Republic of the Philippines

SULTAN KUDARAT STATE UNIVERSITY

EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

COLLEGE OF HEALTH SCIENCES

SURGICAL SCRUB in South Cotabato Provincial Hospital, Koronadal City, South Cotabato
Hospital/Municipality/City/Province
OR Form 1A
Prepared by: O.R. SCRUB FORM
Printed Name and Signature of Student: JENNIFER P. ALAMON Major

Date Performed Patient’s Initials (only) SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BY
and Case Number PERFORMED (Name and Signature) Clinical Instructor
Time Started Name and Signature

November 16, 2023 @ M.G.G.A. Lower Segment Transverse Cesarean Section RAYMUND R. SODUSTA, RN CATHERINE E. LIGO, RN, MN
10:01 in the evening Case Number 16-1393917 with Bilateral Tubal Ligation and Left Lic. No. 0393167 Lic. No. 0221588
Fimbriectomy

November 23, 2023 @ V.C.S. Hernioplasty, Left RAYMUND R. SODUSTA, RN PINKY C. CABRADILLA, RN, MAN
9:45 in the morning Case Number 16-1393990 Lic. No. 0393167 Lic. No. 0306604

November 24, 2023 @ B.P.S. Completion Curettage with Bilateral Tubal RAYMUND R. SODUSTA, RN PINKY C. CABRADILLA, RN, MAN
2:27 in the afternoon Case Number 16-1394003 Ligation Lic. No. 0393167 Lic. No. 0306604

Noted by: Approved by:

MARK ANTHONY G. ALCANTARA, RN, MAN MARK RYAN Y. CONTAOI, PhD, RN

Clinical Coordinator Dean, College of Health Sciences
PRC ID No.: 0602334 Valid Until: October 04, 2025 ADPCN No.:
Date Document is Signed: Time: PRC ID No.: 0402230 Valid Until: March 25, 2027
Highest Nursing Degree Earned: Master of Arts in Nursing Date Document is Signed: Time:
Highest Nursing Degree Earned: Doctor of Philosophy in Nursing

VISION: A leading University in advancing scholarly innovation, multi-cultural convergence, and responsive public service in a borderless Region. | MISSION: The University shall primarily provide advanced instruction and professional training in science and technology, agriculture, fisheries, education and other relevant fields
of study. It shall also undertake research and extension services, and provide progressive leadership in its areas of specialization. | MAXIM: Generator of Solutions. | CORE VALUES: Patriotism, Respect, Integrity, Zeal, Excellence in Public Service.
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

COLLEGE OF HEALTH SCIENCES

SURGICAL CIRCULATING in South Cotabato Provincial Hospital, Koronadal City, South Cotabato
Hospital/Municipality/City/Province
OR Form 1B
Prepared by: O.R. CIRCULATING FORM
Printed Name and Signature of Student: JENNIFER P. ALAMON

Date Performed Patient’s Initials (only) SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number Name and Signature

November 17, 2023 @ C.S.N. Primary Lower Segment Transverse Cesarean RAYMUND R. SODUSTA, RN CATHERINE E. LIGO, RN, MN
8:17 in the evening Case Number 16-1393928 Section Lic. No. 0393167 Lic. No. 0221588

November 23, 2023 @ F.S.D. Debridement of an Open Fracture with RAYMUND R. SODUSTA, RN PINKY C. CABRADILLA, RN, MAN
2:20 in the afternoon Case Number 16-1393993 Percutaneous External Fixation of the Right Tibia Lic. No. 0393167 Lic. No. 0306604

November 24, 2023 @ M.D.M. Suction and Sharp Curettage RAYMUND R. SODUSTA, RN PINKY C. CABRADILLA, RN, MAN
7:40 in the morning Case Number 16-1393999 Lic. No. 0393167 Lic. No. 0306604

Noted by: Approved by:

MARK ANTHONY G. ALCANTARA, RN, MAN MARK RYAN Y. CONTAOI, PhD, RN

Clinical Coordinator Dean, College of Health Sciences
PRC ID No.: 0602334 Valid Until: October 04, 2025 ADPCN No.:
Date Document is Signed: Time: PRC ID No.: 0402230 Valid Until: March 25, 2027
Highest Nursing Degree Earned: Master of Arts in Nursing Date Document is Signed: Time:
VISION: A leading University in advancing scholarly innovation, multi-cultural convergence, and responsive public service in a borderless Region. | MISSION: The University shall primarily provide advanced instruction and professional training in science and technology, agriculture, fisheries, education and other relevant fields
of study. It shall also undertake research and extension services, and provide progressive leadership in its areas of specialization. | MAXIM: Generator of Solutions. | CORE VALUES: Patriotism, Respect, Integrity, Zeal, Excellence in Public Service.
 Republic of the Philippines
SULTAN KUDARAT STATE UNIVERSITY
EJC Montilla, City of Tacurong, 9800
Province of Sultan Kudarat

Highest Nursing Degree Earned: Doctor of Philosophy in Nursing

VISION: A leading University in advancing scholarly innovation, multi-cultural convergence, and responsive public service in a borderless Region. | MISSION: The University shall primarily provide advanced instruction and professional training in science and technology, agriculture, fisheries, education and other relevant fields
of study. It shall also undertake research and extension services, and provide progressive leadership in its areas of specialization. | MAXIM: Generator of Solutions. | CORE VALUES: Patriotism, Respect, Integrity, Zeal, Excellence in Public Service.