bacallan, karen gie s. - ched

8/7/2019 Bacallan, Karen Gie S. - CHED

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Name of School:Central Philippine University SPECIFIED FORMS & SCRUBS

Address: Jaro, Iloilo City As Per PRC Resolution No. 357 Series 2004

and PRC-BON Memorandum No. 01, S. 2008

Name of Student: Bacallan, Karen Gie Sumpio First Course (If any) : N/A Year: N/A

Date School/Program was Recognized: July 1, 1951 School Graduated From: N/A

Accreditation Level: II Year of Admission in the BSN Program: 2006

Year Graduated from the BSN Program: 2010

I. MAJOR CASE

No. Case No. Name of Patient Type of Anesthesia

1 10:55 A.M. 11:30 A.M. November 25, 2008 Pascua, Felix Subarachnoid Block

Prepared by: Supervised by: Noted by: Approved by: ConcurreC

KAREN GIE S. BACALLAN MR. AL Z. QUANICO PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. MAXIMA G. MARFIL

CTC Number : 27816636 Date Signed : Date Signed : Date Signed : Date Signed :

Date : June 23,2010 Degree : BSN Degree : MAN Degree : MAN Degree : BSN

Place : Lapaz Iloilo, City a) PRC No : 0339365 a) PRC No : 0036554 a) PRC No : 0120918 a) PRC No : 0088129

Valid Until : October 29, 2010 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : December 16, 2011

b) PNA No : 046692 b) PNA No : 026006 b) PNA No : 9317 b) PNA No : 5730

Valid Until : October 31, 2010 Valid Until : October 31, 2010 Valid Until : Lifetime Member Valid Until : Lifetime Member

ADPCN No. 0834

Valid Until: December 2010




Time

Started

Time

Ended

Date of

Operation

Operation

Performed

Name of

Surgeon

Name of

Hospital46Chart No.

2008-0099797

Incision and Drainage/ RayAmputation second, third,

fourth toes right foot

Dr. Earl G.Autajay Jr.

Angel SalazarMemorial

General Hospital

Signature over Printed Name ofStudent

Signature over Printed Name ofClinical Instructor

Signature over Printed Name ofClinical Coordinator

Signature over Printed Name of theDean

Signature over Printed Name of the ChiefNurse


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Accreditation Level: II Year of Admission in the BSN Program: 2006Year Graduated from the BSN Program: 2010

I. MAJOR CASE


2 11:00 A.M. 1:46 P.M. May 4, 2009 31 Napatal, Ariel

3 9:05 A.M. 10:45 A.M. May 5, 2009 45 Rojo, Mark Ken Open Cholecystectomy

4 7:45 A.M. 10:15 A.M. May 6, 2009 55 Emberso, Elena Subarachnoid Block

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

KAREN GIE S. BACALLAN MR. JEFFREY T. UMADHAY PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. FREIDA G. SORONGON


Date : June 23,2010 Degree : BSN Degree : MAN Degree : MAN Degree : MAN


Valid Until : January 30, 2011 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : August 16, 2011

b) PNA No : Resigned b) PNA No : 026006 b) PNA No : 9317 b) PNA No : 17428

Valid Until : Valid Until : October 31, 2010 Valid Until : Lifetime Member Valid Until : Lifetime Member

ADPCN No. 0834




TimeStarted

TimeEnded

Date ofOperation

OperationPerformed

Name ofSurgeon

Name ofHospital

Mastoidectomy withtympanoplasty, Left

General EndotrachealTube Anesthesia

Dr. CesarGardose

Western VisayasMedical Center

Subarachnoid Block-epidural

Dr. DelmarBrodeth


Total AbdominalHysterectomy Bilateral

Salpingo Oophorectomy;Adhesiolysis

Adhesiolysis; Ligation ofmesenteric bleeders,Jackson Pratt drain

Dr. Ruphil MaeAnimas-

Dueas andDr. delmar

Brodeth






Signature over Printed Name of the ChiefNurse


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Date School/Program was Recognized: July 1, 1951 School Graduated From: N/AAccreditation Level: II Year of Admission in the BSN Program: 2006


