Pines City Colleges

College 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 D.R. Form ACTUAL DELIVERY Prepared by: FORM Printed Name and Signature of Student __RODANTE P. DANGPA___ Date Performed and Time Started Patients INITIAL Only Case Number (not applicable for Birthing/Lying-In Clinics/Homes) A.D. 386328 Normal Spontaneous Delivery PROCEDURE PERFORMED D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required) SUPERVISED BY Clinical Instructor Name and Signature

April 28, 2013 9:30 pm April 29, 2013 5:05 pm May 01. 2013 10:35 pm

Ms. Gemma Basatan

Ms. Fe L. Bartolome

J.O. 388667 R.S. 404855

Normal Spontaneous Delivery

Ms. Gemma Basatan

Ms. Fe L. Bartolome

Normal Spontaneous Delivery

Ms. Julia Marzan

Ms. Fe L. Bartolome

Pines City Colleges

College 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 ICNB Form IMMEDIATE CARE OF THE NEWBORN Prepared by: FORM Printed Name and Signature of Student __RODANTE P. DANGPA___ Date Performed and Time Started Patients INITIAL Only Case Number (not applicable for Birthing Homes/LyingIn Clinics/Homes) 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 Signature

Pines City Colleges

College 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 ________________________________________________________________________ O.R. Form 1A Hospital, Municipality/City/Province O.R. SCRUB FORM Prepared by: Printed Name with Signature of Student ______________________________________________ Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty (Name AND Signature) Major

SUPERVISED BY Clinical Instructor Name and Signature

Pines City Colleges

College 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 ________________________________________________________________________ O,R, Form 1B Hospital, Municipality/City/Province O.R. CIRCULATING Prepared by: Printed Name and Signature of Student ______________________________________________ Date Performed and Time Started Patients INITIALS Only Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty (Name and Signature) FORM

SUPERVISED BY Clinical Instructor Name and Signature

Pines City Colleges

College of nursing
Magsaysay Ave. Baguio City 2600 Tel. nos.: (074) 445-2210, 445-2209 Fax: (074) 445-2208 www.pcc.edu.ph

O,R, Form 1C O.R. MINOR FORM Prepared by: Printed Name and Signature of Student ______________________________________________ Date Performed and Time Started Patients INITIALS Only Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature

Pines City Colleges

College 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 D.R. Form ASSIST DELIVERY Prepared by: FORM Printed Name and Signature of Student ______________________________________________ Date Performed and Time Started Patients INITIAL Only Case Number (not applicable for Birthing/Lying-In Clinics/Homes) PROCEDURE PERFORMED D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required) SUPERVISED BY Clinical Instructor Name and Signature