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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600

Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

ACTUAL DELIVERY in BENGUET GENERAL HOSPITAL ECONOMIC ENTERPRISE, LA TRINIDAD, BENGUET

Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:

Printed Name and Signature of Student __RODANTE P. DANGPA___

Date

Performed

and

Time Started

Patients INITIAL

Only

PROCEDURE

PERFORMED

D.R. Nurse On Duty(Name and Signature)

(If Midwife on Duty,Signature Not

Required)

SUPERVISED BY

Clinical Instructor

Name and Signature

Case Number

(not applicable for

Birthing/Lying-In

Clinics/Homes)

April 28, 2013

9:30 pm

A.D.

386328 Normal Spontaneous Delivery Ms. Gemma Basatan Ms. Fe L. Bartolome

April 29, 2013

5:05 pm J.O.

388667

Normal Spontaneous Delivery Ms. Gemma Basatan Ms. Fe L. Bartolome

May 01. 201310:35 pm

R.S.404855 Normal Spontaneous Delivery Ms. Julia Marzan Ms. Fe L. Bartolome

D.R. Form

ACTUAL DELIVERY

FORM

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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600

Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

ACTUAL DELIVERY in BENGUET GENERAL HOSPITAL ECONOMIC ENTERPRISE, LA TRINIDAD, BENGUET

Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:

Printed Name and Signature of Student __RODANTE P. DANGPA___

Date

Performed

and

Time Started

Patients INITIAL

Only

Immediate Newborn Cord Care

PERFORMED

Indicate where performed e.g.

D.R., Nursery, NICU, or Home

Nurse On Duty(Name and Signature)

(If Midwife on Duty,signature not required)

SUPERVISED BY

Clinical Instructor

Name and SignatureCase Number

(not applicable for

Birthing Homes/Lying-

In Clinics/Homes)

ICNB Form

IMMEDIATE CARE

OF THE NEWBORN

FORM

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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600

Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

SURGICAL SCRUB in ________________________________________________________________________

Hospital, Municipality/City/Province

Prepared by:

Printed Name with Signature of Student ______________________________________________

Date

Performed

and

Time Started

Patients INITIALS

(only) SURGICAL PROCEDURE

PERFORMED

O.R. Nurse On Duty

(Name AND

Signature)

SUPERVISED BY

Clinical Instructor

Name and Signature

Case Number

O.R. Form 1A

O.R. SCRUB FORM

Major

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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600

Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

SURGICAL SCRUB in ________________________________________________________________________

Hospital, Municipality/City/Province

Prepared by:

Printed Name and Signature of Student ______________________________________________

Date

Performed

and

Time Started

Patients INITIALS

Only

SURGICAL PROCEDURE

PERFORMED

O.R. Nurse On Duty

(Name and

Signature)

SUPERVISED BY

Clinical Instructor

Name and Signature

Case Number

O,R, Form 1B

O.R. CIRCULATINGFORM

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Pines City CollegesCollege of nursing

Magsaysay Ave. Baguio City 2600

Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208

www.pcc.edu.ph

ASSIST DELIVERY in ________________________________________________________________________

Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:

Printed Name and Signature of Student ______________________________________________

Date

Performed

and

Time Started

Patients INITIAL

Only

PROCEDURE

PERFORMED

D.R. Nurse On Duty(Name and Signature)

(If Midwife on Duty,Signature Not

Required)

SUPERVISED BY

Clinical Instructor

Name and Signature

Case Number

(not applicable for

Birthing/Lying-In

Clinics/Homes)

D.R. Form

ASSIST DELIVERY

FORM