Our Lady of the Pillar College-Cauayan ODC Form 1A

Cauayan City, Isabela, Philippines ACTUAL DELIVERY FORM

(078) 652-2602/ (078)897-4175 Telefax (078)652-0685
Email: olpcc@PLDT dsl.net
olpcc@NSCV.com
Website: www.olpcc.edu.ph
ACCREDITATION LEVEL :N/A
ACTUAL DELIVERY in : CAGAYAN VALLEY MEDICAL CENTER
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student: ELMER M. PALOMENO

Date Performed Patient’s INITIAL (only) PROCEDURE PERFORMED D.R Nurse on Duty SUPERVISED BY
and Case Number (Name and Signature) Clinical Instructor
Time Started (not applicable for Birthing (if Midwife on Duty, (Name and Signature)
Home//Lying-In Clinics/Homes)
Signature Not Required)
12 – 9 – 2010 B.J NORMAL SPONTANEOUS
089316 DELIVERY JOHANNA CORTEZ RN KENNETH UGALI RN,MSN
12 – 10 – 2010 C.E NORMAL SPONTANEOUS
089414 DELIVERY RACHELLE GAGNO RN KENNETH UGALI RN,MSN
12 – 11 – 2010 F.S NORMAL SPONTANEOUS
089503 DELIVERY MERRYROSE CAGAID RN KENNETH UGALI RN,MSN

Noted by: JONATHAN M. BARANGAN, RN,MAN Approved by: RUBY V. DE LUNA, RM,RN,MAN
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC ID No. 0249631 Valid Until : FEBRUARY 6, 2012 Dean, PRC ID No: 0403582 Valid Until : MAY 31, 2012
Date document is signed:____________________ Time_____________ Date document is signed: ___________________Time______________
Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING Specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING
 Our Lady of the Pillar College-Cauayan ODC Form 1B
Cauayan City, Isabela, Philippines ASSISTED DELIVERY
(078) 652-2602/ (078)897-4175 Telefax (078)652-0685 FORM
Email: olpcc@PLDT dsl.net
olpcc@NSCV.com
Website: www.olpcc.edu.ph
ACCREDITATION LEVEL :N/A
ACTUAL DELIVERY in CAGAYAN VALLEY MEDICAL CENTER
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student: ELMER M. PALOMENO

Date Performed Patient’s INITIALS (only) PROCEDURE PERFORMED D.R Nurse/Midwife on Duty SUPERVISED BY
And Case Number (Name and Signature) Clinical Instructor
Time Started (not applicable for Birthing ASSISTED DELIVERY (if Midwife on Duty, (Name and Signature)
Home//Lying-In Clinics/Homes Signature Not Required)
12 – 09 – 2010 C.V. NORMAL SPONTANEOUS DELIVERY
089322 JOHANNA CORTEZ RN KENNETH UGALI RN,MSN

Noted by: JONATHAN M. BARANGAN, RN,MAN Approved by: RUBY V. DE LUNA, RM,RN,MAN
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC ID No. 0249631 Valid Until : FEBRUARY 6, 2012 Dean, PRC ID No: 0403582 Valid Until : MAY 31, 2012
Date document is signed:____________________ Time_____________ Date document is signed: ___________________Time______________
Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING Specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

ODC Form 1C
Our Lady of the Pillar College-Cauayan CORD CARE
FORM
 Cauayan City, Isabela, Philippines
(078) 652-2602/ (078)897-4175 Telefax (078)652-0685
Email: olpcc@PLDT dsl.net
olpcc@NSCV.com
Website: www.olpcc.edu.ph
ACCREDITATION LEVEL :N/A
IMMEDIATE NEWBORN CORD CARE in : CAGAYAN VALLEY MEDICAL CENTER
Hospital/Home/Lying-In Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student:ELMER M. PALOMENO

Date Performed Patient’s INITIAL (only) Immediate Newborn Cord Care D.R. Nurse On Duty SUPERVISED BY
and Case Number PERFORMED (Name and Signature) Clinical Instructor
Time Started (not applicable for Birthing (indicate where performed e.g. D.R, Nursery, (if Midwife on Duty, (Name and Signature)
Home/Lying-In Clinics/Homes Signature Not Required)
NICU,or Home)
12 – 11 – 2010 P. J. NORMAL SPONTANEOUS DELIVERY
08479 MERRYROSE CAGAID RN KENNETH UGALI RN, MSN

Noted by: JONATHAN M. BARANGAN, RN,MAN Approved by: RUBY V. DE LUNA, RM,RN,MAN
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC ID No. 0249631 Valid Until : FEBRUARY 6, 2012 Dean, PRC ID No: 0403582 Valid Until : MAY 31, 2012
Date document is signed:____________________ Time_____________ Date document is signed: ___________________Time______________
Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING Specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING