Hananeel PRC Form

OUR LADY OF FATIMA UNIVERSITY
#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City
Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

Name and Address of School: OUR LADY OF FATIMA UNIVERSITY, #1 ESPERANZA ST. HILLTOP MANSION HEIGHTS, LAGRO, QUEZON CITY__________________
Accreditation Level (if any): _PACUCOA Level II____________________ Year Granted: _April 10, 2002__________________________________________________________
Date School/Program was Recognized: April 25, 2001_____ Number: __033_______________________________Year: _2001______________________________________
First Course (if any) :__NOT APPLICABLE___ ___________________ School Graduated From: _NOT APPLICABLE__ Year: NOT APPLICABLE________________________
Year of Admission in the Bachelor of Science in Nursing Program: _2005__________________________________________________________________________________
Year Graduated (BSN Program): _2010_____________________________________________________________________________________________________________
II. Minor Operations

Signature of
No. Date of Operation Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital Name of Qualified CI
Qualified CI
Irene G. Carreon RN,MAN
Subarachnoid Dr. Maoche Nemis Nodado General
1. November 9, 2009 898849 Julian Castillo Mixed Hemorrhoids Hemorrhoidectomy PRC No: 88251
Block Dr. Mike Basa Hospital
PNA No: 013323
Bilateral Tubal Nodado General
2. November 9, 2009 933281 Remedios Ramos Multi Parati Local Anesthesia Dr. Serina Artienda PRC No: 88251
Ligation Hospital
PNA No: 013323
Ovarian New Growth Subarachnoid Dr. Lorelle Reyes Nodado General
3. November 9,2009 921618 Amelia Cardenas Endometrial Biopsy PRC No: 88251
Probably Malignant AUB Block Dr. Marilou Gallego Hospital
PNA No: 013323
Bulacan Maternity Marcellus C. Belisario RN,MAN
Colonoscopy with Intravenous Dr. Jonathan
4. December 3, 2008 142856 John Payumo Internal Hemorrhoids and Childrens PRC No: 0349993
Biopsy Sedation Sandehas
Hospital PNA No: 19636
Bulacan Maternity Marcellus C. Belisario RN,MAN
Sarmiento, Gravida 3 Para 2 Bilateral Tubal Dr. Jocelyn
5. December 3, 2008 135768 Spinal Anesthesia and Childrens PRC No: 0349993
Yolanda Multiparity Ligation Crisostomo
Hospital PNA No: 19636
Prepared by:
BILLONES, HANANEEL Q.__
Signature over printed Name of Student
Noted by: Concurred by: Concurred by: Approved by:
Mrs. MARISOL GARCIA-MANIPOL, LANIE AMNGALINDAN RN MINERVA ESPINO, RN NELIA R. CAPULONG RN,RM.MAN
RN,MAN Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean
Supervised by: Signature over printed name of Clinical Date Signed: __________________
Date Signed: ______________________ Date Signed: ______________________
MARCELLUS C. BELISARIO, RN,MAN Coordinator Degree:_BSN,________ ____________ Degree:_BSN,,RN,_____ ____________ Degree:_BSN,RN, RM, MAN______
Signature over printed name of Faculty
Date Signed: ______________________ a.) PRC NO: 0212126 _________ a.) PRC NO: 0090530 ___________ a.) PRC NO: 0041904__________
Date Signed: ____________________
Degree:__BSN, MAN________________ Valid Until: December 11, 2013____ Valid Until: October 10 2012________ Valid Until: July 31, 2012____
Degree: RN,MAN________ _
b.) PNA NO: _066851_____ _______ b.) PNA NO: _19638____ _______ b.) PNA NO: 18698______________
PRC No: 0349993___________ ___ a.) PRC NO: _0296870_____________
Valid Until: October 31, 2010_____ Valid Until: Lifetime_____________ Valid Until: Lifetime__________
Valid Until: September 12, 2012__ Valid Until: September 2012______
PNA No: 19636 ______________ b.) PNA NO: __013487 _____________ c.) ADPCN NO:_0627_____________
Valid Until:_Liifetime ____ Valid Until:_Lifetime ______ Valid Until: December 2010____

