OCD FORM 1C

Cord Care
BENGUET STATE UNIVERSITY Form
College of Nursing
La Trinidad, Benguet, 2601 Philippines
Phone number: 309-3882; Fax number: 422-2281; E-mail:ents3@yahoo.com; Web site:www.bsu.edu.ph
LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- November 3, 2011

IMMEDIATE NEWBORN CORD CARE in BENGUET GENERAL HOSPITAL

Name of Student: Signature of student:

Date Performed Patient Name
and PROCEDURE PERFORMED PNCU Nurse On Duty SUPERVISED BY:
Case Number
Time Started

Noted by: LAWRENCE C. CARANTO,RN Concurred by: VIRGINIA B. SAGUIDIC, RN

Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 003986 Valid until: January 15,2012
PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 02806 Valid until: Lifetime
Date signed: Time signed : ANSAP No.: 01376 Valid until: December 31,2010
Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
Highest Nursing degree earned: Master of arts in Nursing (MAN)
OCD FORM 1C
Cord Care
BENGUET STATE UNIVERSITY Approved by: VICENTE G.PANAGAN JR.,RN Form
College of Nursing Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
La Trinidad, Benguet, 2601 Philippines
PNA No.: 063313 Valid Until:December 31,2010
Phone number: 309-3882; Fax number: 422-2281; E- mail:ents3@yahoo.com; Web site:www.bsu.edu.ph
LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- ADPCN NO.: 0838 Valid Until: December 31,2010 November 3, 2011
Date signed: Time signed:
IMMEDIATE NEWBORN CORD CARE in BAGUIO GENERAL Specify Highest Nursing Degree Earned: HOSPITAL AND MEDICAL CENTER, Baguio City
Name of Student: Signature of student:
Date Performed Patient Name
and PROCEDURE PERFORMED PNCU Nurse On Duty SUPERVISED BY:
Case Number
Time Started

Noted by: LAWRENCE C. CARANTO,RN Concurred by: ELENA B. TAMPICAN,RN

Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 004369 Valid until: January 27,2011
PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 04718 Valid until: Lifetime
Date signed: Time signed : ANSAP No.: 01036 Valid until: December 31,2010
Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
Highest Nursing degree earned: Master of arts in Nursing (MAN)

Approved by: VICENTE G.PANAGAN JR.,RN

Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
PNA No.: 063313 Valid Until:December 31,2010
ADPCN NO.: 0838 Valid Until: December 31,2010
Date signed: Time signed:
Specify Highest Nursing Degree Earned: