : 2010

PNP / QMMC / EAST AVE / AFPNoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT NORMITA O. CO R.N, MAN LUZ P. PADUA , RN, MAN NORA L. DIAZ, RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 a). PRC No.: 0109984 a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0059003 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: July 25, 2012 Valid until: November 06, 2011 Valid until: January 04, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 002947 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: 10516 b). PNA No.: 15980 Valid until: Lifetime Valid until : December 31, 2010 Valid Until: Lifetime Valid until : Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 090275 c). ANSAP No.: 002776 c). ANSAP No.: 0815 Valid until : December 31, 2010 Valid until: July 28, 2011 Valid until : 2010

AFP / CASAUL / QMMC / PNPGHNoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N COL EVELYN B BAUTISTA NC (GSC) TERESITA A. ROBENIOL , RN, Maed, MAN LUZ P. PADUA, R.N.,MAN., PhD PSUPT. NORMITA O. CO, R.N, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 a). PRC No.: 0059003 a). PRC No.: 0083576 a). PRC No.: 0187428 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid until: February 19, 2010 Valid until: July 25, 2012 Valid until: August 11, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 42646 b). PNA No.: 11959 b). PNA No.: 002947 b). PNA No.: 15980 Valid until: Lifetime Valid until : Lifetime Valid Until: December 09, 2009 Valid until : Lifetime Valid until : Dec. 31, 2010 Valid until : Lifetime

c). ANSAP No.: 000206 c). ANSAP No.: 090275 c). ANSAP No.: 0815

Valid until : July 28, 2011 Valid until: Dec. 31, 2010 Valid until : 2010

AFP / QMMC / PNPNoted by: Concurred by: Concurred by: Concurred by: Approved by : DALISAY L. PEÑAMANTE, R.N. M.A.N. COL EVELYN B BAUTISTA NC (GSC) LUZ P.PADUA,R.N,M.A.N,PhD PSUPT NORMITA O CO RN MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed : Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree : Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a ). PRC No.: 0059003 a). PRC No.: 0187428 a). PRC No.: 0109984 a). PRC No. : 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid Until: July 25, 2012 Valid until: August 11,2009 Valid Until : February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 11959 b). PNA No.: 002947 b). PNA No. : 15980 Valid until: LIFETIME Valid until: Lifetime Valid Until: Lifetime Valid until: December 31, 2010 Valid Until : Lifetime

c). ANSAP No; 000206 c.) ANSAP No: 090275 c). ADPCN No.: 0815 Valid Until: July 28, 2011 Valid Until: December 31, 2010 Valid Until : 2010

QCGH / QMMC / PNPGHNoted by: Concurred by: Concurred by: Concurred by: Approved by : DALISAY L. PEÑAMANTE, R.N. M.A.N. MARILOU GUILLERMINA JUAN-PALAFOX,RN,MAN LUZ P.PADUA,R.N,M.A.N,PhD PSUPT NORMITA O CO RN MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed : Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree : Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a ). PRC No.: 0118849 a). PRC No.: 0187428 a). PRC No.: 0109984 a). PRC No. : 0210791 Valid until: February 25, 2011 Valid until: Febuary 10, 2011 Valid Until: July 25, 2012 Valid until: August.11,2012 Valid Until : February 12, 2012 b). PNA No.: 15979 b). PNA No.: 18459 b). PNA No.: 11959 b). PNA No.: 002947 b). PNA No. : 15980 Valid until: LIFETIME Valid until: Lifetime Valid Until: Lifetime Valid until: December 31, 2010 Valid Until : Lifetime

c). ANSAP No; 3271 c.) ANSAP No: 090275 c). ADPCN No.: 0815 Valid Until: Lifetime Valid Until: December 31, 2010 Valid Until : 2010

