Page 1 of 13

CEBU CITY MEDICAL CENTER – COLLEGE OF NURSING

in consortium with
CEBU T E C H N O L O G I C A L U N I V E R S I T Y
(formerly CEBU STATE COLLEGE OF SCIENCE AND TECHNOLOGY)

Name of Student : JORGE NACORDA VALLESER

Name and Address of School : Cebu City Medical Center – College of Nursing in consortium with
Cebu Technological University
N. Bacalso Avenue corner Panganiban Street, Cebu City
Accreditation Level (if any) : none Year Granted :
Date School/Program was recognized : June 04 Number : Cebu City Charter Ordinance 679 Year: 1970
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 (BSN Program) : 2011

I. MAJOR OPERATIONS
Signature of
Date of Case Name of Operation Types of Name of Name of Name of O.R.
No. Diagnosis O.R. Scrub
Operation No. Patient Performed Anesthesia Surgeon Hospital Scrub Nurse
Nurse
Open
Osteoclasis
Supracondylar,
Left Elbow, Cebu City Mrs. Anna
1 January27, 338374 A.G.C.J. Fracture, Supracondylar Close General Dr. Carlos
Open Medical Benia E.
2010 Left Anesthesia Luis G. Fanlo
Reduction Center Bacayo
Jr.
Internal
Fixation,

Exploratory
1. Empyematous Gallbladder Laparotomy
Secondary to acute acalculus Appendectomy,
2 February 339965 B.R.G.. cholecystitis Cholecystecto General Dr. Louis Cebu City Mr. Rommil
05,2010 2.Acute appendicitis gangrenous my with Anesthesia Anthony O. Medical Galahad M.
with localized peritonitis intraoperative Delos Reyes Center Blancas
Cholangiogram
 Page 2 of 13

I. MAJOR OPERATIONS

Signature of
Date of Case Name of Types of Name of Name of Name of O.R.
No. Diagnosis Operation Performed O.R. Scrub
Operation No. Patient Anesthesia Surgeon Hospital Scrub Nurse
Nurse

Primary Low Transverse General Dr. Mona July Cebu City Mrs.Anna
3 February 199601 R.T.S.
Caesarian Section Anesthesia M. Auguis Medical Katherine B.
18, 2010
Center Jumalon

Below Knee Amputation, Spinal

4 February 199601 M.T.G. Diabetic Foot Right, Dr. Ross C. Cebu City Ms. Bethsaida
Right Anesthesia
19, 2010 Wayner Type IV Villero Medical G. Gabato
Center
 Page 3 of 13

I. MAJOR OPERATIONS

Signature of
Date of Case Name of Operation Types of Name of Name of Name of O.R.
No. Diagnosis O.R. Scrub
Operation No. Patient Performed Anesthesia Surgeon Hospital Scrub Nurse
Nurse

1.Open
Cholecystectomy
with Intraoperative
Cholangiogram
1.Chronic Cholecystitis Secondary Application of
Dr. Louis Cebu City
5 February 242681 A.J.A.J. To Multiple Cholelithiasis Hemostatic General Mr. Julnor M.
agent.Application Anthony O. Medical
11, 2010 2.Umbilical Hernia Incarcerated Anesthesia Amacna
of Jackson Pratt Delos Reyes Center
(Omentum) Drain
2.Umbilical
Hernioplasty

PREPARED BY:

JORGE NACORDA VALLESER

Class 2011

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

Divina T. Villarin Rosita M. Manlunas Lyrma S. Soledad Vicenta M. Jaluague

Signature over printed name of Faculty Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean
Date Signed : Date Signed : Date Signed : Date Signed :
Degree : R.N., M.N. Degree : R.N., M.N. Degree : R.N., M.H.A., M.N. Degree : R.N., M.N.
a) PRC No. : 0115064 a) PRC No. : 0068712 a) PRC No. : 0079370 a) PRC No. : 0039294