I. MAJOR CASE


5 10:30 A.M. 10:52 A.M. February 25, 2010 02-92-96 Arca, Gina Local Anesthesia


KAREN GIE S. BACALLAN PROF. JANETTE E. YAP PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL


Date : June 23,2010 Degree : MAN Degree : MAN Degree : MAN Degree : BSN


Valid Until : January 24, 2013 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : November 21, 2010



ADPCN No. 0834 c.) ANSAP N 00065

Valid Until: December 2010 Valid Until: December 2010

TimeStarted

TimeEnded

Date ofOperation

OperationPerformed

Name ofSurgeon

Name ofHospital

Bilateral Tubal Ligation( Pomeroy)

Dr. Mary AnnLedesma

Aleosan DistrictHospital

MS. ELIODORA A. BEASSignature over Printed Name of

StudentSignature over Printed Name of

Clinical InstructorSignature over Printed Name of

Clinical CoordinatorSignature over Printed Name of the

DeanSignature over Printed Name of the Chief

Nurse


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Name of School: Central Philippine University SPECIFIED FORMS & SCRUBS







II. MINOR CASE

No. Date of Operation Name of Patient Type of Anesthesia

1 9:40 A.M. 10:20 A.M. December 10, 2008 12 Consuelo, Aloro Local Anesthesia


KAREN GIE S. BACALLAN MR. AL Z. QUANICO PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. MAXIMA G. MARFIL




Valid Until : October 29, 2010 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : December 16, 2011


Valid Until : October 31, 2010 Valid Until : October 31, 2010 Valid Until : Lifetime Member Valid Until : Lifetime Member ADPCN No. 0834


TimeStarted

TimeEnded

CaseNo.

OperationPerformed

Name ofSurgeon

Name ofHospital

Excision of sebaceous cystat left elbow

Dr. GraceMajaducon-

Alvarez

Angel SalazarMemorialGeneralHospital





Signature over Printed Name of theChief Nurse


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II. MINOR CASE


2 2:30 P.M. 2:45 P.M. September 8, 2009 22132 Lavilla, Raffy Local Anesthesia


KAREN GIE S. BACALLAN MRS. NENIT S. SOLDEVILLA PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. CECILIA L. LOSARIA



Place : Lapaz Iloilo, City a) PRC No : 0114283 a) PRC No : 0036554 a) PRC No : 0120918 a) PRC No : 0049663Valid Until : March 5, 2013 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : November 22, 2012



ADPCN No. 0834 c. ANSAP No. 02935

TimeStarted

TimeEnded

CaseNo.

OperationPerformed

Name ofSurgeon

Name ofHospital

Suturing 0f wound andligation of bleeder left

thumb

Dr. AliciaCordero

Dr. Ricardo YLadrido

MemorialHospital







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Valid Until: December 2010 Valid Until: December 31, 2010








II. MINOR CASE


3 10:35 A.M. 10:57 A.M. March 12, 2010 01-76-05 Camarista, Mariano Local Anesthesia

4 11:07 A.M. 11:16 A.M. March 12, 2010 5-18--56 Alquisada, Vicente Jr. Local Anesthesia

Prepared by: Supervised by: Noted by: Approved by: Supervised by:

KAREN GIE S. BACALLAN PROF JANETTE E. YAP PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL


Date : June 23,2010 Degree : MAN Degree : MAN Degree : BSN, RN, MAN Degree : BSN


Valid Until : January 24, 2013 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : November 21, 2010b) PNA No : 026016 b) PNA No : 026006 b) PNA No : 9317 b) PNA No : 1872



Valid Until: December 2010 Valid Until: December 2010

TimeStarted

TimeEnded

CaseNo.

OperationPerformed

Name ofSurgeon

Name ofHospital

Excision of sebaceous cystat occipital area

Dr. PaulChristopher

Lim


Cauterization of warts atleft big toe

Dr. PaulChristopher

Lim


MS. ELIODORA A. BEAS







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II. MINOR CASE


5 1:50 P.M. 2:10 P.M. March 15, 2010 2010-1726 Gabinete, Vicente Local Anesthesia

Prepared by: Supervised by: Noted by: Approved by: Supervised by:

KAREN GIE S. BACALLAN MRS. ROSEMARIE D. CRISPE PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. LIBERTY T. TRABADO


Date : June 23,2010 Degree : BSN Degree : MAN Degree : BSN, RN, MAN Degree : BSN

Place : Lapaz Iloilo, City a) PRC No : 0067242 a) PRC No : 0036554 a) PRC No : 0120918 a) PRC No : 0149875Valid Until : August 24, 2011 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : September 4, 2011


Valid Until : Lifetime Member Valid Until : October 31, 2010 Valid Until : Lifetime Member Valid Until : Lifetime Member


TimeStarted

TimeEnded

CaseNo.

OperationPerformed

Name ofSurgeon

Name ofHospital

Suturing of laceratedwound at left elbow

Dr. SocratesCuarte

Ramon TabianaMemorial

District Hospital







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Valid Until: December 2010 Valid Until: December 31,


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III. ACTUAL DELIVERIES

No. Diagnosis Name of Mother Age Name of Hospital

1 21856 Pasan, Jona Mae 12:37 P.M. Male






Valid Until : March 5, 2013 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : November 22, 2012b) PNA No : 048612 b) PNA No : 026006 b) PNA No : 9317 b) PNA No : 16705




CaseNumber

Date ofDelivery

Time ofDelivery

Genderof Baby

Type ofDelivery

Pregnancy Uterine FullTerm delivered to a live

baby boy via NormalSpontaneous Vaginal

Delivery

23 yearsold

September 9,2009

Dr. Ricardo Y Ladrido MemorialHospital

NormalSpontaneous

Vaginal Delivery







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IV. DELIVERIES ASSISTED

No. Diagnosis Name of Mother Age Name of Hospital

1 Oliveros, Cora October 25,2009 9:30 P.M. Male

2 Sanicolas, Joan October 25, 2009 11:32 P.M. Female


KAREN GIE S. BACALLAN MRS. MARIA ROSITA N. SALDAJENO PROF. CECILIA B. ARCENAS PROF. FAITH LEILA A. QUEROL MRS. MAXIMA G. MARFIL



Place : Lapaz Iloilo, City a) PRC No : 0200979 a) PRC No : 0036554 a) PRC No : 0120918 a) PRC No : 0088129Valid Until : October 2, 2011 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : December 16, 2011



ADPCN No. 0834

CaseNumber

Date ofDelivery

Time ofDelivery

Genderof Baby

Type ofDelivery

186Chart Number:

2006-0060736

Pregnancy Uterine Full Termdelivery via Normal Spontaneous

Vaginal Delivery to a live baby boyin Cephalic presentation. Birth

Weight 2.8 kilograms, Gravida10

Para10(100010)

42 yearsold

Angel Salazar Memorial GeneralHospital

NormalSpontaneous

Vaginal Delivery

188Chart Number:

2008-0098021

Pregnancy Uterine Full Termdelivery via Normal Spontaneous

Vaginal Delivery to a live girl boy in

Cephalic presentation. Birth Weight2.5 kilograms, Gravida 3 Para1

(3001)

32 years

old

Angel Salazar Memorial General

Hospital

Normal

SpontaneousVaginal Delivery


Signature over Printed Name of ClinicalInstructor





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V. CORD DRESSING

No. Date Performed Time of Delivery Gender of Baby Name of Mother Age Name of Hospital

1 22279 September 14, 2009 12:58 P.M. Female Daniel, Sol Dr. Ricardo Y Ladrido Memorial Hospital

2 22474 September 23, 2009 5:16 P.M. Female Dellomes, Yvonne Dr. Ricardo Y Ladrido Memorial Hospital






Valid Until : March 5, 2013 Valid Until : July 7, 2011 Valid Until : May 20, 2012 Valid Until : November 22, 2012



c) ADPCN No. 0834 c) ANSAP No: 02935


CaseNumber

29 yearsold

27 yearsold






bacallan, karen gie s. - ched

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