AFP / QMMC / NOVA DISTRICTNoted by: Concurred by: Concurred by: Concurred by: Approved by : DALISAY L. PEÑAMANTE, R.N. M.A.N. COL EVELYN B BAUTISTA NC (GSC) LUZ P.PADUA,R.N,M.A.N,PhD JOSEPHINE B. LEONARDO, RN,MAN, Ph.D NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed : Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree : Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a ). PRC No.: 0059003 a). PRC No.: 0187428 a). PRC No.: 81174 a). PRC No. : 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid Until: July 25, 2012 Valid until: April 03, 2011 Valid Until : February 12, 2012 b). PNA No.: 15979 b). PNA No.: 10516 b). PNA No.: 11959 b). PNA No.: 15614 b). PNA No. : 15980 Valid until: LIFETIME Valid until: Lifetime Valid Until: Lifetime Valid until: Lifetime Valid Until : Lifetime

c). ANSAP No; 000206 c). ADPCN No.: 0815 Valid Until: July 28, 2011 Valid Until : 2010

LYING-IN / CASAULNoted by : Concurred by : Concurred by : Approved by :

DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH TERESITA A. ROBENIOL, R.N., MaEd, M.A.N. NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 a). PRC No.: 0089902 a). PRC No.: 0083576 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: February 19, 2010 Valid until: February 12, 2012

b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 42646 b). PNA No.: 15980

Valid until: Lifetime Valid until : Lifetime Valid Until: December 09, 2009 Valid until : Lifetime

c). ANSAP No.: 0815 Valid until : 2010

QMMC / LYING-IN / QCGHNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. LUZ P. PADUA, RN, MAN, PhD. FE M. JUSTIMBASTE, RN, MPH MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN NORA VELMA M. GAYOD, R.N., M.A.N. Signature over printed Name of Clinical Coordinator Signature over printed Name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Date Signed: __ Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0187428 a). PRC No.: 0089902 a). PRC No.: 0118849 a). PRC No.: 0210791 __ Valid until: February 25, 2011 Valid until: July 25, 2012 Valid until: December 04, 2012 Valid until: February 10, 2011 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 11959 b). PNA No.: 14184 b). PNA No.: 18459 b). PNA No.: 15980 Valid until: LIFETIME Valid Until: Lifetime Valid until: Lifetime Valid Until: Lifetime Valid Until: Lifetime

c). ANSAP No.: 3271_______ _ c). ADPCN No.: 0815_____ _ _ Valid until: Lifetime Valid until: 2010

LYING-IN / CASAUL / FABELLANoted by: Concurred by: Concurred by: Concurred by: Approve by : DALISAY L. PEÑAMANTE, RN, MAN FE M. JUSTIMBASTE, RN, MPH TERESITA A. ROBENIOL, RN, MaEd, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0089902 a). PRC No.: 0083576 a). PRC No.: 0039563 a). PRC No.: 0210791_____

Valid until: February 25, 2011 Valid until: December 04, 20012 Valid until: February 19, 2012 Valid until: October 12, 2012 Valid until: ____ February 12, 2012___

b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 42646 b). PNA No.: 18153 b). PNA No.: _____ 15980____________ Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No.: ___ 257 c). ADPCN No.: 0815 Valid until: ____ Lifetime___________ Valid until : 2010

LYING-IN / CASAUL / QCGHNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN FE M. JUSTIMBASTE, RN, MPH TERESITA A. ROBENIOL, RN, MaEd, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Asst. Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0089902 a). PRC No.: 0083576 a). PRC No.: 0118849 a). PRC No.: 0210791_ Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: February 19, 2012 Valid until: February 10, 2011 Valid until: ____ February 12, 2012 b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 42646 b). PNA No.: 18459 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime_________ _ Valid until : Lifetime

c). ANSAP No.: __ _ 3271 c). ADPCN No.: ___ 0815 Valid until: ____ Lifetime___________ _ Valid until: ____ 2010______________

QCGH / CASAUL / FABELLANoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN TERESITA A. ROBENIOL,RN, MaEd, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0083576 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: February 19, 2012 Valid until: ____ February 12, 2012___

b). PNA No.: 15979 b). PNA No.: 18459 b). PNA No.: 18153 b). PNA No.: 42646 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ December 09, 2009 Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until : Lifetime Valid until: ____ 2010______________