Valid until : July 11, 2012 Valid until : February 22, 2011 Valid until : October 05, 2011 Valid until : April 05, 2011
b) PNA No. : 13963 b) PNA No. : b) PNA No. : 3373 b) PNA No. :
Valid Until : LIFE MEMBER Valid Until : Valid Until : LIFE MEMBER Valid Until :
c) ANSAP No. : 009 c) ADCPN No. : 271
Valid Until : LIFE MEMBER Valid Until : December 31, 2010

I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
__________________________
Signature of Applicant
Subscribed and sworn to before me this __________ day of _______________________ 20_____, ______________________________, Philippines.

NOTARY PUBLIC
 Page 4 of 13

CEBU CITY MEDICAL CENTER – COLLEGE OF NURSING

in consortium with
CEBU T E C H N O L O G I C A L U N I V E R S I T Y
(formerly CEBU STATE COLLEGE OF SCIENCE AND TECHNOLOGY)

Name of Student : JORGE NACORDA VALLESER

Name and Address of School : Cebu City Medical Center – College of Nursing in consortium with
Cebu Technological University
N. Bacalso Avenue corner Panganiban Street, Cebu City
Accreditation Level (if any) : none Year Granted :
Date School/Program was recognized : June 04 Number : Cebu City Charter Ordinance 679 Year: 1970
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 (BSN Program) : 2011

II. MINOR OPERATIONS

Signature of
Date of Case Name of Operation Types of Name of Name of O.R.
No. Diagnosis Name of Surgeon O.R. Scrub
Operation No. Patient Performed Anesthesia Hospital Scrub Nurse
Nurse

Cebu City
June 27, Lipoma, Right Local Dr. Ian James G. Mrs. Babelina P.
1 307396 C.C.L. Excision of Medical
2009 Subscapsular Anesthesia Pason Pepito
Lipoma Center
Area

Cebu City
2 August 24, Incomplete Completion Intravenous Mrs. Justina D.
299403 D.T.G. Dr. Rina T. Ocba Medical
2009 Abortion Curettage Sedation Claudio
Center
 Page 5 of 13

II. MINOR OPERATIONS

Signature of
Date of Case Name of Operation Types of Name of Name of O.R.
No. Diagnosis Name of Surgeon O.R. Scrub
Operation No. Patient Performed Anesthesia Hospital Scrub Nurse
Nurse

Normal
Spotaneous
Local Dr. Zenia Z. Cebu City Mrs. Carla S.
3 October Vaginal Episiorrhaphy
198319 E.L.J. Anesthesia Panganiban Medical Corpin
25, 2009 Delivery With
Center
Episiotomy

Normal
Local Dr. Lyndel B. Cebu City
4 November A.A.C. Spontaneous Episiorrhaphy Mrs. Joy N. Milan
198589 Anesthesia Nisnisan Medical
08, 2009 Vaginal
Center
Delivery With
Episiotomy

II. MINOR OPERATIONS

 Page 6 of 13

Signature of
Date of Case Name of Operation Types of Name of Name of O.R.
No. Diagnosis Name of Surgeon O.R. Scrub
Operation No. Patient Performed Anesthesia Hospital Scrub Nurse
Nurse

Foot Defect
Wound
February Right Leg General Cebu City
5 Dressing And Dr. Pompe M. Mrs. Maria Ana C.
17, 2010 331261 J.L.P. Posterior 3rd Anesthesia Medical
Debridement Pilpa Laborte
Right Foot Center

PREPARED BY:

JORGE NACORDA VALLESER

Class 2011

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

Divina T. Villarin Rosita M. Manlunas Lyrma S. Soledad Vicenta M. Jaluague

Signature over printed name of Faculty Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean
Date Signed : Date Signed : Date Signed : Date Signed :
Degree : R.N., M.N. Degree : R.N., M.N. Degree : R.N., M.H.A., M.N. Degree : R.N., M.N.
a) PRC No. : 0115064 a) PRC No. : 0068712 a) PRC No. : 0079370 a) PRC No. : 0039294