I. Major Operations
Date of Operation Type of Name of Signature of
No. Case No. Name of Patient Diagnosis Name of Hospital Name of Qualified CI
Operation Performed Anesthesia Surgeon Qualified CI
Pregnancy Uterine 37 weeks Dra. Ma. Bulacan Maternity Marcellus C. Belisario RN,MAN
Spinal
1. December 13, 132732 Basillo Ruth gestation Cephalic in Labor Caesarian Section Grace Agnes and Childrens PRC No: 0349993
Anesthesia
2007 Para6 Bautista Hospital PNA No: 19636
Pregnancy Uterine Full Term, Bulacan Maternity Marcellus C. Belisario RN,MAN
December 19, Spinal Dra. Pricilla
2. 088171 Ma. Thersa Castro cephalic in Labor Gravida3 Caesarian Section and Childrens PRC No: 0349993
2007 Anesthesia Quiambao
Para1 Hospital PNA No: 19636
Jonel Ramirez RN,MAN
January 7, Ruptured Appendix Exploratory Subarachnoid Dr. Aristotle Batangas Regional
3. 381315 Rodel Dayte PRC No;450849
2010 Laparotomy Anesthesia Arellano Hospital
PNA No: 2256
Combined Spinal Jonel Ramirez RN,MAN
January 8, Dr. Jose Batangas Regional
4. 373456 Jose Benemer Cholelithiasis Cholecystectomy and Epedural PRC No: 450849
2010 Tenorio Hospital
Anesthesia PNA No: 2256
Jonel Ramirez RN,MAN
January 9, Exploratory Laparotomy Closure of Subarachnoid Dr. Aristotle Batangas Regional
5. 364339 Edgardo Paner PRC No: 450848
2010 colostomy colostomy Anesthesia Arellano Hospital
PNA NO: 2256
Prepared by: Noted by: Concurred by: Concurred by: Approved by:
BILLONES, HANANEEL Q.___ Mrs. MARISOL GARCIA-MANIPOL, _MINERVA ESPINO, RN ____ AMOR CALAYAN RN,RM,MAN,PH.D. NELIA R. CAPULONG RN,RM.MAN
Signature over printed Name of Student RN,MAN Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse Signature over printed name of Dean
Signature over printed name of Clinical Date Signed: ______________________ Date Signed: _______________________ Date Signed: __________________
Supervised by: Coordinator Degree:_BSN,RN___________________ Degree:_BSN, RN_RM,MAN, PH.D._____
MARCELLUS C. BELISARIO, RN,MAN Degree:_BSN,RN, RM, MAN______
Date Signed: ______________________ a.) PRC NO:_0090530________________ a.) PRC NO: _151514 _____________ a.) PRC NO: 0041904__________
Signature over printed name of Faculty Valid Until: October 10, 2009________ Valid Until: _August 2010____________
Degree:__BSN, MAN________________ Valid Until: July 31, 2012____
Date Signed: ____________________ b.) ANSAP NO: _____________________ b.) PNA NO: _038801 ______________
Degree: RN,MAN________ _ b.) PRC NO: _0296870_____________ b.) PNA NO: 18698______________
Valid Until: ______________________ Valid Until: _December 2010_______ Valid Until: Lifetime__________
PRC No: 0349993___________ ___ Valid Until: September 2012______
c.) PNA NO: 19638 _______________ c.) ADPCN NO:_0627_____________
Valid Until: September 12, 2012__ b.) PNA NO: __013487 _____________
Valid Until: _Lifetime _______ Valid Until: December 2010____
PNA No: 19636 ______________ Valid Until:_Lifetime ______
Valid Until:_Liifetime ____