PNP / QCGH / CASAULNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN PSUPT. NORMITA O. CO, RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN TERESITA A. ROBENIOL,RN, MaEd, MAN NORA VELMA M. GAYOD,RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0109984 a). PRC No.: 0118849 a). PRC No.: 0083576 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: February 10, 2011 Valid until: February 19, 2012 Valid until: ____ February 12, 2012___


Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: Lifetime Valid until : __ December 09, 2009 _ Valid until : Lifetime

c). ANSAP No. : 090275 c). ANSAP No: 3271 c). ADPCN No.: ___ 0815 Valid until : December 31, 2010 Valid until : Lifetime Valid until: ____ 2010______________

QCGH / FABELLA / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN LUZ P. PADUA, RN, MAN, PhD NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: February 12, 2012

b). PNA No.: 15979 b). PNA No.: 18459 b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: 15980

Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No: 257 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until : Lifetime Valid until : 2010

QCGH / FABELLA / lying-inNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN FE M. JUSTIMBASTE, RN, MPH NORA VELMA M. GAYOD,R.N.,MAN

Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0089902 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: December 04, 2012 Valid until: February 12, 2012



c). ANSAP No. : 3271 c). ANSAP No: 257 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until : Lifetime Valid until : 2010

QCGH / AFP / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN COL EVELYN B BAUTISTA NC (GSC) LUZ P. PADUA, R.N.,MAN., PhD NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 a). PRC No.: 0118849 a). PRC No.: 0059003 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: January 04, 2012 Valid until: July 25, 2012 Valid until: February 12, 2012



c). ANSAP No. : 3271 c). ANSAP No: 000206 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until : July 28, 2011 Valid until : 2010

QCGH / EAST AVE. / AFPNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN COL EVELYN B BAUTISTA NC (GSC) NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 a). PRC No.: 0118849 a). PRC No.: 0059003 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: January 04, 2012 Valid until: November 06, 2011 Valid until: February 12, 2012



c). ANSAP No. : 3271 c). ANSAP No: 000206 c). ADPCN No.: 0815 Valid Until : Lifetime Valid until : July 28, 2011 Valid until : 2010

NOVA DISTRICT / QCGHNoted by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. JOSEPHINE B. LEONARDO, R.N., M.A.N., Ph.D MARILOU GUILLERMINA JUAN-PALAFOX, R.N., M.A.N NORA VELMA M. GAYOD, R.N., M.A.N. ___ Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 81174 a). PRC No.: 0118849 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: April 3, 2011 Valid Until: February 10, 2011 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 15614 b). PNA No.: 18459 b). PNA No.: 15980 Valid until: Lifetime Valid until: Lifetime Valid Until: Lifetime Valid until: Lifetime c) ANSAP No.: _____ _3271________ __ _ c). ADPCN No.: 0815_______ _ Valid until: _____ __Lifetime _____ _____ Valid until: 2010 ________

NOVA DISTRICT / FABELLANoted by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. JOSEPHINE B. LEONARDO, R.N., M.A.N., Ph.D MARIE THERESE A. PACABIS, RN.,M.A.N NORA VELMA M. GAYOD, R.N., M.A.N. Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 81174 a). PRC No.: 0039563 a). PRC No.: 0210791 ________ Valid until: February 25, 2011 Valid until: April 3, 2011 Valid Until: October 12, 2012 Valid until: February 12, 2012 _____ b). PNA No.: 15979 b). PNA No.: 15614 b). PNA No.: 18153 b). PNA No.: 15980__________ Valid until: Lifetime Valid until: Lifetime Valid Until: Lifetime Valid until: Lifetime __ c). ANSAP No.: 257 c). ADPCN No.: 0815________________ Valid Until : Lifetime Valid until: 2010

NOVA DISTRICT / QMMCNoted by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. JOSEPHINE B. LEONARDO, R.N., M.A.N., Ph.D LUZ P. PADUA, R.N.,MAN., PhD NORA VELMA M. GAYOD, R.N., M.A.N. ___ Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 81174 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: April 3, 2011 Valid Until: July 25, 2012 Valid until: February 12, 2012 b). PNA No.: 15979 b). PNA No.: 15614 b). PNA No.: 11959 b). PNA No.: 15980