Valid until : July 11, 2012 Valid until : February 22, 2011 Valid until : October 05, 2011 Valid until : April 05, 2011
b) PNA No. : 13963 b) PNA No. : b) PNA No. : 3373 b) PNA No. :
Valid Until : LIFE MEMBER Valid Until : Valid Until : LIFE MEMBER Valid Until :
c) ANSAP No. : 009 c) ADCPN No. : 271
Valid Until : LIFE MEMBER Valid Until : December 31, 2010

I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
__________________________
Signature of Applicant
Subscribed and sworn to before me this __________ day of _______________________ 20_____, ______________________________, Philippines.

NOTARY PUBLIC
 Page 7 of 13

CEBU CITY MEDICAL CENTER – COLLEGE OF NURSING

in consortium with
CEBU T E C H N O L O G I C A L U N I V E R S I T Y
(formerly CEBU STATE COLLEGE OF SCIENCE AND TECHNOLOGY)

Name of Student : JORGE NACORDA VALLESER

Name and Address of School : Cebu City Medical Center – College of Nursing in consortium with
Cebu Technological University
N. Bacalso Avenue corner Panganiban Street, Cebu City
Accreditation Level (if any) : none Year Granted :
Date School/Program was recognized : June 04 Number : Cebu City Charter Ordinance 679 Year: 1970
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 (BSN Program) : 2011

III. ACTUAL DELIVERIES

Supervised by: Name
No. Case No. Diagnosis Name of Age Date of Time of Gender Name of Type of Delivery and Signature of
Mother Delivery Delivery of Baby Hospital Qualified Clinical
Instructor

1 197746 Pregnancy Uterine T.A.Y. 14 September 25, 10:55 A.M. Female Cebu City Normal Spontaneous
Ms. Divina T. Villarin
34 2/7 Weeks in 2009 Medical Center Vaginal Delivery with
R. N., M. N.
Labor Episiotomy

2 197869 Pregnancy 37 1/7 M.G.E.K 21 October 02, 11:04 A.M Male Cebu City Normal Spontaneous
Weeks in Labor 2009 Medical Center Vaginal Delivery with Ms. Divina T. Villarin
Episiotomy R. N., M. N.

3 200948 Pregnancy Uterine J.G.T. 23 April 07, 08:11 A.M. Female Cebu City Normal Spontaneous Ms. Divina T. Villarin
Full Term Not in 2010 Medical Center Vaginal Delivery with R. N., M. N.
Labor with Episiotomy
Ruptured Bag of
Water
 Page 8 of 13
III. ACTUAL DELIVERIES

No. Case No. Diagnosis Name of Age Date of Time of Gender Name of Hospital Type of Delivery Supervised by: Name and
Mother Delivery Delivery of Baby Signature of Qualified
Clinical Instructor

4 200899 Pregnancy Uterine E.C.T. 41 April 07, 08:27 A.M. Male Cebu City Medical Normal Spontaneous Ms. Divina T. Villarin
Full Term in Labor 2010 Center Vaginal Delivery with R. N., M. N.
Episiotomy

5 190480 Pregnancy Uterine C.B.Y. 33 April 07, 03:43 P.M. Female Cebu City Medical Normal Spontaneous Ms. Divina T. Villarin
Full Term in Labor 2010 Center Vaginal Delivery R. N., M. N.

