manila doctors college - prc form samples
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Sample PRC FormsTRANSCRIPT
Name of Student: VIDAL, CELESTE BALBINName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2006Year Graduated (BSN Program): 2010
I. Major Operations
NoDate of
OperationCase No.
Name of Patient
DiagnosisOperation Performed
Type of Anesthesia
Name of Surgeon
Name of Hospital
Name and Signature of O.R. Scrub Nurse
Supervised by Qualified Clinical Instructor
1 March 10, 2010
1234 C.B.V.Chronic Calculi
CholecystitisCholecystectomy General
Dr. Nicomedes Cruz
Manila Doctors Hospital
______________________Mark Vincent Macapagal,
RN
____________________________________Celeste B. Vidal, RN, MD, MAN
PRC No.: 0296107 PNA No.: 049809Valid Until: November 16, 2012 Valid Until: October 31, 2010
2
3
4
5
Noted by:
Evelyn J. Torio Clinical Coordinator
Manila Doctors CollegeDate Signed: __________ Degree: RN, MAN a. PRC No.: 0088770Valid Until: October 23, 2010b. PNA No.: 008328Valid Until: October 2010
Concurred by:
Celeste B. VidalChief Nurse
Manila Doctors HospitalDate Signed: ___________Degree: RN, MD, MAN a. PRC No.: 0296107Valid Until: November 16, 2012b. PNA No.: 049809Valid Until: October 31, 2010
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors College
Date Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009
Name of Student: VIDAL, CELESTE BALBINName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2006Year Graduated (BSN Program): 2010
II. Minor Operations
NoDate of
OperationCase No.
Name of Patient
Diagnosis Operation PerformedType of
AnesthesiaName of Surgeon Name of Hospital
Supervised by Qualified Clinical Instructor
1 March 10, 2010
1234 C.B.V. Diabetic Foot, LeftDebridement, Drainage
of AbscessSpinal
Dr. Jose Ronaldo Galang
Manila Doctors Hospital
____________________________________Celeste B. Vidal, RN, MD, MAN
PRC No.: 0296107 PNA No.: 049809Valid Until: November 16, 2012 Valid Until: October 31, 2010
2
3
4
5
Noted by:
Evelyn J. Torio Clinical Coordinator
Manila Doctors CollegeDate Signed: __________ Degree: RN, MAN a. PRC No.: 0088770Valid Until: October 23, 2010b. PNA No.: 008328Valid Until: October 2010
Concurred by:
Celeste B. VidalChief Nurse
Manila Doctors HospitalDate Signed: ___________Degree: RN, MD, MAN a. PRC No.: 0296107Valid Until: November 16, 2012b. PNA No.: 049809Valid Until: October 31, 2010
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors College
Date Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009
Name of Student: VIDAL, CELESTE BALBINName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2006
Year Graduated (BSN Program): 2010
III. Actual Deliveries
No Case No. DiagnosisName of Mother
Age Date of
DeliveryTime of Delivery
Gender of Baby
Name of Hospital Type of DeliverySupervised by Qualified
Clinical Instructor
1 1234
Pregnancy Uterine Full Term 39 5/7 Weeks.
Age of Gestation, Cephalic in Labor, Gravida 3 Parity 2
C.B.V. 28 March 10,
20101:00 am Boy
Manila Doctors Hospital
Normal Spontaneous
Delivery
____________________________________Celeste B. Vidal, RN, MD, MAN
PRC No.: 0296107 PNA No.: 049809Valid Until: November 16, 2012 Valid Until: October 31, 2010
2
3
4
5
Noted by:
Evelyn J. Torio Clinical Coordinator
Manila Doctors CollegeDate Signed: __________ Degree: RN, MAN a. PRC No.: 0088770Valid Until: October 23, 2010b. PNA No.: 008328Valid Until: October 2010
Concurred by:
Celeste B. VidalChief Nurse
Manila Doctors HospitalDate Signed: ___________Degree: RN, MD, MAN a. PRC No.: 0296107Valid Until: November 16, 2012b. PNA No.: 049809Valid Until: October 31, 2010
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors College
Date Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009
Name of Student: VIDAL, CELESTE BALBINName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2006
Year Graduated (BSN Program): 2010
IV. Assisted Deliveries
No Case No. DiagnosisName of Mother
Age Date of
DeliveryTime of Delivery
Gender of Baby
Name of Hospital Type of DeliverySupervised by Qualified
Clinical Instructor
1 1234
Pregnancy Uterine Full Term 39 5/7 Weeks.
Age of Gestation, Cephalic in Labor, Gravida 3 Parity 2
C.B.V. 28 March 10,
20101:00 am Boy
Manila Doctors Hospital
Normal Spontaneous
Delivery
____________________________________Celeste B. Vidal, RN, MD, MAN
PRC No.: 0296107 PNA No.: 049809Valid Until: November 16, 2012 Valid Until: October 31, 2010
2
3
4
5
Noted by:
Evelyn J. Torio Clinical Coordinator
Manila Doctors CollegeDate Signed: __________ Degree: RN, MAN a. PRC No.: 0088770Valid Until: October 23, 2010b. PNA No.: 008328Valid Until: October 2010
Concurred by:
Celeste B. VidalChief Nurse
Manila Doctors HospitalDate Signed: ___________Degree: RN, MD, MAN a. PRC No.: 0296107Valid Until: November 16, 2012b. PNA No.: 049809Valid Until: October 31, 2010
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors College
Date Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009
Name of Student: VIDAL, CELESTE BALBINName & Address of School: Manila Doctors College, President Diosdado Macapagal Boulevard, Metropolitan Park, Pasay CityAccreditation Level (if any): PAASCU Level II Re-accredited Status Year Granted: January 31, 2009 to November 2011Date School/Program was Recognized: July 6, 1981 Number: 098 Year: 1981First Course (if any): Not Applicable School Graduated From: Not ApplicableYear of Admission in the Bachelor of Science in Nursing Program: 2006Year Graduated (BSN Program): 2010
V. Cord Dressing
o Case No.Date
PerformedName of Baby
Gender of Baby
Name of Mother Age Name of HospitalSupervised by Qualified
Clinical Instructor
1 09-0849March 10,
2010Baby C.B.V. Girl C.B.V. 28 Manila Doctors Hospital
____________________________________Celeste B. Vidal, RN, MD, MAN
PRC No.: 0296107 PNA No.: 049809Valid Until: November 16, 2012 Valid Until: October 31, 2010 e
2
3
4
5
Noted by:
Evelyn J. Torio Clinical Coordinator
Manila Doctors CollegeDate Signed: __________ Degree: RN, MAN a. PRC No.: 0088770Valid Until: October 23, 2010b. PNA No.: 008328Valid Until: October 2010
Concurred by:
Celeste B. VidalChief Nurse
Manila Doctors HospitalDate Signed: ___________Degree: RN, MD, MAN a. PRC No.: 0296107Valid Until: November 16, 2012b. PNA No.: 049809Valid Until: October 31, 2010
Approved by:
Norma M. DumadagDean, College of NursingManila Doctors College
Date Signed: ___________Degree: RN, MN a. PRC No.: 0018659 Valid Until: December 29, 2011b. PNA No.: 5350Valid Until: Lifetimec. ADPCN: 0802Valid Until: October 2009