III. Actual Deliveries

Date of Time of Gender Signature of
No. Case No. Diagnosis Name of Mother Age Name of Hospital Type of Delivery Supervised by: Qualified C.I.
Delivery Delivery of Baby Qualified C.I.
Pregnancy Uterine Full Term Normal Rosanie C. Moro RN,PH.D
Novaliches District
1. 142607 Gravida 2, Para 0, 39 weeks Age Melissa Corpus 27 July 23, 2007 2:06 am Female Spontaneous PRC No: 66491
Hospital
of Gestation, Cephalic in Labor Delivery PNA NO: 25665
Pregnancy Uterine Full Term Normal Rosanie C. Moro RN,PH.D
Novaliches District
2. 161401 Gravida 2, Para 1 39 weeks Age Aquino Karen 26 June 3, 2008 12:10 am Female Spontaneous PRC No: 66491
Hospital
of Gestation, Cephalic in Labor Delivery PNA No: 25665
Norberta Alcarion
Pregnancy Uterine Full Term Ospital ng Lungsod ng Normal
Maria Edelyn January 29, RN,RM,MAN
3. 621134 Gravida 1, Para 0, 39 weeks Age 17 9:13 am Male San Jose Del Monte Spontaneous
Echal 2010 PRC No: 170101
of Gestation, Cephalic in Labor Bulacan Delivery PNA No: 7996
Norberta C. Alcarion
January 30, RN,RM,MAN
4. 398629 Gravida 1, Para 0, 38 weeks Age Maricel Fernando 25 8:36 pm Male San Jose Del Monte Spontaneous
2010 PRC No: 170101
Norberta C. Alcarion
January 30, RN,RM,MAN
5. 398586 Gravida 2, Para 1 38 weeks Age Orita Botolle 25 10:58pm Male San Jose Del Monte Spontaneous
2010 PRC No: 170101
Prepared by: Noted by: Concurred by:
BILLONES, HANANEEL Q.__ Concurred by: Approved by:
Mrs. MARISOL GARCIA-MANIPOL, ESTELITA B. LORENZO RN,RM,MAN NELIA R. CAPULONG RN,RM.MAN
Signature over printed Name of Student JOSEPHINE B. LEONARDO_RN,MAN,PH.D.
RN,MAN Signature over printed name of Chief Nurse Signature over printed name of Dean
Signature over printed name of Chief Nurse
Signature over printed name of Clinical Date Signed: _______________________
Supervised by: Date Signed: __________________
Coordinator Degree:_RN,RM,MAN __________
NORBERTA C. Date Signed: ___________________
Date Signed: ______________________ a.) PRC NO: _0111348________________ Degree: BSN,RN,MAN, PH.D_______ Degree:_BSN,RN, RM, MAN______
ALCARION,RN,RM,MAN
Degree:__BSN, MAN________________ Valid Until: September 3, 2011_______ a.) PRC NO: 0081174__________ a.) PRC NO: 0041904__________
Signature over printed name of Faculty
b.) PNA NO: 1078 _____________ Valid Until: July 31, 2012____
Date Signed: ___________________ c.) PRC NO: _0296870_____________ Valid Until:_ April 3, 2011_____
Valid Until: _December 2009_________ b.) PNA NO: 18698______________
Degree: _BSN,RN,RM, MAN_______ Valid Until: September 2012______ b.) PNA NO: _15614______________
Valid Until: Lifetime__________
PRC No: 170101 ________________ b.) PNA NO: __013487 _____________ Valid Until:_Lifetime___________
c.) ADPCN NO:_0627_____________
Valid Until; June 6, 2012__________ Valid Until:_Lifetime ______ Valid Until: December 2010____
PNA No: 7996 _________________
Valid Until: October 2010________

IV. Deliveries Assisted

Case Date of Time of Gender of Signature of
No. Diagnosis Name of Mother Age Name of Hospital Type of Delivery Supervised by: Qualified C.I.
No. Delivery Delivery Baby Qualified C.I.
Pregnancy Uterine Full Term Gravida Normal Jeneth Gutierez RN, MAN
Melany Lacuesta September
1. 0619 3, Para 2 38 weeks Age of Gestation, 28 12:06 am Female Sacred Angel Hospital Spontaneous PRC No: 327465
Baclao 29, 2009
Cephalic in Labor Delivery PNA No: 19031
September
2. 0620 1, Para 0 39 weeks Age of Gestation, Rona Palomeras 28 12:39 am Male Sacred Angel Hospital Spontaneous PRC No: 327465
29, 2009
Cynthia Anne October 2,
3. 0624 1, Para 0 40 weeks Age of Gestation, 22 7:32 am Female Sacred Angel Hospital Spontaneous PRC No: 327465
Cordino 2009
Pregnancy Uterine Full Term Gravida Normal Daisy Y. Yadan, RN, MAN
December
4. 1050801 1, Para 0 39 weeks Age of Gestation, Karen Sudlan Erica 27 3:07 pm Male Fatima Medical Center Spontaneous PRC No: 0317896
9, 2007
Pregnancy Uterine Full Term Gravida Normal Daisy Y. Yadan, RN, MAN
Elonnie O. December
5. 1089871 1, Para 0 39 weeks Age of Gestation, 23 12:12 am Male Fatima Medical Center Spontaneous PRC No: 0317896
Crisostomo 12, 2007
Prepared by: Approved by:

