UNIVERSIDAD DE ZAMBOANGA

DEPARTMENT OF NURSING
ZAMBOANGA CITY

NAME OF STUDENT : AJIHIL, FATIMA SOFIA PEÑAFIEL

NAME AND ADDRESS OF SCHOOL : UNIVERSIDAD DE ZAMBOANGA, DON TORIBIO ST., TETUAN, ZAMBOANGA CITY
ACCREDITATION LEVEL (IF ANY): ______________________
DATE PROGRAM RECOGNIZED : FEBRUARY 05, 2007___ NUMBER : ______02_____ YEAR GRANTED : ___2007____
YEAR OF ADMISSION IN THE BSN PROGRAM : ____2006____
YEAR GRADUATED – BSN PROGRAM : ___2010____

III-MANAGED
NO. FAMILY NAME OF AGE DATE OF TIME OF GENDER DIAGNOSIS TYPE OF NAME OF NAME & Name & Signature
NO. MOTHER DELIVERY DELIVERY OF BABY DELIVERY INSTITUTION SIGNATURE OF of Qualified C.I.
NURSE/MIDWIFE
ON DUTY

Parturition Zcharina J. Tinaytina R.N,M.N

3 3622 Jania 19 February 1:00 am Male uterine full- Normal Sangali Health Dolorez D. Date Signed: ___________
Balahim years 23, 2010 term Spontaneous Center Marcelino, RM. PRC No.:0278596
old delivered Vaginal Valid Until:May 23, 2011
cephalic to Delivery PNA No:
an alive baby
Valid Until:
boy with an
APGAR Score
of 8

Prepared by: AJIHIL, FATIMA SOFIA PEÑAFIEL

NOTED BY: CONCURRED BY: APPROVED BY:

REYNITA BIONG-SAGUBAN, R.N., M.N. PILAR F. ALMARIO, R.N. VIVIAN C. LAPUT, R.N., M.N.
BSN Clinical Coordinator PHN III, Nurse Supervisor, City Health Office, Zamboanga City BSN Program Chair
Universidad de Zamboanga Date Signed: ____________________ Universidad de Zamboanga
Date Signed: ____________________ Degree: Bachelor of Science in Nursing Date Signed: ____________________
Degree: Bachelor of Science in Nursing Master of Nursing Professional Certificate Degree: Bachelor of Science in
Nursing
Master in Nursing a) PRC No.: 0067491 Master in Nursing
a) PRC No.:0311858 Valid Until: August 19, 2010 a) PRC No.:0205976
Valid Until: January 24, 2012 b) PNA No.: 17889 Valid Until: March 13, 2012
b) PNA No.:16767 Valid Until: Lifetime member b) PNA No.: 016768
Valid Until: December 31, 2009 Valid Until: December 31, 2009