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
V. CORD DRESSING
Name of Hospital / Lying In Clinic / Home Supervised by:
NO. Case No. Date Performed Name of Baby Gender of Baby Name of Mother
Age Delivery
Faculty with Master Degree / Clinical Instructor Midwife On Duty

1 007415 September 2, 2009 Baby Girl Mahipos Female Mercedita Mahipos Lanao Norte Provincial Hospital EVALYN M. LECCIONES, MN, RN
24 PRC No.: 0245303 PNA No.: 2011-067319
Valid Until: May 09, 2012 Valid Until: October 2011
Date Signed: __________

DARILYN G. LITERATUS, MN, RN

2 179555 February 7, 2010 Baby Girl Lamping Female Nor – Hakeeme Lamping 18 Mindanao Sanitarium and Hospital PRC No.:0301632 PNA No.: 16829
Valid Until: Novemver 25, 2012 Valid Until: Lifetime
Date Signed: __________

30 EVALYN M. LECCIONES, MN, RN Felisarida Cabang, RM

Barangay Pugaan Health Center and Lying PRC No.: 0245303 PNA No.: 2011-067319 PRC No.: 75494
3 100585 August 29, 2010 Baby Girl Bajarias Female Mercy Bajarias
Inn Valid Until: May 09, 2012 Valid Until: October 2011 Valid Until: May 16, 2012
Date Signed: __________ Date Signed:_________

DARILYN G. LITERATUS, MN, RN

PRC No.:0301632 PNA No.: 16829
4 018826 September 18, 2010 Baby Boy Caballero Male Riza Caballero 30 Lanao Norte Provincial Hospital
Valid Until: Novemver 25, 2012 Valid Until: Lifetime
Date Signed: __________

DARILYN G. LITERATUS, MN, RN

5 018978 September 25, 2010 Baby Boy Monteza Male Cleo Monteza 27 Lanao Norte Provincial Hospital PRC No.:0301632 PNA No.: 16829
Valid Until: Novemver 25, 2012 Valid Until: Lifetime
Date Signed: __________

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

______JAY G. DELA CRUZ______ LUCY MAY L. BUCAYAN, MN, RN TRANSFIGURACION C. LEE, MN, RN _NOEMI T. MORENTE, MAN, RN G’TER G. GAID, Ph.D, MAN, RN
Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name Signature Over Printed Name
Student Clinical Coordinator Chief Nurse (LNPH) Nursing Service Director (MSH) Dean

Date Signed: ____________ Date Signed: ____________ Date Signed: ____________ Date Signed: ____________ Date Signed: ____________
a.) PRC No.: 0193232 a.) PRC: 0059574 a.) PRC No.: 0161458 a.) PRC No.: 0302269
Valid Until: May 25, 2013 Valid Until: August 6, 2011 Valid Until: October 1, 2011 Valid Until: September 13, 2012
a.) PNA No.: 035664 b.) PNA: 13935 b.) PNA No: 15898 b.) PNA No: 16832
Valid Until: October 31, 2011 Valid Until: Lifetime Valid Until: Lifetime Valid Until: Lifetime
c.) ANSAP No: 0513 c.) ANSAP No: 090900 c.) ADPCN No.: 0768
Valid Until: Lifetime Valid Until: January 1, 2012 Valid Until: 2011