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PRC FORMS ADZU
 

PRC FORMS ADZU

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    PRC FORMS ADZU PRC FORMS ADZU Presentation Transcript

    • Ateneo de Zamboanga University COLLEGE OF NURSING Zamboanga City Prepared by: FAMI, FIRST SECOND MIDDLE Name and Address of School: Ateneo de Zamboanga University, La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 Date When School Program was recognized: CHED Memorandum No.1 series of 2005 First Course: Not applicable School Graduated From: Ateneo de Zamboanga University Year of Admission in the Bachelor of Science in Nursing Program: June 2007 Year: Not Applicable Year Graduated (BSN Program): March 2011 ___________________________ NAME OF STUDENT MAJOR OPERATION Name and Name and No. Date of Case No. Name of Patient Diagnosis Operation Anesthesia Name of Name of Signature of Signature of Operation Performed Surgeon Hospital Scrub Nurse Qualified CI Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University ODC Form 1 COLLEGE OF NURSING O.R. SCRUB From La Purisima Street, Zamboanga City Major Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 CHED Memorandum No.1 series of 2005 Surgical Scrub in _______________________________________ Hospital, Municipality/City/Province Prepared by: Name of Student: _ _______________________________________________________ Signature of Student: ________________________________________________________________ Patient’s Name SUPERVISED BY: Date Performed and Time Started Case Number PROCEDURE PERFORMED O.R. NURSE ON DUTY CLINICAL INSTRUCTOR (NAME ONLY) NAME AND SIGNATURE Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University COLLEGE OF NURSING Zamboanga City Prepared by: FAMI, FIRST SECOND MIDDLE Name and Address of School: Ateneo de Zamboanga University, La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 Date When School Program was recognized: CHED Memorandum No.1 series of 2005 First Course: Not applicable School Graduated From: Ateneo de Zamboanga University Year of Admission in the Bachelor of Science in Nursing Program: June 2007 Year: Not Applicable Year Graduated (BSN Program): March 2011 ___________________________ NAME OF STUDENT MINOR OPERATION Name and Name and No. Date of Case No. Name of Patient Diagnosis Operation Anesthesia Name of Name of Signature of Signature of Operation Performed Surgeon Hospital Scrub Nurse Qualified CI Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University ODC Form 2 COLLEGE OF NURSING O.R. SCRUB From La Purisima Street, Zamboanga City Minor Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 CHED Memorandum No.1 series of 2005 Surgical Scrub in _______________________________________ Hospital, Municipality/City/Province Prepared by: Name of Student: _____________________________________________ _____________ Signature of Student: ________________________________________________________ Patient’s Name SUPERVISED BY: Date Performed and Time Started Case Number PROCEDURE PERFORMED O.R. NURSE ON DUTY CLINICAL INSTRUCTOR (NAME ONLY) NAME AND SIGNATURE Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University COLLEGE OF NURSING Zamboanga City Prepared by: FAMI, FIRST SECOND MIDDLE Name and Address of School: Ateneo de Zamboanga University, La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 Date When School Program was recognized: CHED Memorandum No.1 series of 2005 First Course: Not applicable School Graduated From: Ateneo de Zamboanga University Year of Admission in the Bachelor of Science in Nursing Program: June 2007 Year: Not Applicable Year Graduated (BSN Program): March 2011 ___________________________ NAME OF STUDENT ACTUAL DELIVERIES Name & Signature of No. Case No. Diagnosis Name of Patient Age Date of Delivery Time of Gender of Name of Hospital Type of Delivery Qualified C.I. Delivery the Baby Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University ODC Form 3 COLLEGE OF NURSING ACTUAL DELIVERY La Purisima Street, Zamboanga City FORM Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 CHED Memorandum No.1 series of 2005 Surgical Scrub in _______________________________________ Hospital, Municipality/City/Province Prepared by: Name of Student: _ ___________________ _______________________________ Signature of Student: ________________________________________________________________ Patient’s Name SUPERVISED BY: Date Performed and Time Started Case Number PROCEDURE PERFORMED O.R. NURSE ON DUTY CLINICAL INSTRUCTOR (not applicable for Birthing/lying- (NAME ONLY) NAME AND SIGNATURE in