Valid until: Lifetime Valid until: Lifetime Valid Until: Lifetime Valid until: Lifetime c). ADPCN No.: 0815_______ _ Valid until: 2010 ________

LYING-IN / NOVA DISTRICT / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH JOSEPHINE B. LEONARDO, RN, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0089902 a). PRC No.: 81174 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: April 3, 2011 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 15614 b). PNA No.: 14597 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ Lifetime______ ____ Valid until : Lifetime

c). ADPCN No.: ___ 0815 Valid until: ____ 2010_____________

LYING-IN / EAST AVE.Noted by : Concurred by : Concurred by : Approved by :

DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:


a). PRC No.: 0190486 a). PRC No.: 0089902 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: November 06, 2011 Valid until: February 12, 2012


Valid until: Lifetime Valid until : Lifetime Valid Until: Lifetime Valid until : Lifetime

c). ADPCN : 0815 Valid until : 2010

FABELLA / EAST AVE.

Noted by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARIE THERESE A. PACABIS, RN, RM, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:


a). PRC No.: 0190486 a). PRC No.: 0039563 a). PRC No.: 0045102 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: October 12, 2012 Valid until: November 06, 2011 Valid until: February 12, 2012



c). ANSAP No: 257 c). ADPCN No.: 0815 Valid until : Lifetime Valid until: 2010

QMMC / EAST AVE.Noted by : Concurred by : Concurred by : Approved by :

DALISAY L. PEÑAMANTE, RN, MAN NORA L. DIAZ, RN, MAN LUZ P. PADUA, RN, MAN, PhD. NORA VELMA M. GAYOD,RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:


a). PRC No.: 0190486 a). PRC No.: 0045102 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: November 06, 2011 Valid until: July 25, 2012 Valid until: February 12, 2012




FABELLA / PNPGH / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT. NORMITA O. CO, R.N, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0109984 a). PRC No.: 0039563 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: October 12, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___


Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime c). ANSAP No. : 090275 c). ANSAP No: 257 c). ADPCN No.: ___ 0815

Valid until : December 31, 2010 Valid until : Lifetime Valid until: ____ 2010______________

FABELLA / QCGH / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___


Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until : Lifetime Valid until: ____ 2010______________

QCGH / FABELLA / CASAULNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN TERESITA A. ROBENIOL, RN, MaEd, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0118849 a). PRC No.: 0039563 a). PRC No.: 0083576 a). PRC No.: 0210791_________ Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: October 12, 2012 Valid until: February 19, 2012 Valid until: ____ February 12, 2012 _ b). PNA No.: 15979 b). PNA No.: 18459 b). PNA No.: 18153 b). PNA No.: 42646 b). PNA No.: _____ 15980___________ Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ December 09, 2009 _ Valid until : Lifetime

c). ANSAP No. : 3271 c). ANSAP No: 257 c). ADPCN No.: ___ 0815

Valid until : Lifetime Valid until : Lifetime Valid until: ____ 2010____________

QCGH / LYING-IN / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN FE M. JUSTIMBASTE, RN, MPH NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0118849 a). PRC No.: 0089902 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 10, 2011 Valid until: December 04, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___



c). ANSAP No. : 3271 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010______________

LYING-IN /QMMC / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH LUZ P. PADUA, R.N.,MAN., PhD NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0089902 a). PRC No.: 0187428 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: July 25, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 11959 b). PNA No.: 14597 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ Lifetime______ ____ Valid until : Lifetime


LYING-IN / QMMC / FABELLANoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N FE M. JUSTIMBASTE, RN, MPH LUZ P. PADUA, R.N.,MAN., PhD MARIE THERESE A. PACABIS R.N., R.M., M.A.N NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0089902 a). PRC No.: 0187428 a). PRC No.: 0039563 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: December 04, 2012 Valid until: July 25, 2012 Valid until: October 12, 2012 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 14184 b). PNA No.: 11959 b). PNA No.: 18153 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: Lifetime Valid until : __ Lifetime______ ___ _ Valid until : Lifetime

c). ANSAP: 257 c). ADPCN No.: ___ 0815 Valid until: Lifetime Valid until: ____ 2010__ __________

FABELLA / AFP / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. ___ _ MARIE THERESE A. PACABIS R.N., R.M., M.A.N NORA L. DIAZ R.N., M.A.N.______ COL EVELYN B BAUTISTA NC (GSC) NORA VELMA M. GAYOD, R.N., M.AN._ _ Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed Name of Chief Nurse Signature over printed Name of Command Nurse Signature over printed Name of DeanDate Signed: ____ Date Signed:_____________________________ Date Signed: ________ Date Signed: ________ Date Signed: ____ ______ Degree: Bachelor of Science in Nursing ____ Degree: Bachelor Of Science In Nursing ____ Degree: Bachelor Of Science In Nursing Degree: Master of Arts In Nursing _ Degree: Bachelor Of Science In Nursing__ a). PRC No.: 0190486 ______ ____ a). PRC No: 0039563 ____ ____________ a).PRC No.: 0045102 a).PRC No.: 0059003 ________ a).PRC No.: 0210791_____ _____ Valid until: February 25, 2011 ____ Valid until: October 12, 2012____ Valid until: November 06, 2011 Valid until: January 4, 2012 Valid Until: February 12, 2012_ __ b). PNA No.: 15979 ____ b). PNA No.: 18153____ ____________ b).PNA No.: 14597 _______ __ b).PNA No.: 10516 _________ _ b).PNA No.: 15980 __________ Valid until: Lifetime _____________ Valid until: Lifetime_____ ___ Valid until: Lifetime ________ Valid until: Lifetime ____ _____ Valid Until: Lifetime ____ _____

c). ANSAP: 257_____ _ ___________ c).ANSAP No: 000206 _ c).ADPCN No.: 0815___ ____ ____ Valid until: Lifetime ___ Valid until: July 28, 2011 Valid until: 2010_____ _________

AFP / FABELLA / QMMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N COL EVELYN B BAUTISTA NC (GSC) MARIE THERESE A. PACABIS, RN, RM, MAN LUZ P. PADUA, R.N.,MAN., PhD NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Command Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 a). PRC No.: 0059003 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: January 04, 2012 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: February 12, 2012



c). ANSAP No. : 000206 c). ANSAP No: 257 c). ADPCN No.: 0815 Valid Until : July 28, 2011 Valid until : Lifetime Valid until : 2010

PNPGH / CASAUL / EAST AVE.Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT. NORMITA O. CO, R.N, MAN TERESITA A. ROBENIOL, , RN, MaEd, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 002947 b). PNA No.: 42646 b). PNA No.: 14597 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: ___ 0815 Valid until : December 31, 2010 Valid until: ____ 2010_____________

CASAUL / FABELLA / QMMC Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N TERESITA A. ROBENIOL, , RN, MaEd, MAN MARIE THERESE A. PACABIS, RN, RM, MAN LUZ P. PADUA, R.N.,MAN., PhD NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0083576 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 19, 2012 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____ February 12, 2012___

b). PNA No.: 15979 b). PNA No.: b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010______________

EAST AVE. / FABELLA / QMMC Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N NORA L. DIAZ, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN LUZ P. PADUA, R.N.,MAN., PhD NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0045102 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: November 06, 2011 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____ February 12, 2012___



c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010______________

PCMC / FABELLA / QMMC Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN AMELINDA S. MAGNO, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN LUZ P. PADUA, RN, MAN, PhD NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0156074 a). PRC No.: 0039563 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: October 12, 2012 Valid until: July 25, 2012 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 15963 b). PNA No.: 18153 b). PNA No.: 11959 b). PNA No.: _____ 15980____________


c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010____ _________

PCMC / PNPGH / QMMC Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN AMELINDA S. MAGNO, RN, MAN PSUPT. NORMITA O. CO, R.N, MAN LUZ P. PADUA, RN, MAN, PhD NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0156074 a). PRC No.: 0109984 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: August 11, 2012 Valid until: July 25, 2012 Valid until: ___ February 12, 2012___


Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 31, 2010 Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No: 090275 c). ADPCN No.: ___ 0815 Valid until : December 31, 2010 Valid until: ____ 2010____ _________

PCMC / QCGH / QMMC Noted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN AMELINDA S. MAGNO, RN, MAN MARILOU GUILLERMINA JUAN-PALAFOX, RN, MAN LUZ P. PADUA, RN, MAN, PhD NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Master of Arts in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0156074 a). PRC No.: 0118849 a). PRC No.: 0187428 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: February 10, 2011 Valid until: July 25, 2012 Valid until: ___ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 15963 b). PNA No.: 18459 b). PNA No.: 11959 b). PNA No.: _____ 15980____________


c). ANSAP No: 3271 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010____ _________

PNP / CASAUL / EAST AVENoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N PSUPT. NORMITA O. CO, R.N, MAN TERESITA A. ROBENIOL, , RN, MaEd, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 002947 b). PNA No.: 42646 b). PNA No.: 14597 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : December 31, 2010 Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No. : 090275 c). ADPCN No.: ___ 0815

Valid until : December 31, 2010 Valid until: ____ 2010_____________

QMMC/ CASAUL / EAST AVENoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N LUZ P. PADUA, RN, MAN, PhD TERESITA A. ROBENIOL, , RN, MaEd, MAN NORA L. DIAZ, RN, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: July 25, 2012 a). PRC No.: 0083576 a). PRC No.: 0045102 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: Nov. 06, 2011 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 11959 b). PNA No.: 42646 b). PNA No.: 14597 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime


QMMC/ CASAUL / LYING-INNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N LUZ P. PADUA, RN, MAN, PhD TERESITA A. ROBENIOL, , RN, MaEd, MAN FE M. JUSTIMBASTE, RN, MPH NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: July 25, 2012 a). PRC No.: 0083576 a). PRC No.: 0089902 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: December 04, 2012 Valid until: ____ February 12, 2012___ b). PNA No.: 15979 b). PNA No.: 11959 b). PNA No.: 42646 b). PNA No.: 14184 b). PNA No.: _____ 15980____________ Valid until: Lifetime___ Valid until : Lifetime Valid Until: December 09, 2009 Valid until : __ Lifetime__________ Valid until : Lifetime

c). ADPCN No.: ___ 0815 Valid until: ____ 2010________ _____

PCMC / FABELLANoted by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N. AMELINDA S. MAGNO, R.N, M.A.N MARIE THERESE A. PACABIS,R.N,R.M, M.A.N NORA VELMA M. GAYOD, R.N., M.AN.___ Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed Name of Chief Nurse Signature over printed Name of DeanDate Signed: Date Signed:_______________________ Date Signed: ___ __ Date Signed: ____ _____ Degree: Bachelor of Science in Nursing Degree:__ Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing ____ Degree: Bachelor of Science in Nursing __ a). PRC No.: 0190486 ______ a).PRC No: 0156074___ a). PRC No.: 0039563 _____ a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until::_ June 03, 2011___ Valid until: October 12, 2012 _____ Valid Until: February 12, 2012_______ b). PNA No.: 15979 b).PNA No._ 15963___ b). PNA No.: 18153 _____ b). PNA No.: 15980 Valid until: LIFETIME Valid until:_ Lifetime____ Valid until: Lifetime _____ Valid Until: LIFETIME

c) ANSAP No : 257 _______________ c). ADPCN No.: __________ _ Valid until: Lifetime _______ Valid until: ________

PCMC / QMMCNoted by : Concurred by : Concurred by : Approved by :

DALISAY L. PEÑAMANTE, R.N. M.A.N AMELINDA S. MAGNO, R.N, M.A.N LUZ P. PADUA, RN, MAN, PhD. NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:


a). PRC No.: 0190486 a). PRC No.: 0156074 a). PRC No.: 0187428 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: July 25, 2012 Valid until: February 12, 2012




PCMC / PNPNoted by : Concurred by : Concurred by : Approved by :

