Admission Checklist

BSN III
Central Philippine Adventist College

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
Committed to the Development of the Whole Man
(TO BE SUBMITTED TO THE LEVEL COORDINATOR DURING ENROLLMENT)
(Kindly fill in the information below. Please dont leave any information blank. Use Black ink pen. Write legibly.)
NAME: _____________________________________________________________ CONTACT NUMBER: ________________
(First Name)
(Middle Name)
(Last Name)
EMAIL ADDRESS: __________________________CIVIL STATUS: ______GENDER:______RELIGION:_______ AGE: _______
HOME ADDRESS: ______________________________________________________________________________________
(No./Purok/Street)
(Baranggay)
(Municipality)
(Province)
(Zip Code)
BIRTHDATE: ___________________________BIRTHPLACE:________________________________HT:________ WT:________
MOTHERS NAME: __________________________________________________ CONTACT NUMBER: __________________
FATHERS NAME: __________________________________________________ CONTACT NUMBER: __________________
SPONSORS NAME: _________________________________________________CONTACT NUMBER: __________________
COMPLETE & CORRECT MAILING ADDRESS: __________________________________________________________________
(No./Purok/Street) (Baranggay) (Municipality) (Province)
(Zip
Code)
REQUIREMENTS
REMARKS
DATE
SIGNATURE
(For AHSE Only)
STEP 1. Secure letter of Acceptance to the Clinical Division (Clinical Coordinator)
STEP 2. Pay the Clinical Internship Fee (Paid In Cash at BO) (For AHSE Only)
OR #
STEP 3. Checking of Paraphernalia (C/O LEVEL III Clinical Instructors)
A. Standard Uniform of CPAC-SN (Refer to Tailor Model)
A
B. Basic RLE Paraphernalia
B
C. CHN Bag Contents
C
D. Black Umbrella
D
E. Bible
E
F. Church Hymnal
F
G. Latest Lesson Quarterly
G
H. Students Handbook
I. RLE Book
H
(Please see attached checklist for complete list of paraphernalia)
I
STEP 4. Residence Dean
1. Girls Dormitory (Mrs. R. Benitado)
2. Boys Dormitory (Pastor J. Bucol)
3. Cottage (Mrs. E. Tagaygay)
4. Villagers Permit with letter signed by village guardian
5. Day Student Contract duly signed by VP-Student Affairs (Dr. R. Baloyo)
STEP 5. Level III Asst. Coordinator (Miss Renelyn D. Metran, RN)
Submit the following:
1. Brown Envelope enclosed in a Transparent Envelope (long size)
with the following contents:
A. Photocopy of NSO Birth Certificate (Correct & Clear)
B. Photocopy of Letter of Acceptance to the Clinical Division
(AHSE Only)
C. Medical Certificate after PE from Bacolod Adventist Medical
Center (to be signed by Attending Physician)
D. (Photocopy) Hepa-B Testing and Complete Immunization
Card
E. Written Consent for the following:
i. Travel/Home Vacation (letter coming from parents)
ii. Specific Names of Person and places where the
concerned student can spend week-end or overnight.
F. Notarized original and photocopy of Memorandum of
Agreement (MOA) duly signed by Parents/Guardian
G. Notarized original and photocopy of Statement of Waiver
duly signed by Parents/Guardian
H. Couples Consent
I. Stamps (Php.50.00 worth of stamps)
J. Colored picture 2X2 (2 pcs.)
K. Notarization fee (optional)
STEP 6. Level III Coordinator (Miss Julie Joy R. Lacificar, RN)
1. GPA 2.5 & above (as of Summer 2010)
2. Completion of all academic requirements in Level II
(No subject & grade deficiencies)
3. Complete Requirements in Step 3 and Step 5.
4. No Pending behavioral cases with the DSA
Submitted by: ________________________________
1
2
3
4
5
1
A
B
C
D
E
F
G
H
I
J
K
1
2
3
4
Received by: ____________________________________
Mailing Address:
Main Campus: Alegria, Murcia, Negros Occidental Tel. No. (034) 710-0307 Fax No. (034) 710-0585
Clinical Division: Bacolod Adventist Medical Center Compound, C.V. Ramos Avenue, Taculing, Bacolod City Te. No. (034) 433-2407 Fax No. (034) 433-2363
Website: www.cpacsn.info Email: inquiry@cpacsn.info

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
Students Signature
Level III Coordinator