Clinics/Homes) Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University COLLEGE OF NURSING Zamboanga City Prepared by: FAMI, FIRST SECOND MIDDLE Name and Address of School: Ateneo de Zamboanga University, La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 Date When School Program was recognized: CHED Memorandum No.1 series of 2005 First Course: Not applicable School Graduated From: Ateneo de Zamboanga University Year of Admission in the Bachelor of Science in Nursing Program: June 2007 Year: Not Applicable Year Graduated (BSN Program): March 2011 ___________________________ NAME OF STUDENT DELIVERIES ASSISTED Name & Signature of No. Case No. Diagnosis Name of Patient Age Date of Delivery Time of Gender of Name of Hospital Type of Delivery Qualified C.I. Delivery the Baby Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PRC I.D. No. 0063627 Valid until: December 12, 2012 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University ODC Form 4 COLLEGE OF NURSING D.R. ASSIST FORM La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 CHED Memorandum No.1 series of 2005 Surgical Scrub in _______________________________________ Hospital, Municipality/City/Province Prepared by: Name of Student: _ _______________________ _______________________________ Signature of Student: ________________________________________________________________ Patient’s Name SUPERVISED BY: Date Performed and Time Started Case Number PROCEDURE PERFORMED O.R. NURSE ON DUTY CLINICAL INSTRUCTOR (not applicable for Birthing/lying- (NAME ONLY) NAME AND SIGNATURE in Clinics/Homes) Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University COLLEGE OF NURSING Zamboanga City Prepared by: FAMI, FIRST SECOND MIDDLE Name and Address of School: Ateneo de Zamboanga University, La Purisima Street, Zamboanga City Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 Date When School Program was recognized: CHED Memorandum No.1 series of 2005 First Course: Not applicable School Graduated From: Ateneo de Zamboanga University Year of Admission in the Bachelor of Science in Nursing Program: June 2007 Year: Not Applicable Year Graduated (BSN Program): March 2011 ___________________________ NAME OF STUDENT CORD DRESSING No. Case No. Date Performed Name of the Baby Gender of Name of the Mother Age of the Name of Hospital Name & Signature of the Baby Mother Qualified C.I. Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • Ateneo de Zamboanga University ODC Form 5 COLLEGE OF NURSING D.R. CORD CARE La Purisima Street, Zamboanga City FORM Recognition and Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013 CHED Memorandum No.1 series of 2005 Surgical Scrub in _______________________________________ Hospital, Municipality/City/Province Prepared by: Name of Student: _ _____________________________________________________ Signature of Student: ________________________________________________________________ Patient’s Name SUPERVISED BY: Date Performed and Time Started Case Number PROCEDURE PERFORMED O.R. NURSE ON DUTY CLINICAL INSTRUCTOR (not applicable for Birthing/lying- (NAME ONLY) NAME AND SIGNATURE in Clinics/Homes) Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, R.N., MEd., M.N. Clinical Coordinator, Ateneo de Zamboanga University, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date signed: Date signed: PRC I.D. No. 0062360 Valid Until : January 29, 2011 PNA No. 017407 Valid Until : November 12, 2010 PNA No. 2927 Valid until: Life Member ANSAP I.D. No. 006547 Valid Until: January 3, 2012 ANSAP No. 0381 Valid until: Life Member Approved by: Maria Lorna Bello-Paber, R.N., M.A.N. Dean, Ateneo de Zamboanga University, College of Nursing Highest Nursing Degree Earned Bachelor of Science in Nursing Master of Arts in Nursing Date signed: PRC No. 0059150 Valid Until : September 15, 2010 PNA No. 6141 Valid Until : Lifetime Member ADPCN No. 0655 Valid Until : December 31, 2010
    • PRC NUMBERS: For Zamboanga City Medical Center Noted by: Concurred by: Flor P. San Luis, RN, MN Evelyn Tindick-Monsanto, RN, Med, MN Clinical Coordinator, ADZU, College of Nursing Chief Nurse, Zamboanga City Medical Center Highest Nursing Degree Earned: Bachelor of Science in Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Master in Education Master in Nursing Date & time document is signed: ______________ Time: ___________ Date & time document is signed: ______________ Time: ______ PRC I.D. No: 0062360 Valid until: January 29, 2011 PRC I.D. No. 0063627 Valid Until: December 12, 2009 PNA No. 017407 Valid Until: December 31, 2010 PNA No. 2927 Valid Until: Life Member ANSAP No. 0381 Valid Until: Life Member Approved by: Maria Lorna Bello- Paber, RN, MAN Dean, ADZU College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ______________ Time: ___________ PRC No.: 0069150 Valid Until: September 15, 2010 PNA No. 6141 Valid Until: Lifetime Member ADPCN No. 0655 Valid Until: December 31, 2009 For Ciudad Medical Zamboanga Noted by: Concurred by: Ma. Lourdes Concepcion-Follero, RN, MN Celita P. Calma, RN, MAN Clinical Coordinator, ADZU, College of Nursing Chief Nurse, Ciudad Medical Zamboanga Highest Nursing Degree Earned: Bachelor of Science in Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Master of Arts in Nursing Date & time document is signed: ____________________ Time: _____ Date & time document is signed: ______________ Time: ______ PRC I.D. No: 0115066 Valid Until: December 06, 2011 PRC I.D. No. 069666 Valid Until: March 9, 2012 PNA No. 016740 Valid Until: December 31, 2009 PNA No. 18799 Valid Until: Lifetime Member ANSAP No. 01038 Valid Until: December 31, 2009 Approved by: Maria Lorna Bello- Paber, RN, MAN Dean, ADZU College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ______________ Time: ___________ PRC No.: 0069150 Valid Until: September 15, 2010 PNA No. 6141 Valid Until: Lifetime Member
    • ADPCN No. 0655 Valid Until: December 31, 2009 For Zamboanga Doctors Hospital Noted by: Concurred by: Ma. Lourdes Concepcion-Follero, RN, MN Maria Bella M. Tandoc, RN, MAN Clinical Coordinator, ADZU, College of Nursing Chief Nurse, Zamboanga Doctors Hospital Highest Nursing Degree Earned: Bachelor of Science in Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Master of Arts in Nursing Date & time document is signed: ____________________ Time: ___________ Date & time document is signed: ______________ Time: ______ PRC I.D. No. 0115066 Valid until December 06, 2011 PRC I.D. No. 0041245 Valid Until::February 04, 2010 PNA No. 016740 Valid Until: December 31, 2009 PNA No. 12434 Valid Until: Lifetime Member ANSAP No. Valid Until: December 31, 2009 Approved by: Maria Lorna Bello- Paber, RN, MAN Dean, ADZU College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ______________ Time: ___________ PRC No.: 0069150 Valid Until: September 15, 2010 PNA No. 6141 Valid Until: Lifetime Member ADPCN No. 0655 Valid Until: December 31, 2009 For Western Mindanao Medical Center Noted by: Concurred by: Ma. Lourdes Concepcion-Follero, RN, MN Ma. Dolores B. Pacatang, RN Clinical Coordinator, ADZU, College of Nursing Chief Nurse, Western Mindanao Medical Center Highest Nursing Degree Earned: Bachelor of Science in Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ____________________ Time: ___________ Date & time document is signed: ______________ Time: ______ PRC I.D. No. 0115066 Valid until: December 06, 2011 PRC I.D. No. 074214 Valid Until::February 2, 2011 PNA No. 016740 Valid Until: December 31, 2009 PNA No. 18033 Valid Until: Lifetime Member ANSAP No. 02629 Valid Until: December 31, 2009 Approved by: Maria Lorna Bello- Paber, RN, MAN Dean, ADZU College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ______________ Time: ___________ PRC No.: 0069150 Valid Until: September 15, 2010 PNA No. 6141 Valid Until: Lifetime Member ADPCN No. 0655 Valid Until: December 31, 2009
    • For Zamboanga Puericulture Lying-In Maternity Hospital Noted by: Concurred by: Ma. Lourdes Concepcion-Follero, RN, MN Ma. Theresa Geraldine Pioquinto, RN Clinical Coordinator, ADZU, College of Nursing Chief Nurse, ZPMH Highest Nursing Degree Earned: Bachelor of Science in Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & TIME document is signed: ____________________ Time: ___________ Date & TIME document is signed: ______________ Time: ______ PRC I.D. No. 0115066 Valid until December 06, 2011 PRC I.D. No. 0177945 Valid Until::October 11, 2011 PNA No. 016740 Valid Until: December 31, 2009 PNA No. 016531 Valid Until: December 31, 2009 Approved by: Maria Lorna Bello- Paber, RN, MAN Dean, ADZU College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & time document is signed: ______________ Time: ___________ PRC No.: 0069150 Valid Until: September 15, 2010 PNA No. 6141 Valid Until: Lifetime Member ADPCN No. 0655 Valid Until: December 31, 2009 For DOS Noted by: Ma. Lourdes Concepcion-Follero, RN, MN Clinical Coordinator, ADZU, College of Nursing Highest Nursing Degree Earned: Bachelor of Science in Nursing Master in Nursing Date & TIME document is signed: ____________________ Time: ___________ PRC I.D. No. 0115066 Valid until December 06, 2011 PNA No. 016740 Valid Until: December 31, 2009