SAINT MICHAEL’S COLLEGE OF LAGUNA

School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
IMMEDIATE NEWBORN CORD SANTA ROSA COMMUNITY HOSPITAL, STA ROSA CITY LAGUNA
CARE in
Hospital, Municipality/City/Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name D. R.

PROCEDURE SUPERVISED BY
Performed Nurse/ Midwife Clinical Instructor
and Case Number PERFORMED On Duty Name and Signature
Time Started
Baby boy Cinco Cord Care Matilde De Leon
January 16,2009 083837 Reynante Tenorio
3:00PM

January 18,2009 Baby girl Daluano Cord Care Matilde De Leon

4:05PM Reynante Tenorio

Noted Concurred
by: JULITA L. PAROCHA by: SHEILA C. CASIS
Clinical Coordinator, PRC Valid June 16, Chief Nurse, PRC ID Valid Until
ID No.
0122277
Until 2011 No. 0264470 January 29, 2013
Valid
PNA No. 003333 October 31, 2010 PNA No. 17498 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN

Approved MARIA REGINA M. MANABAT

 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
by:
Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. ________________0658_______ Valid until _______ December 23,2010_______ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_____________RN,MAN___________

SURGICAL SCRUB NEW SINAI MDI., STA. ROSA CITY,LAGUNA

in
Hospital, Municipality/ City/ Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name

Performed
PROCEDURE O. R. Nurse On SUPERVISED BY
and Case Number PERFORMED Duty Clinical Instructor
Minor Operation Name and Signature
Time Started
April 04,2009 Rollyn Dela Cruz Hemorrhoidectomy Norhilane Estrada
9:00AM 091301 Maria Victoria Marfil

Noted Concurred
by: JULITA L. PAROCHA by: DR. MANUEL ALMELOR
Clinical Coordinator, PRC Valid June 16, Chief Nurse, PRC ID Valid Until
ID No.
0122277
Until 2011 No. 0367408 November 11, 2013
Valid
PNA No. 003333 December 2009 PNA No. 009666 Valid Until November 31, 2010
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: MD,RN, MAN
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph

Approved by: MARIA REGINA M.C MANABAT

Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. __________________0658_______ _____ Valid until ______ December 23,2010_______ ________ Date Document is signed
______________________ Time _____
Highest Nursing Degree Earned________RN,MAN_____________________________

SURGICAL SCRUB SANTA ROSA COMMUNITY HOSPITAL, STA ROSA CITY, LAGUNA
in
Hospital, Municipality/ City/ Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name

Performed
PROCEDURE O. R. Nurse On SUPERVISED BY
and Case Number PERFORMED Duty Clinical Instructor
Major Operation Name and Signature
Time Started
January 09 2009 Prudencio Allegre Exploratory Laparotomy:appendectomy Almira Capuso
4:00PM 083827 Reynante Tenorio
January 10 2009 Irene Cerezo Cesarean Section with Bilateral Tubal Matilde de Leon
3:00PM 083975 Ligation Reynante Tenorio

Noted Concurred
by: JULITA L. PAROCHA by: SHEILA C. CASIS
Clinical Coordinator, PRC Valid June 16, Chief Nurse, PRC ID Valid Until
ID No.
0122277
Until 2011 No. 0264470 January 29, 2013
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
Valid
PNA No. 003333 October 31, 2010 PNA No. 17498 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN,MAN

Approved MARIA REGINA M.C MANABAT

by:
Dean, PRC ID 0133771
Valid Until September 7, PNA No. 033496 Valid Until
No. 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until _December 23, 2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned___RN,MAN__________________________________

SURGICAL SCRUB SANTA ROSA COMMUNITY HOSPITAL, STA ROSA CITY LAGUNA
in
Hospital, Municipality/ City/ Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name

Performed
PROCEDURE O. R. Nurse On SUPERVISED BY
and Case Number PERFORMED Duty Clinical Instructor
Minor Operation Name and Signature
Time Started
January 10, 2009 Anasias Beato Appendectomy Melanie Berroya
6:00PM 083743 Reynante Tenorio

Noted Concurred
by: JULITA L. PAROCHA by: SHIELA C. CASIS
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
Clinical Coordinator, PRC Valid June 16, Chief Nurse, PRC ID Valid Until
ID No.
0122277
Until 2011 No. 0264470 January 29, 2013
Valid
PNA No. 003333 October 31, 2010 PNA No. 17498 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN,MAN

Approved MARIA REGINA M.C MANABAT

by:
Dean, PRC ID 0133771
Valid Until September 7, PNA No. 033496 Valid Until
No. 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until _____ December 23,2010_______ _________ Date Document is signed ______________________ Time _____________
Highest Nursing Degree Earned_______RN,MAN______________________________

ACTUAL DELIVERY SANTA ROSA COMMUNITY HOSPITAL, STA ROSA LAGUNA

in
Hospital, Municipality/City/Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name D. R.