Date: _______________
REQUIREMENTS
A. STANDARD UNIFORM OF CPAC-SN (REFER TO TAILOR MODEL)
1. Two white pre-clinical uniforms
2. Type C (CHN Uniform, white standard blouse & black pants)
3. OR/DR Scrubsuit with mask and cap (Maroon)
4. White Smock/Lab Gown
5. One pair of prescribed white duty shoes
6. One pair of black shoes for CHN
7. Three pairs of white nurses stockings for ladies, white socks for men.
8. Three pairs of brown stockings for ladies, black socks for men.
B. BASIC RLE PARAPHERNALIA (leave the items in the level 3 office after checking)
1. Wristwatch with second hand
2. BP Apparatus
3. Stethoscope
4. Nameplate
5. Tourniquet
6. Bandage Scissors
7. Separate Black & Red Pen
8. New Pocketsize Notebook
9. Penlight
10. Nailcutter
11. Tape Measure
12. Rag
C. CHN BAG CONTENTS
1. Spirit of Ammonia
2. Betadine 10%
3. Sterile Applicators (3 packs)
4. Sterile Cotton Balls (3 packs)
5. Sterile (2x2,4x4) (at least 3 packs each size)
6. Penlight
7. Nail Cutter
8. Tongue Depressor (3 pcs)
9. Elastic Bandage (1)
10. Plasters (Hypoallergenic & Leukoplast) (1 each)
11. Alcohol
12. Syringe (1ml, 3ml, 5ml) (at least 5 each)
13. Needles (g19, 23 & 25) (at least 5 each)
14. Thermometers (Oral, Rectal, Axillae)
15. Hydrogen Peroxide
16. Medicine Cups
17. Medicine Dropper
18. Sterile Gloves (2 pcs)
19. Forceps (Curved & Straight)
20. Thumb Forcep
21. Towels (Face & Hand)
22. Tape Measure
23. Cord Clamp
24. Suction Bulb
25. Ice Bag
26. Hot Water Bag
27. Spring Balance
28. Kidney Basin
29. Soap with dish
30. Medicines (Paracetamol, Mefenamic, Antacids)
31. Disposable Mask
32. Manila Paper
D. Black Umbrella
E. Bible
F. Church Hymnal
G. Lesson Quarterly
H. Students Handbook
I. RLE Book
REMARK
S
DATE
SIGNATURE
Clinical Instructors Signature: __________________

Mailing Address:

SCHOOL OF NURSING
DATE
JUNE
8,9,10
7,8,9,10
7
15
16-AM
16-PM
17-18
21
28
JULY
6,7,8,9
11
18
16-18
25
AUGUST
2
3,4,5,6
8
22
9,10,11,12,13
12
30
15,16,17,18,19,20,21
22
SEPTEMBER
1
11
7,8,9,10
12
19
13-14
26?
28-30
OCTOBER
1
2
5,6,7,8
17
18
20
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
ACTIVITY
Requirement Checking
Orientation/Registration
Parents Orientation
Classes Begin/General Orientation
(AHSE) Level Orientation/ Entry Competency Examination;
(BSN) Class on Biostatistics
(BSN) Level Orientation/ Entry Competency Examination;
(AHSE) Class on Nursing Research
Orientation to Clinical Area and Student Handbook
BSN-Start of theory classes; AHSE-Skills Checking
AHSE-Start of theory classes; BSN-Skills Checking
General Prelim Examination
BSN Prelim Examination
AHSE Prelim Examination
Socio-Spiritual Retreat
Submission of Evaluation for Prelim Grades
Presentation of Model Case Study
General Midterm Examination
BSN Midterm Examination
AHSE Midterm Examination
SG Days
Foundation Day/Evangelism Day
Deadline for Evaluation of Grades and Letter to Parents
Week of Prayer
Bayanihan
Release of capping clearance
Deadline for 50 nursing procedure for AHSE
General Pre-Final Examination
BSN Pre-Final Examination
AHSE Pre-Final Examination
Signing of capping clearance
Capping and Pinning Ceremony
Signing of Clearance by Level Coordinator for Final Exam
Signing of Clearance by the Dean for Final Exam
Deadline of clearances
General Final Examination
BSN & AHSE Final Examination
Start of Make-up Duty
Deadline for Submission of Final Grades
Date Accomplished: ___________________________
PLANNED ACTIVITIES AND CALENDAR OF EVENTS FOR LEVEL III

1st SEMESTER
SCHOOL YEAR 2010-2011
Prepared By:
Julie Joy R. Lacificar, RN
Supervised By:
Vevian F. Ghulam, RN
Clinical Coordinator
Approved By:
Czarina Mae Lumague, RN, Ph.D
Dean, CPAC School of Nursing
Mailing Address:

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
DATE
NOVEMBER
25,26,27, 28,29
3
5
22,23,24,25,26
28
30
DECEMBER
5
10,11,12
19
JANUARY 2011
2
11,12,13,14
9
16
30
FEBRUARY
31,1,2,3,4
15,16,17,18
20
27
28
MARCH
5
8,9,10,11
12 13
14,15,16,17
20
27
28
23 27
APRIL
ACTIVITY
Orientation/Registration
Classes Begin / Orientation to CLMMRH
Negros Day
General Prelim Examination
BSN Prelim Examination
Bonifacio Day
AHSE Prelim Examination
Socio-Spiritual Retreat
Start of Christmas Vacation
Classes Resume
General Midterm Examination
BSN Midterm Examination
AHSE Midterm Examination
Deadline of Submission of Grades and Letter to Parents
SG DAYS
Pre-Final Examination
BSN Pre-Final Examination
AHSE Pre-Final Examination
Start of Students Week of Devotion
End of Students Week of Devotion
Seniors Final Exam
Signing of Clearance
General Final Examination
BSN & AHSE Final Examination
Graduation Day
Deadline for Evaluation of Grades and Letters to Parents
Start of Make-Up Duty
Registration for Summer
Start of Summer Class
End of Summer Class
Summer Break/Make Up Duty
Exit Competency Examination
PLANNED ACTIVITIES AND CALENDAR OF EVENTS

2ND SEMESTER
SY 2010-2011
Prepared By:
Julie Joy R. Lacificar, RN
Supervised By:
Vevian F. Ghulam, RN
Clinical Coordinator
Approved By:
Czarina Mae Lumague, RN, Ph.D
Dean, CPAC School of Nursing
FINANCIAL REPORT
LEVEL III
Mailing Address:

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
2ND SEMESTER, SY 2009-2010
Make-Up Fee Collected

CIs Share (25%)
Nursing Fund (50%)
Level Share (25%)
Php. 15,500.00
Php. 3,875.00 (Given)
Php. 7,750.00
Php. 3,875.00
Chapel Fines Collected
Php. 9,500.00
Summary of Expenses
Lunch with Mrs. Piojo
Cash Box
L3 Meeting Food & Fare
USB Hub
Gasoline/Communication
Total
Php. 1,494.00
Php. 300.00
Php. 1,747.00
Php. 200.00
Php. 500.00
Php. 4,241.00
Summary:
Make-up Fee Fund
Level Share
Chapel Fines
Total Money Collected
Less Expenses
Cash on Hand
Php. 7,750.00
Php. 3,875.00
Php. 9,500.00
Php. 21,125.00
Php. 4,241.00
Php. 16,884.00
Prepared By:
Miss Julie Joy R. Lacificar, RN
MISSION
Mailing Address:

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
CENTRAL PHILIPPINE ADVENTIST COLLEGE SCHOOL OF NURSING SEEKS TO DEVELOP

COMPETENT AND COMPASSIONATE CHRISTIAN NURSES TO SERVE THE WORLDWIDE
COMMUNITY BY PROMOTING HEALTHFUL LIVING, CARING FOR THE SICK AND SHARING
THE GOOD NEWS OF THE LOVING GOD.
VISION
CENTRAL PHILIPPINE ADVENTIST COLLEGE SCHOOL OF NURSING ENVISIONS EXCELLENT
NURSING EDUCATION PROGRAM AND WORLDWIDE RECOGNITION AND ACCEPTANCE OF
HER NURSING GRADUATES.
PHILOSOPHICAL PRINCIPLES
PERSON IT IS GODS PURPOSE FOR MAN TO RECOGNIZE GOD AS HIS CREATOR AND
HEALER.
NURSING IT IS AN INSTRUMENT THROUGH WHICH THE LOVE OF GOD MAY BE
SHARED. APPLIED NURSING IS AN ART BASED ON SCIENTIFIC
KNOWLEDGE
AND SKILLS TO ASSIST INDIVIDUALS, FAMMILIES AND COMMUNITIES TO ATTAIN
OPTIMUM HEALTH.
NURSING EDUCATION IT IS A PROCESS THAT PREPARES NURSES FOR CHRISTCENTERED AND SERVICE-ORIENTED MINISTRY.
OBJECTIVES OF THE DEPARTMENT

