Bukidnon State University: DR Actual

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BUKIDNON STATE UNIVERSITY

COLLEGE OF NURSING
Fortich St. Malaybalay, Bukidnon 8700
Tel (088) 221 2196, Fax (088) 813 2717
www.bsc.edu.ph
Delivery Room/Pediatric Cases (NCM 101 and NCM 102 Cases)
Hospital/Home/Lying in Clinic/Municipality/Province

DR Actual
Date Performed and Time
of Delivery

Patients
Initial Only

Case
Number

Nurse on Duty (Name and


signature)
(If midwife on duty,
Signature not required)

October 28,2014,8:13AM
January 25,2015,3:53PM
February 13,2015,2:08PM

RAAN
JDN
MAL

20140010056
20150000951
20150001672

Chaya Guia B. Sarmiento


Marichu L. De Asis
Bernardita S. Cahiles

Supervised By Clinical
Instructor
(Name and Signature)
Beulah Joy K. Damasco RN,
MAN
Fatima C. Tanzo RN, MN
Fatima C. Tanzo RN, MN

HOSPITAL

BPMC
BPMC
BPMC

Newborn Care

Noted By:

Carina Joane V. Barroso, RN, MN, MAN


RLE Coordinator
PRC I.D. No. _______________ Valid Until ___________
Date Signed: ________________ Time: _____________
Highest Nursing Degree Earned: Masters of Arts in Nursing
PNA Number: ________________ Valid Until: _________
Approved By:

DR Assist
Date Performed and Time of
Delivery

Patients
Initial
Only

Case
Number

Nurse on Duty (Name and


signature)
(If midwife on duty,
Signature not required)

Supervised By Clinical
Instructor
(Name and Signature)

HOSPITAL

August 1,2014,10:06AM
November20,2014,10:30A
M
December20,2014,1:33PM

AUT
LER

20140006522
20140011348

Chaya Guia B. Sarmiento


Bernardita S. Cahiles

Beulah Joy K. Damasco RN,


MAN
Fatima C. Tanzo RN, MN

BPMC
BPMC

CBC

20140012103

Zennat A. Bayon

Fatima C. Tanzo RN, MN

BPMC

Bernarda C. Lleno, DM
Dean, College of Nursing
PRC I.D. No. ________________ Valid Until ________
Date Signed: _________________ Time: _____________
Highest Nursing Degree Earned: Masters of Arts in Nursing
PNA Number: ________________ Until Lifetime
ADPCN: ___________________ Valid Until ___________

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