Mindanao Sanitarium & Hospital College

Brgy San Miguel, Iligan City 9200

Name of the Student: Jay G. Dela Cruz

Name & Address of School: Mindanao Sanitarium & Hospital College, Brgy. San Miguel, Iligan City 9200 School code: 1362
Accreditation Level: Level 1 Year Granted: February 28, 2008
Date School Program was Recognized: Oct. 17, 2002 Number: 0043 Year: 2002
First Course (If any): None School Graduated From: Not Applicable Year: Not Applicable_______________________________________
Year of Admission in the Bachelor of Science in Nursing Program: 2007
Year Graduated from the BSN Program: 2011
III. ACTUAL / HANDLED
Time of Gender of Type of Delivery Supervised by:
NO. Case No. Diagnosis Name of Patient Age Date of Delivery Name of Hospital
Delivery Baby
Pregnancy Uterine Alive Baby Girl Faculty with Master Degree / Clinical Instructor Midwife
Via Normal Spontaneous Vaginal
Normal Spontaneous
Delivery APGAR 8 and Birth Gregorio T.Lluch EVALYN M. LECCIONES, MN, RN
1 070755 Jessica Alcordo 35 April 22, 2010 3:08 pm Female Vaginal Delivery with
Weight 1.65 Kilograms, Memorial Hospital PRC No.: 0245303 PNA No.: On Process
Episiotomy
Preeclapmsia, Severe, Gravida 5, Valid Until: May 09, 2010 Valid Until: On Process
Para 5 Date Signed: __________
Pregnancy Uterine Full Term,
Spontaneous Delivery An Alive
Normal Spontaneous DARILYN G. LITERATUS, MN, RN
Baby Boy Via Normal Lanao Norte Provincial
2 004066 Angelita Pongase 21 August 1, 2010 2:00 am Male Vaginal Delivery with PRC No.:0301632 PNA No.: 16829
Spontaneous Vaginal Delivery Hospital
Episiotomy Valid Until: Novemver 25, 2011 Valid Until: Lifetime
Cephalic, Weight 2.5 Kilograms,
Date Signed: __________
Gravida 2, Para 2

Felisarida Cabang, RM
EVALYN M. LECCIONES, MN, RN
Barangay Pugaan PRC No.: 75494
Normal Spontaneous PRC No.: 0245303 PNA No.: On Process
3 004032 Pregnancy Uterine Full Term Emelita Paduala 33 August 3, 2010 6:22 am Female Health Center and Lying Valid Until: May 16, 2012
Vaginal Delivery Valid Until: May 09, 2010 Valid Until: On Process
Inn Date Signed:_________
Date Signed: __________

Pregnancy Uterine Full Term,

DARILYN G. LITERATUS, MN, RN
Normal Spontaneous Vaginal
Lanao Norte Provincial Normal Spontaneous PRC No.:0301632 PNA No.: 16829
4 018963 Delivery , Alive Baby Girl, Arlyn Bondaug 31 September 24, 2010 11:46 am Female
Hospital Vaginal Delivery Valid Until: Novemver 25, 2011 Valid Until: Lifetime
Cephalic Clear Bow, Weight 3
Date Signed: __________
Kilograms, Gravida 3, Para 3

Pregnancy Uterine Full Term,

Normal Spontaneous Vaginal DARILYN G. LITERATUS, MN, RN
Lanao Norte Provincial Normal Spontaneous
5 004144 Delivery , Alive Baby Girl, Liezel Cajeta 23 September 25, 2010 11:40 pm Female PRC No.:0301632 PNA No.: 16829
Hospital Vaginal Delivery
Cephalic, Weight 3 Kilograms, Valid Until: Novemver 25, 2011 Valid Until: Lifetime
Gravida 2, Para 2 Date Signed: __________

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

_____JAY G. DELA CRUZ ______ LUCY MAY L. BUCAYAN, MN, RN MYRNA P. SUAN, MN, RN TRANSFIGURACION C. LEE, MN, RN G’TER G. GAID, MAN, RN
Signature Over Printed Name of Signature Over Printed Name of Signature Over Printed Name of Signature Over Printed Name of Signature Over Printed Name of
Student Clinical Coordinator Chief Nurse (GTLMH) Chief Nurse (LNPH) Dean

Date Signed: ____________ Date Signed: ____________ Date Signed: __________ Date Signed: __________ Date Signed: ________
a.) PRC No.: 0193232 a.) PRC No.: 78434 a.) PRC No.:0059574 a.) PRC No.: 0302269
Valid Until: Valid Until: April 8, 2012 Valid Until: September 13, 2012 Valid Until: September 13, 2012
b.) PNA: 035664 b.) PNA No: 4249 b.) PNA No: 16832 b.) PNA No: 16832
Valid Until: October 31, 2011 Valid Until: Lifetime Valid Until: Lifetime Valid Until: Lifetime
c.) ANSAP No.: On Process c.) ANSAP No: 0513 c.) ADPCN No.: 0768
Valid Until: On Process_ Valid Until: Lifetime Valid Until: 2011