UNIVERSITY OF PANGASINAN

COLLEGE OF NURSING
Dagupan City
University Seal

NAME OF STUDENT: SANDOVAL, Alfredo Jr. Basa First Course (if any):
Name and Address of School: University of Pangasinan School graduated from:
Arellano St., Dagupan City Year: ________________________________
Accreditation Level (if any): Level I (PACUCOA) Year Granted: March 05, 2007 Year of admission in the BSN Program: November 2005
Date School/Program was recognized: May 19, 1976 Number: 44 Year: 1976 Year graduated from BSN Program: 2010

V. CORD DRESSING
Case TIME of GENDER of NAME of Name and Signature of Qualified
No. DATE PERFORMED DELIVERY
NAME of BABY NAME of MOTHER AGE Clinical Instructor
No. BABY HOSPITAL

1 01837 September 13, 2009 1:13 PM Baby Mumar Female Princess Ann S. Mumar 26 MapCH
Miss Charmaine Grace M. Tidalgo, RN

2 01817 September 09, 2009 8:02 AM Baby Lagran Male Cherrylyn R.Lagran 29 MapCH
Miss Charmaine Grace M. Tidalgo, RN
LEGEND: MapCH = Mapandan Community Hospital (Primary)

Prepared by: Concurred by:

ALFREDO B. SANDOVAL JR. GRACE Z. JOVELLANOS
Student MapCH, Chief Nurse
Date Signed:
Degree: BSN-RN
a.) PRC No. 0064042 Valid Until: September 16, 2011
b.) PNA No. 029073 Valid Until: December 31, 2009
c.) ANSAP No. 09-0050 Valid Until: December 31, 2009

Supervised by: Noted by: Approved by:

CHARMAINE GRACE M. TIDALGO ZENAIDA M. BAUTISTA MELANIA C. CENON
Clinical Instructor Clinical Coordinator Dean

Date Signed: _____________________________________________________ Date Signed: _____________________________________________________ Date Signed:

Degree: BSN-RN Degree: BSN-RN, MAN Degree: ________BSN-RN, MAN, MAEd, PhD_________________________
a.) PRC No. 0351726 Valid Until: December 27, 2009 a.) PRC No. 0133422 _____ Valid Until: July 27, 2011 a.) PRC No. 100236 Valid Until: January 6, 2012
b.) PNA No. 029048 Valid Until: December 31, 2009 b.) PNA No. 029069 Valid Until: December 31, 2009 b.) PNA No. 17978 Valid Until: Lifetime Member
c.) ANSAP No. 09-0054 Valid Until: December 31, 2009 c.) ADPCN No. 0185 Valid Until: December 31, 2009