DALISAY L. PEÑAMANTE, RN, MAN AMELINDA S. MAGNO, RN, MAN PSUPT. NORMITA O. CO, RN, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean Date Signed: Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 a). PRC No.: 0156074 a). PRC No.: 0109984 a). PRC No.: 0210791 Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: August 11, 2012 Valid until: February 12, 2012


Valid until: Lifetime Valid until : Lifetime Valid Until: December 31, 2010 Valid until : Lifetime

c). ANSAP No: 090275 c). ADPCN : 0815 Valid until: December 31, 2010 Valid until : 2010

CASAUL / FABELLA / PCMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN TERESITA A. ROBENIOL, RN, MAN MARIE THERESE A. PACABIS, RN, RM, MAN AMELINDA S. MAGNO, RN, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing

a). PRC No.: 0190486 ______ a). PRC No.: 0083576 a). PRC No.: 0039563 a). PRC No.: 0156074 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 19, 2012 Valid until: October 12, 2012 Valid until: June 03, 2011 Valid until: ____ February 12, 2012_ __ b). PNA No.: 15979 b). PNA No.: 42646 b). PNA No.: 18153 b). PNA No.: 15963 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Dec. 09, 2009 Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime

c). ANSAP No: 257 c). ADPCN No.: ___ 0815 Valid until : Lifetime Valid until: ____ 2010 __________

CASAUL / EAST AVE. / PCMCNoted by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, RN, MAN TERESITA A. ROBENIOL, R.N, MAN NORA L. DIAZ, RN, MAN AMELINDA S. MAGNO, RN, MAN NORA VELMA M. GAYOD, RN, MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean


a). PRC No.: 0190486 ______ a). PRC No.: 0083576 a). PRC No.: 0045102 a). PRC No.: 0156074 a). PRC No.: 0210791___________ Valid until: February 25, 2011 Valid until: February 19, 2012 Valid until: Nov. 06, 2011 Valid until: June 03, 2011 Valid until: ____ February 12, 2012_ __ b). PNA No.: 15979 b). PNA No.: 42646 b). PNA No.: 14597 b). PNA No.: 15963 b). PNA No.: _____ 15980____________

Valid until: Lifetime___ Valid until : Dec. 09, 2009 Valid Until: Lifetime Valid until : __ Lifetime__________ Valid until : Lifetime

c). ADPCN No.: ___ 0815 Valid until: ____ 2010 __________

PCMC / PNP / CASAUL / FABELLANoted by: Concurred by: Concurred by: Concurred by: Concurred by: Approved by:

DALISAY L. PEÑAMANTE, R.N. M.A.N AMELINDA S. MAGNO, RN, MAN PSUPT NORMITA O CO , RN, MAN TERESITA A. ROBENIOL, RN, MaEd, MAN MARIE THERESE A. PACABIS, RN, RM, MAN NORA VELMA M. GAYOD,R.N.,MAN Signature over printed Name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean

Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Date Signed: Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: BSN, RN, MAN Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing a). PRC No.: 0190486 ______ a). PRC No.: 0156074 a). PRC No.: 0109984 a). PRC No.: 0083576 a). PRC No.: 0039563 a). PRC No.: 0210791

Valid until: February 25, 2011 Valid until: June 03, 2011 Valid until: August 11, 2012 Valid until: February 19, 2012 Valid until: ___ _ October 12, 2012 Valid until: _ _ February 12, 2012 b). PNA No.: 15979 b). PNA No.: 15963 b). PNA No.: 002947 b). PNA No.: 42646 b). PNA No.: _____ 18153____________ b). PNA No.: ____15980_ Valid until: Lifetime___ Valid until : Lifetime Valid Until: Dec. 31, 2010 Valid until : __ Lifetime__________ Valid until : Lifetime Valid until : Lifetime

c). ANSAP No.: 090275 c). ANSAP No.: ___ 257 c). ANSAP No.: 0815 Valid until : Dec. 31, 2010 Valid until: ____ Lifetime________ ____ Valid until : 2010

Documents

Chief Nurses Updated (2011)