PROCEDURE SUPERVISED BY
Performed Nurse/ Midwife Clinical Instructor
and Case Number PERFORMED On Duty Name and Signature
Time Started
January 17,2009 Noemi Bangloy Normal Spontaneous Vaginal Delivery Matilde de Leon
3:30PM
083985 Reynante Tenorio
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph

Noted Concurred
by: JULITA L. PAROCHA by: SHIELA C. CASIS
Clinical Coordinator, PRC Valid Chief Nurse, PRC ID Valid Until
ID No. 0122277 Until June 16, 2011
No. 0264470 January 29, 2013
Valid
PNA No. 003333 December 2009 PNA No. 17498 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN,MAN

Approved MARIA REGINA MC MANABAT

by:
Dean, PRC ID 0133771
Valid Until September 7, PNA No. 033496 Valid Until
No. 2010 October 31, 2010
ADPCN No. ____________ 0658___________ Valid until ___December 23, 2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_______RN,MAN_____________________________

ASSISTED DELIVERY BIÑAN DOCTORS HOSPITAL INC., CITY OF BIÑAN LAGUNA

in
Hospital, Municipality/City/Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name D. R.

PROCEDURE SUPERVISED BY
Performed Nurse/ Midwife Clinical Instructor
and Case Number PERFORMED On Duty Name and Signature
Time Started
October 26,2009 Irelyn Ponal Normal spontaneous vaginal delivery Junica Hernandez
11:00AM 100116 Julita L. Parocha
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph

Jocelyn Vargas Normal spontaneous vaginal delivery Ria Caballes

October 27,2009 100146 Julita L. Parocha
10:00AM
February 08, 2010 Richelle Javilo Normal spontaneous vaginal delivery Monette Magallones
1:05PM 070368 Julita L. Parocha

Connie Acierto Normal spontaneous vaginal delivery Rose Anne Española

February10,2010 020195 Julita L. Parocha
2:00AM

Concurred
Noted by: JULITA L. PAROCHA ERLINDA BACAY-HAIN
by:
Assistant Hospital
Clinical Coordinator, PRC ID Valid June 16,
0122277 Director, Nursing 0065918 Valid Until March 29, 2011
No. Until 2011 Services PRC ID No.
Valid
PNA No. 003333 October 31, 2010 PNA No. 14626 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN, PhD

Approved by: MARIA REGINA M.C MANABAT

Dean, PRC ID 01337711 Valid Until September 7, 2010 PNA No. 033496 Valid Until October 31, 2010
No.
ADPCN No. ________0658_______________ Valid until __December 23,2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_____ RN,MAN _______

ACTUAL DELIVERY BIÑAN DOCTOR’S HOSPITAL.INC, CITY OF BIÑAN LAGUNA

in
Hospital, Municipality/City/Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Patient’ s Name SUPERVISED BY

Clinical Instructor
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
Date D. R.
Performed Case Number PROCEDURE Nurse/ Midwife Name and Signature
and PERFORMED On Duty
Time Started
October 26,,2009 Katherine Oztar Normal Spontaneous Vaginal Delivery Monette Magallones
7:15AM
090290 Julita L. Parocha
October 29,,2009 Jacquiline Maligo Normal Spontaneous Vaginal Delivery Mirasol Salinog
8:00AM
090343 Julita L. Parocha

Noted Concurred
by: JULITA L. PAROCHA by: ERLINDA BACAY-HAIN
Assistant Hospital
Clinical Coordinator, PRC Valid June 16,
Director, Nursing Valid Until
ID No.
0122277
Until 2011 0065918 March 29, 2011
Services PRC ID No.
Valid
PNA No. 003333 October 31, 2010 PNA No. 14626 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN, PhD

Approved MARIA REGINA M.C MANABAT

by:
Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until __December 23,2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_______RN,MAN______________________________

IMMEDIATE NEWBORN CORD BIÑAN DOCTOR’S HOSPITAL INC., CITY OF BIÑAN LAGUNA
CARE in
Hospital, Municipality/City/Province
Prepared by:
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name D. R.

PROCEDURE SUPERVISED BY
Performed Nurse/ Midwife Clinical Instructor
and Case Number PERFORMED On Duty Name and Signature
Time Started
October 29,2009 Baby girl Delgado Cord Care Rose Anne Española
7:05AM Julita L. Parocha
020195
February 9,2010 Baby Boy Dallo Cord Care Mirasol Salinog
1:00PM 100153 Julita L. Parocha
February 7,2010 Baby Girl fuabel Cord Care Mirasol Salinog
8:00AM 100095 Julita L. Parocha

Noted Concurred
by: JULITA L. PAROCHA by: ERLINDA BACAY-HAIN
Assistant Hospital
Clinical Coordinator, PRC Valid June 16,
Director, Nursing Valid Until
ID No.
0122277
Until 2011 0065918 March 29, 2011
Services PRC ID No.
Valid
PNA No. 003333 October 31, 2010 PNA No. 14626 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN, PhD

Approved MARIA REGINA M.C MANABAT

by:
Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until __December 23,2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_______RN,MAN______________________________
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
SURGICAL SCRUB BIÑAN DOCTOR’S HOSPITAL INC., CITY OF BIÑAN LAGUNA
in
Hospital, Municipality/ City/ Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name

Performed
PROCEDURE O. R. Nurse On SUPERVISED BY
and Case Number PERFORMED Duty Clinical Instructor
Major Operation Name and Signature
Time Started
October 27,2009 Maricel Cornero Cholecystectomy Rose Anne Española
7:43AM Julita L. Parocha
100552
October 29,2009 Francis Atienza Exploratory Laparotomy:Appendectomy Ria Caballes
11:57AM 100514 Julita L. Parocha

Noted Concurred
by: JULITA L. PAROCHA by: ERLINDA BACAY-HAIN
Assistant Hospital
Clinical Coordinator, PRC Valid June 16,
Director, Nursing Valid Until
ID No.
0122277
Until 2011 0065918 March 29, 2011
Services PRC ID No.
Valid
PNA No. 003333 October 31, 2010 PNA No. 14626 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN, PhD

Approved MARIA REGINA M.C MANABAT

by:
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph
Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until __December 23,2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_______RN,MAN______________________________

SURGICAL SCRUB BIÑAN DOCTOR’S HOSPITAL INC., CITY OF BIÑAN LAGUNA

in
Hospital,
Municipality/ City/ Province
Prepared by:
Name of BERIN, JAY- R PEÑA Signature of
Student Student

Date Patient’ s Name

Performed
PROCEDURE O. R. Nurse On SUPERVISED BY
and Case Number PERFORMED Duty Clinical Instructor
Minor Operation Name and Signature
Time Started
July 07,2008 Baylon Bagnes Myringotomy and ventilating tube Rose Anne Española
10:48AM Julita L. Parocha
070325 insertion
October 28,2009 Antonio Maguingay Inguinal Herniorrhaphy Ria Caballes
2:01PM
100532
Julita L. Parocha
February 08,2010 Allan Barrientos Closed Reduction Ria Caballes
10:20AM
020138
Julita L. Parocha

Noted Concurred
by: JULITA L. PAROCHA by: ERLINDA BACAY-HAIN
Assistant Hospital
Clinical Coordinator, PRC Valid June 16,
Director, Nursing Valid Until
ID No.
0122277
Until 2011 0065918 March 29, 2011
Services PRC ID No.
Valid
PNA No. 003333 October 31, 2010 PNA No. 14626 Valid Until LIFETIME MEMBERSHIP
Until
Date document is Date document is
Time Time
signed: signed:
Highest Nursing Degree Earned: RN,MAN Highest Nursing Degree Earned: RN, MAN, PhD
 SAINT MICHAEL’S COLLEGE OF LAGUNA
School of Nursing
Old National Road, City of Biñan, Laguna
(049) 511-9359 loc 312  Tele fax (02) 520-6749  www.smcl.edu.ph

Approved MARIA REGINA M.C MANABAT

by:
Dean, PRC ID 01337711 Valid Until PNA No. 033496 Valid Until
No. September 7, 2010 October 31, 2010
ADPCN No. ________0658_______________ Valid until __December 23,2010____________ Date Document is signed ______________________ Time _________________
Highest Nursing Degree Earned_______RN,MAN______________________________