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ODC Form 1A
COLLEGE OF NURSING, NASIPIT, TALAMBAN, CEBU CITY 6000 PHILIPPINES
ACTUAL DELIVERY FORM
PHONE: 032 3433005; FAX: 032 3433006; nursdean@usc.edu.ph; www.usc.edu.ph
PAASCU ACCREDITED, LEVEL II, MAY 5, 2008 – MAY 2011
ACTUAL DELIVERY in CEBU CITY MEDICAL CENTER, N. BACALSO ST., CEBU CITY
Hospital/ Home/ Lying-in Clinic, Municipality/ City/ Province
Prepared by:
ACTUAL DELIVERY
(STRICTLY NO DESIGNATES)
Noted by: Laarne E. Pontillas, R.N., M.S.N., M.A.N. Approved by: Antonia F. Pascual, R.N., M.N., M.S.N.
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. 0190308 Valid Until June 22, 2011 Clinical Coordinator, PRC I.D. No. 0054229 Valid Until August 5, 2012
Date document is signed ______________ Time ________________ Date document is signed ______________ Time ________________
Please specify Highest Nursing Degree Earned Master of Science in Nursing Please specify Highest Nursing Degree Earned Master in Nursing