On Discovering Myself

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...