1. TO DEVELOP THE STUDENTS SCIENTIFIC KNOWLEDGE, COMPETENCE AND SKILLS
AND APPROPRIATE HEALTH PROFESSIONAL ATTITUDES.
2. TO INCULCATE IN THE STDUENT CHRISTIAN COMMITMENT AND COMPASSION IN
THE CARE OF CLIENTS.
3. TO DEVELOP CRITICAL THINKING IN THE APPLICATION OF THE NURSING PROCESS
TO PROMOTE HEALTH, PREVENT ILLNESS, AND ALLEVIATE PAIN AND SUFFERING.
4. TO ASSIST THE ADMINISTRATION IN THE EMPLOYMENT OF QUALIFIED
PROFESSIONALS TO HANDLE ADMINISTRATIVE AND ACADEMIC RESPONSIBILITIES.
5. TO ENCOURAGE PROFESSIONAL GROWTH THROUGH ESTABLISHED CONTINUING
EDUCATION PROGRAM.
6. TO MAINTAIN FINANCIAL VIABILITY THROUGH APPROVED AND SUSTAINED
BUDGET.
Mailing Address:

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
MISSION STATEMENT
CENTRAL PHILIPPINE ADVENTIST COLLEGE IS COMMITTED TO DEVELOPING
AND TRAINING STUDENTS TO BE PRODUCTIVE, SERVICE-ORIENTED AND
WINSOME WITNESSES OF THE LORD JESUS CHRIST.
VISION
CENTRAL PHILIPPINE ADVENTIST ENDEAVORS TO BE A CHRISTIAN
INSTITUTION OF ACADEMIC EXCELLENCE, CONTINUOSLY UPGRADING ITS
FACULTY AND FACILITIES, AND ESTABLISHING HEALTHY LINKAGES WITH OTHER
INSTITUTIONS, WHOSE STUDENTS AND GRADUATES PERFORM CREDITABLY
AND HONORABLY IN THEIR CHOSEN PROFESSION, AND ABLE TO RESPOND TO
THE HOLISTIC NEEDS OF LOCAL AND GLOBAL COMMUNITIES.
PHILOSOPHY
GOD IS THE CREATOR AND SOURCE OF ALL KNOWLEDGE, AS REVEALED IN
THE BIBLE AND CONVEYED IN FULL THROUGH HIS SON, JESUS CHRIST,
WHOSE PLAN OF SALVATION IS THE AIM OF TRUE EDUCATION.
Mailing Address:

SCHOOL OF NURSING
CLINICAL DIVISION
ACSCU-AAI Level II
AAA Accredited
BACHELOR OF SCIENCE IN NURSING CURRICULUM

(CMO NO. 14 SERIES OF 2009)
At the end of the third year, given actual clients / situation with various
physiologic and psychosocial alterations, the student shall be able to
demonstrate the competencies in the following in the following key areas of
responsibilities such as safe and quality nursing care, health education,
communication, collaboration and teamwork, ethico-moral and legal, quality
improvement, research, record management and management of resources
and environmental.
Specifically, the student shall:
a. Utilize the nursing process in the care of clients across the lifespan with
problems in oxygenation, fluid and electrolyte balance, metabolism and
endocrine functioning, perception coordination and maladaptive behavior;
b. Apply the research process in addressing nursing/health problems to
improve quality of care;
c. Integrate the role of culture and history in the plan of care;
d. Apply principles of good governance in the effective delivery of quality
health care;
e. Observe the core values cherished by the nursing profession (love of God,
caring, love of country and of people) and the bioethical principles in the
care of clients;
f. Apply a nursing theory in the management of care of client for case study;
and
g. Demonstrate a Christ-like life by being LOVING, KIND, GENTLE,
Peacemaker, Respect, Honest, Good and Faithful.
Mailing Address:

Admission Checklist

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BSN III

Central Philippine Adventist College

(TO BE SUBMITTED TO THE LEVEL COORDINATOR DURING ENROLLMENT)

Received by: ____________________________________

Central Philippine Adventist College

Level III Coordinator

Clinical Instructors Signature: __________________

Central Philippine Adventist College

Committed to the Development of the Whole Man

Date Accomplished: ___________________________

PLANNED ACTIVITIES AND CALENDAR OF EVENTS FOR LEVEL III

Central Philippine Adventist College

PLANNED ACTIVITIES AND CALENDAR OF EVENTS

Central Philippine Adventist College

2ND SEMESTER, SY 2009-2010

Make-Up Fee Collected

Chapel Fines Collected

Central Philippine Adventist College

CENTRAL PHILIPPINE ADVENTIST COLLEGE SCHOOL OF NURSING SEEKS TO DEVELOP

OBJECTIVES OF THE DEPARTMENT

Central Philippine Adventist College

Central Philippine Adventist College

BACHELOR OF SCIENCE IN NURSING CURRICULUM

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