Академический Документы
Профессиональный Документы
Культура Документы
Prepared by:
Printed Name and Signature of Student ______________________________________
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse On duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- Signature not Required)
In Clinics/Homes
Prepared by:
Printed Name and Signature of Student ______________________________________
Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse On duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- Signature not Required)
In Clinics/Homes ASSISTED DELIVERY
Prepared by:
Printed Name and Signature of Student ______________________________________
Date Performed Patient's INITIAL Only Immediate Newborn Cord Care Nurse On duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number Indicate where performed e.g. D.R., Nursery, (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- NICU, or Home Signature not Required)
In Clinics/Homes
Prepared by:
Printed Name and Signature of Student ______________________________________
Prepared by:
Printed Name and Signature of Student ______________________________________
Concurred By:
LANNIE O. CAPINPUYAN
Signature over printed Name
Chief Nurse - J.R. Borja General Hospital
Date Signed:
Degree: BSN, RN, MAN
a) PRC No.: 0118996
Valid until: October 19, 2017
b) PNA No.:_______
Valid until:_______________
c) ANSAP No. _______
Concurred By: