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    University of San Carlos: Date Performed and Time Started Patient's INITIALS (Only) Procedure Performed Case Number

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    fabaquita
    This document is an assisted delivery form from the University of San Carlos College of Nursing. It documents an assisted delivery performed by student Jose M. Cruz on July 10, 2010 at 4:25pm at Cebu City Medical Center under the supervision of clinical instructor Phoebe Marie B. Ramas. The delivery was for patient L.E.P. 000546. The form was approved by the clinical coordinator Laarne E. Pontillas and dean Antonia F. Pascual.

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    University of San Carlos: Date Performed and Time Started Patient's INITIALS (Only) Procedure Performed Case Number

    Uploaded by

    fabaquita
    56 views1 page
    This document is an assisted delivery form from the University of San Carlos College of Nursing. It documents an assisted delivery performed by student Jose M. Cruz on July 10, 2010 at 4:25pm at Cebu City Medical Center under the supervision of clinical instructor Phoebe Marie B. Ramas. The delivery was for patient L.E.P. 000546. The form was approved by the clinical coordinator Laarne E. Pontillas and dean Antonia F. Pascual.

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    Assisted Delivery Form

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    This document is an assisted delivery form from the University of San Carlos College of Nursing. It documents an assisted delivery performed by student Jose M. Cruz on July 10, 2010 at 4:25pm at Cebu City Medical Center under the supervision of clinical instructor Phoebe Marie B. Ramas. The delivery was for patient L.E.P. 000546. The form was approved by the clinical coordinator Laarne E. Pontillas and dean Antonia F. Pascual.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    56 views1 page

    University of San Carlos: Date Performed and Time Started Patient's INITIALS (Only) Procedure Performed Case Number

    Uploaded by

    fabaquita
    This document is an assisted delivery form from the University of San Carlos College of Nursing. It documents an assisted delivery performed by student Jose M. Cruz on July 10, 2010 at 4:25pm at Cebu City Medical Center under the supervision of clinical instructor Phoebe Marie B. Ramas. The delivery was for patient L.E.P. 000546. The form was approved by the clinical coordinator Laarne E. Pontillas and dean Antonia F. Pascual.

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    © All Rights Reserved
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    Download as doc, pdf, or txt
    of 1

    UNIVERSITY OF SAN CARLOS

    ODC Form 1B
    ASSISTED DELIVERY FORM

    COLLEGE OF NURSING, NASIPIT, TALAMBAN, CEBU CITY 6000 PHILIPPINES


    PHONE: 032 3433005; FAX: 032 3433006; [email protected]; www.usc.edu.ph
    PAASCU ACCREDITED, LEVEL II, MAY 5, 2008 MAY 2011

    ACTUAL DELIVERY in CEBU CITY MEDICAL CENTER, N. BACALSO ST., CEBU CITY
    Hospital/ Home/ Lying-in Clinic, Municipality/ City/ Province

    Prepared by:
    Printed Name with Signature of Student: Jose M. Cruz

    Patients INITIALS (only)


    Date Performed and
    Time Started
    July 10, 2010
    4:25 pm

    Case Number

    PROCEDURE PERFORMED

    (not applicable for Birthing/


    Lying-in Clinics/ Homes)

    L.E.P.
    000546

    ASSISTED DELIVERY

    D.R. Nurse On Duty


    (Name and Signature)
    (if Midwife on Duty, Signature Not Required)

    SUPERVISED BY
    Clinical Instructor
    (Name and Signature)

    Mary Dale E. Sanchez, R.N.

    Phoebe Marie B. Ramas, R.N., M.A.N.

    Noted by: Laarne E. Pontillas, R.N., M.S.N., M.A.N.

    Approved by: Antonia F. Pascual, R.N., M.N., M.S.N.

    (Print Name and Signature)

    (Print Name and Signature)

    Clinical Coordinator, PRC I.D. No. 0190308 Valid Until June 22, 2011

    DEAN, PRC I.D. No. 0054229 Valid Until August 5, 2012

    Date document is signed ______________ Time ________________

    Date document is signed ______________ Time ________________

    Please specify Highest Nursing Degree Earned Master of Science in Nursing

    Please specify Highest Nursing Degree Earned Master in Nursing

    Master of Arts in Nursing


    (STRICTLY NO DESIGNATES)

    Master of Science in Nursing

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