PREPARED BY:

JORGE NACORDA VALLESER

Class 2011

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

Divina T. Villarin Rosita M. Manlunas Lyrma S. Soledad Vicenta M. Jaluague

Signature over printed name of Faculty Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean
Date Signed : Date Signed : Date Signed : Date Signed :
Degree : R.N., M.N. Degree : R.N., M.N. Degree : R.N., M.H.A., M.N. Degree : R.N., M.N.
a) PRC No. : 0115064 a) PRC No. : 0068712 a) PRC No. : 0079370 a) PRC No. : 0039294

Valid until : July 11, 2012 Valid until : February 22, 2011 Valid until : October 05, 2011 Valid until : April 05, 2011
b) PNA No. : 13963 b) PNA No. : b) PNA No. : 3373 b) PNA No. :

Valid Until : LIFE MEMBER Valid Until : Valid Until : LIFE MEMBER Valid Until :
c) ANSAP No. : 009 c) ADCPN No. : 271
Valid Until : LIFE MEMBER Valid Until : December 31, 2010

I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
__________________________
Signature of Applicant
Subscribed and sworn to before me this __________ day of _______________________ 20_____, ______________________________, Philippines.

NOTARY PUBLIC
 Page 9 of 13

CEBU CITY MEDICAL CENTER – COLLEGE OF NURSING

in consortium with
CEBU T E C H N O L O G I C A L U N I V E R S I T Y
(formerly CEBU STATE COLLEGE OF SCIENCE AND TECHNOLOGY)

Name of Student : JORGE NACORDA VALLESER

Name and Address of School : Cebu City Medical Center – College of Nursing in consortium with
Cebu Technological University
N. Bacalso Avenue corner Panganiban Street, Cebu City
Accreditation Level (if any) : none Year Granted :
Date School/Program was recognized : June 04 Number : Cebu City Charter Ordinance 679 Year: 1970
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 (BSN Program) : 2011

IV. DELIVERIES ASSISTED

No. Case Diagnosis Name of Age Date of Time of Gender Name of Type of Delivery Supervised by: Name
No. Mother Delivery Delivery of Baby Hospital and Signature of
Qualified Clinical
Instructor

1 308635 Pregnancy Full C.R.T. 25 September 10, 8:16 A.M. Female Cebu City Normal Spontaneous Ms. Divina T. Villarin
Term in Labor 2009 Medical Center Vaginal Delivery with R. N., M. N.
Episiotomy

.
2 197940 Pregnancy Uterine R.B.C. 23 October 08, 07:31 A.M. Male Cebu City Normal Spontaneous Ms. Divina T. Villarin
Full Term in Labor 2010 Medical Center Vaginal Delivery R. N., M. N.
 Page 10 of 13
.
3 200920 Pregnancy Uterine C.C.P.G. 20 April 06, 09:55 P.M. Female Cebu City Normal Spontaneous Ms. Divina T. Villarin
Full Term in Labor 2010 Medical Center Vaginal Delivery with R. N., M. N.
Episiotomy

IV. DELIVERIES ASSISTED

No. Case Diagnosis Name of Age Date of Time of Gender Name of Type of Delivery Supervised by: Name
No. Mother Delivery Delivery of Baby Hospital and Signature of
Qualified Clinical
Instructor

4 200966 Pregnancy Uterine K.M.T. 19 April 08, 11:47 A.M Female Cebu City Normal Spontaneous Ms. Divina T. Villarin
37 Weeks in Labor 2010 Medical Center Vaginal Delivery with R. N., M. N.
Episiotomy

5 200970 Pregnancy Uterine M.C.C. 16 April 08, 01:38 P.M Male Cebu City Normal Spontaneous Ms. Divina T. Villarin
Full Term in Labor 2010 Medical Center Vaginal Delivery with R. N., M. N.
Episiotomy

PREPARED BY:

JORGE NACORDA VALLESER

Class 2011

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

Divina T. Villarin Rosita M. Manlunas Lyrma S. Soledad Vicenta M. Jaluague

Signature over printed name of Faculty Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean
Date Signed : Date Signed : Date Signed : Date Signed :
Degree : R.N., M.N. Degree : R.N., M.N. Degree : R.N., M.H.A., M.N. Degree : R.N., M.N.
a) PRC No. : 0115064 a) PRC No. : 0068712 a) PRC No. : 0079370 a) PRC No. : 0039294

Valid until : July 11, 2012 Valid until : February 22, 2011 Valid until : October 05, 2011 Valid until : April 05, 2011
b) PNA No. : 13963 b) PNA No. : b) PNA No. : 3373 b) PNA No. :
Valid Until : LIFE MEMBER Valid Until : Valid Until : LIFE MEMBER Valid Until :
c) ANSAP No. : 009 c) ADCPN No. : 271
Valid Until : LIFE MEMBER Valid Until : December 31, 2010
 Page 11 of 13
I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
__________________________
Signature of Applicant
Subscribed and sworn to before me this __________ day of _______________________ 20_____, ______________________________, Philippines.

NOTARY PUBLIC

CEBU CITY MEDICAL CENTER – COLLEGE OF NURSING

in consortium with
CEBU T E C H N O L O G I C A L U N I V E R S I T Y
(formerly CEBU STATE COLLEGE OF SCIENCE AND TECHNOLOGY)

Name of Student : JORGE NACORDA VALLESER

Name and Address of School : Cebu City Medical Center – College
of Nursing in consortium with
Cebu Technological University
N. Bacalso Avenue corner Panganiban Street, Cebu City
Accreditation Level (if any) : none Year Granted :
Date School/Program was recognized : June 04 Number : Cebu City Charter Ordinance 679 Year: 1970
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 (BSN Program) : 2011

V. CORD DRESSING

No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Supervised by: Name and
Signature of Qualified Clinical
Instructor

1 197731 September 24, 2009 Baby Girl Cabigting Female G.R.C. 40 Cebu City Ms. Divina T. Villarin
Medical Center R. N., M. N.
 Page 12 of 13

2 197760 September 25, 2009 Baby Girl Siega Female M.R.S. 39 Cebu City Ms. Divina T. Villarin
Medical Center R. N., M. N.

3 200918 April 05, 2010 Baby Boy Poncardas Male J.P.P. 20 Cebu City Ms. Divina T. Villarin
Medical Center R. N., M. N.

V. CORD DRESSING

Supervised by: Name and

No. Case No. Date Performed Name of Baby Gender of Baby Name of Mother Age Name of Hospital Signature of Qualified Clinical
Instructor

Cebu City Ms. Divina T. Villarin

4 947734 April 06, 2010 Baby Girl Roma Female M.R.R. 35
Medical Center R. N., M. N.

Ms. Divina T. Villarin

5 200963 April 08, 2010 Baby Boy Yap Male D.B.Y. 19 Cebu City
R. N., M. N.
Medical Center

PREPARED BY:

JORGE NACORDA VALLESER

Class 2011

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

Divina T. Villarin Rosita M. Manlunas Lyrma S. Soledad Vicenta M. Jaluague

Signature over printed name of Faculty Signature over printed name of Clinical Coordinator Signature over printed name of Chief Nurse Signature over printed name of Dean
Date Signed : Date Signed : Date Signed : Date Signed :
Degree : R.N., M.N. Degree : R.N., M.N. Degree : R.N., M.H.A., M.N. Degree : R.N., M.N.
a) PRC No. : 0115064 a) PRC No. : 0068712 a) PRC No. : 0079370 a) PRC No. : 0039294
 Page 13 of 13
Valid until : July 11, 2012 Valid until : February 22, 2011 Valid until : October 05, 2011 Valid until : April 05, 2011
b) PNA No. : 13963 b) PNA No. : b) PNA No. : 3373 b) PNA No. :
Valid Until : LIFE MEMBER Valid Until : Valid Until : LIFE MEMBER Valid Until :

c) ANSAP No. : 009 c) ADCPN No. : 271

Valid Until : LIFE MEMBER Valid Until : December 31, 2010

I declare under oath that these cases had been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is a true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
__________________________
Signature of Applicant
Subscribed and sworn to before me this __________ day of _______________________ 20_____, ______________________________, Philippines.

NOTARY PUBLIC