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ODC Form 1B
ASSISTED DELIVERY FORM
Republic of the Philippines
BATANGAS STATE UNIVERSITY
COLLEGE OF NURSING
Gov. Pablo Borbon Campus 1, Rizal Ave., Batangas City
Tel. No.: (043) 300-2202 loc. 120 E-mail Address: bsu_collegeofnursing@yahoo.com
ASSISTED DELIVERY in MArtin MArasigan Memorial Hospital, CUENCA, BATANGAS
Prepared by: LOURDJEAN RECTO AMERICA
Signature over printed Name of Student
Date Performed and Time Started | Patient’s INITIALS Only | PROCEDURE PERFORMEDASSISTED DELIVERY | D.R. Nurse On Duty | SUPERVISED BYClinical InstructorName and Signature |
| Case Number | | | |
June 16.20102:05pm | M.B.09-19459 | Normal Spontaneous Delivery | Marilou Puso, RN,MAN | Victoria M. Magpantay ,RN,MAN |
June 15.201010:50am | M.P.08-03258 | Normal Spontaneous Delivery | Marilou Puso, RN,MAN | Victoria M. Magpantay ,RN,MAN |
May 5.20109:32am | G.E.10-24298 | Normal Spontaneous Delivery | Marilou Puso, RN,MAN | Victoria M. Magpantay ,RN,MAN |
Noted by: ISMAEL I. DIMAULATAN Approved by: GLORIA M. CASAO
Clinical Coordinator, PRC I.D. No. 0114228 Valid Until: April 09, 2014 Dean, PRC I.D. No. 0152935 Valid Until: November 17, 2013
Date document is signed: ______________________ Time: _________ Date document is signed: _______________________ Time: ________
Please specify Highest Nursing Degree Earned: Master of Arts in Nursing Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
ODC Form 1B
ASSISTED DELIVERY FORM
Republic of the Philippines
BATANGAS STATE UNIVERSITY
COLLEGE OF NURSING
Gov. Pablo Borbon Campus 1, Rizal Ave., Batangas City
Tel. No.: (043) 300-2202 loc. 120 E-mail Address: bsu_collegeofnursing@yahoo.com
ASSISTED DELIVERY in BATANGAS HEALTH CARE HOSPITAL (JESUS OF NAZARETH) ,BATANGAS CITY
Prepared by: LOURDJEAN RECTO AMERICA
Signature over printed Name of Student
Date...