COLEGIO DE DAGUPAN

Formerly COMPUTRONIX COLLEGE

COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

I. MAJOR OPERATIONS

Supervised by: Name and

DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Pregnancy Uterine
Low Transverse Pangasinan Provincial
1. 01-05-2010 215427 Mary Ann Broguero 42 4/7 weeks Age of
Cesarean section
spinal Dr. Emmeline Geminiano
Hospital
Jermaine Jayson Burca
gestation G2P1
Pregnancy Uterine Low Transverse
Pangasinan Provincial
2. 01-12-2010 216265 Juliet Segunda Grace 41 2/7 weeks Age of Cesarean section with spinal Dra. Pajarlo & Dra. Burca
Hospital
Jermaine Jayson Burca
gestation G6P5 bilateral tubal Ligation
Below knee amputation Pangasinan Provincial
3. 01-18-2010 415520 Danny Decano Estrada Diabetic left foot
left foot
spinal Dr. Fernandez
Hospital
Jermaine Jayson Burca
Pangasinan Provincial
4 01-13-2010 215947 Cezaria Vallo Cholecystolithiasis Cholecystectomy spinal Dra. Sy & Dra. Ritumalta
Hospital
Jermaine Jayson Burca
To considered
Jammele Pascua Explore Laparatomy ileo Dr. Terrado & Dra. Pangasinan Provincial
5. 01-13-2010 216290
Setbiaga
Intussusception ileo
ascending anastomosis
spinal
Retumalta Hospital
Jermaine Jayson Burca
acending
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a. PRC No.: Valid Until: a. PRC No.: Valid Until:
b. PNA No. : Valid Until: b. PNA No.: Valid Until: b. PNA No.: Valid Until:
c. ANSAP No.: Valid Until: c. ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

II. MINOR OPERATIONS

Supervised by: Name and

DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
1. 10-15-2009 24849 Richelle Sarte Martinez 4 cm lacerated wound suturing Local Dr. Rosario Region 1 Medical Center Marc Daryl S. Sarmiento
2. 10-18-2009 25713 Randall Joshua Solis 3 cm Lacerated wound Suturing Local Dr. Bautista Region 1 Medical Center Marc Daryl S. Sarmiento
Pneumohydrothoracyc Chest Thoracotomy tube
3. 10-19-2009 25714 Bonifacio Cayabyab
left insertion
Local Dr. Bautista Region 1 Medical Center Marc Daryl S. Sarmiento
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a. PRC No.: Valid Until: a. PRC No.: Valid Until:
b.PNA No. : Valid Until: b. PNA No.: Valid Until: b. PNA No.: Valid Until:
c.ANSAP No.: Valid Until: c. ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

III. MINOR OPERATIONS

Supervised by: Name and

DATE OF OPERATION TYPES OF
NO. CASE NO. NAME OF PATIENTS DIAGNOSIS NAME OF SURGEON NAME OF HOSPITALS Signature of Qualified Clinical
OPERATION PERFORMED ANESTHESIA
Instructors
Pregnancy Uterine
Pangasinan Provincial
1. 01-05-2010 215284 Theresa Letegio 41 2/7 weeks Age of Bilateral Tubal Ligation Local Dr. Garcia
Hospitals
Jermaine Jayson Burca
gestation G3P1
Indirect Inguinal Herniorraphy with Pangasinan Provincial
2. 01-25-2010 216402 Salvador Millo Lavarias
hernia right accidental appendectomy
Spinal Dr. Sy
Hospitals
Jermaine Jayson Burca
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a. PRC No.: Valid Until: a. PRC No.: Valid Until:
b. PNA No. : Valid Until: b. PNA No.: Valid Until: b. PNA No.: Valid Until:
c. ANSAP No.: Valid Until: c. ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

IV. DELIVERIES HANDLED

Supervised by: Name and

DATE OF TIME OF GENDER
NO. CASE NO. DIAGNOSIS NAME OF MOTHER AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
Normal Spontaneous
1. Pangasinan Provincial Hospital
Delivery
2.
3.
4
5.
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a. PRC No.: Valid Until: a. PRC No.: Valid Until:
b. PNA No. : Valid Until: b. PNA No.: Valid Until: b. PNA No.: Valid Until:
c.ANSAP No.: Valid Until: c.ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

V. DELIVERIES ASSISTED

Supervised by: Name and

DATE OF TIME OF GENDER
NO. CASE NO. DIAGNOSIS NAME OF MOTHER AGE NAME OF HOSPITALS TYPE OF Signature of Qualified
DELIVERY DELIVERY OF BABY
DELIVERY Clinical Instructors
Normal Spontaneous
1. Pangasinan Provincial Hospital
Delivery
2.
3.
4
5.
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a.PRC No.: Valid Until: a. PRC No.: Valid Until:
b. PNA No. : Valid Until: b.PNA No.: Valid Until: b. PNA No.: Valid Until:
c. ANSAP No.: Valid Until: c.ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE
 COLEGIO DE DAGUPAN
Formerly COMPUTRONIX COLLEGE
COLLEGE OF NURSING
Arellano St., 2400 Dagupan City, Pangasinan

NAME OF STUDENT: Mejia, Aijem Ryan V.

Name and Address of School: COLEGIO DE DAGUPAN, ARELLANO ST., CITY OF DAGUPAN, PHILIPPINES C-2400
Accredited Level (If any): Not Applicable Year Granted: Not Applicable
Date School/ Program was Recognized: May 19, 2006 Number: 004s. 2006
First Course (If any): None School Graduated from Year:
Year of Admission in Bachelor Science in Nursing Year Graduated in Bachelor Science Nursing Programs

VI. CORD DRESSING

CASE DATE OF GENDER OF Supervised by: Name and Signature of Qualified

NO. NAME OF BABY NAME OF MOTHER AGE NAME OF HOSPITALS
NO. PERFORMED BABY Clinical Instructors
1. 194307 07-13-2009 Baby Girl Alegree Lavarias Female Mary Ann Lavarias 28 Pangasinan Provincial Hospital April Sison
2. 197133 07-21-2009 Baby Girl Jimenez Female Myra Jimenez 28 Pangasinan Provincial Hospital April Sison
3. 196881 07-20-2009 Baby Girl Aloran Female Michelle C. Aloran 23 Pangasinan Provincial Hospital April Sison
4 07-22-2009 Baby Girl Garcia Female Lara Garcia 25 Pangasinan Provincial Hospital April Sison
5. 191433 07-28-2009 Baby Girl Gangoso Female Ellen Gangoso 28 Pangasinan Provincial Hospital April Sison
Concurred by: Approved By: Approved By:

_________________________________________ ____________________________________ __________________________________

Chief Nurse Dean Clinical Coordinator, Level IV
COLLEGE OF NURSING COLLEGE OF NURSING

Date Signed: Date Signed: Date Signed:

Degree: Degree: Degree:
a. PRC No.: Valid Until: a. PRC No.: Valid Until: a. PRC No.: Valid Until:
b.PNA No. : Valid Until: b. PNA No.: Valid Until: b. PNA No.: Valid Until:
c.ANSAP No.: Valid Until: c.ANSAP No.: Valid Until:

Prepared by:
_____________________
STUDENT’S SIGNATURE