BILLONES, HANANEEL Q.___ Noted by: Concurred by: Concurred by: Concurred by: NELIA R. CAPULONG RN,RM.MAN
Signature over printed Name of Student Mrs. MARISOL GARCIA-MANIPOL, CECILE GUEVARRA RN, MAN________ MYLENE BERNADETTE O. SANTOS, RN, MAN, MD Signature over printed name of Dean
Signature over printed name of Chief Nurse Signature over printed name of Chief Nurse
Supervised by: RN,MAN Date Signed: __________________
Signature over printed Name of Student Signature over printed name of Clinical Date Signed: _______________________ Date Signed: ___________
DAISY Y. YADAN, RN MAN Degree:BSN,MAN,MD Degree:_BSN,RN, RM, MAN______
_______________________________ Coordinator Degree:_RN,RM,MAN __________
Signature over printed name of Faculty a.) PRC NO: 0192913 a.) PRC NO: 0041904__________
a.) PRC NO: _293775_________________
Date Signed: __________________ Date Signed: ______________________ Valid Until: February 28, 2013 Valid Until: July 31, 2012____
Valid Until: _March 13, 2013_________
Degree: _BSN,RN,RM, MAN______ Degree:__BSN, MAN________________ b.) PNA NO: 004987 b.) PNA NO: 18698______________
b.) PNA NO: 18471 _____________
PRC No: 0317896 _____________ d.) PRC NO: _0296870_____________ Valid Until: October 31, 2010 Valid Until: Lifetime__________
Valid Until: _December 2009_________
Valid Until; June 6, 2012_________ Valid Until: September 2012______ c.) ANSAP NO: 090890 c.) ADPCN NO:_0627_____________
PNA No: 012938_______________ b.) PNA NO: __013487 _____________ Valid Until: December 2011 Valid Until: December 2010____
Valid Until: October 2010________ Valid Until:_Lifetime ______

V. Cord Dressing
Date Gender of Supervised by: Signature of Signature of
No. Case No. Name of Baby Name of Mother Age Name of Hospital
Performed Baby Qualified C.I. Qualified C.I.
Rosanie C. Moro RN,PhD
1. 142608 July 24, 2007 Baby Girl Ritchelle Female Rirchelle Gelbolingo 28 Novaliches District Hospital PRC No: 66491
PNA NO: 25665
Rosanie C. Moro RN,PhD
2. 161279 June 2, 2008 Baby Boy Mauricio Male Mauricio Leanie 22 Novaliches District Hospital PRC No: 66491
PNA No: 25665
Norberta C. Alcarion RN,RM,MAN
January 5, Ospital ng Lungsod ng San
3. 398815 Baby Girl Joli Female Joli Gabalda San Juan 23 PRC No: 170101
2009 Jose Del Monte Bulacan
PNA No: 1077
4. 358616 Baby Boy Coredes Male Teresita Coredes 25 Jose Del Monte Bulacan
PRC No: 170101
2009 PNA No: 1077
5. 398603 Baby Boy Mangao Male Mery Joy Mangao 21 PRC No: 170101
2009 Jose Del Monte Bulacan
PNA No: 1077 Approved by:
NELIA R. CAPULONG RN,RM.MAN
Prepared by: Noted by: Concurred by: Signature over printed name of Dean
Concurred by:
BILLONES, HANANEEL Q.___ Mrs. MARISOL GARCIA-MANIPOL, JOSEPHINE B. LEONARDO RN,MN,PH.D.
Date Signed: __________________
ESTELITA B. LORENZO_RN,RM,MAN__
Signature over printed Name of Student RN,MAN Signature over printed name of Chief Nurse
Signature over printed name of Chief Nurse Degree:_BSN,RN, RM, MAN______
Supervised by: Signature over printed name of Clinical Date Signed: ________________________
NORBERTA C. ALCARION, RN,M,MAN Coordinator Date Signed: ____________________ a.) PRC NO: 0041904__________
Degree: RN,MAN,PH.D_______________
Signature over printed name of Faculty Valid Until: July 31, 2012____
Date Signed: ______________________ Degree:_BSN,RM, RN, MAN _______ a.) PRC NO: __0081174______________
Date Signed: ____________________ b.) PNA NO: 18698______________
Degree:__BSN, MAN________________ a.) PRC NO: ___0111348__________ Valid Until: _April 3, 2011 ______
Degree: BSN,RM,RN,MAN__________ Valid Until: Lifetime__________
Valid Until: _September 3, 2011__ b.) PNA NO: ___15614 _____________
PRC No: 170101___________ e.) PRC NO: _0296870_____________ c.) ADPCN NO:_0627_____________
Valid Until:___Lifetime ___________
Valid Until; June 6, 2012_____ Valid Until: September 2012______ b.) PNA NO: __1078_____________ Valid Until: December 2010____
PNA No: 1077_____________ b.) PNA NO: __013487 _____________ Valid Until: __December 2009_____
Valid Until: December 2009 Valid Until:_Lifetime ______

Hananeel PRC Form

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OUR LADY OF FATIMA UNIVERSITY

#1 Esperanza St. Hilltop Mansion Heights, Lagro, Quezon City

Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

II. Minor Operations

Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

III. Actual Deliveries

Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

IV. Deliveries Assisted

Prepared by: Approved by:

Name of Student: BILLONES, HANANEEL Q.____________________________________________________________________________________________________

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