UNIVERSIDAD DE ZAMBOANGA

Don Toribio St., Tetuan, Zamboanga City, Philippines

Telephone No. (062) 990-1849 / Fax No. (062) 991-3094 / Web-Site: www.uz.edu.ph

Accredited by: ISO 9001:2008 Certified/CIP/3310/05/03/410 / May 02, 2011 ACTUAL DELIVERY in Tetuan Health Center, Zamboanga City Hospital, Municipality / City / Province

D.R. Form ACTUAL DELIVERY FORM

Prepared by: Printed Name with Signature of Student: PELING, ALWIDA SABDANI
Patients INITIALS (only) Case Number
(not applicable for Birthing /Lying In Clinics / Homes)

Date Performed and Time Started

PROCEDURE PERFORMED

D.R. Nurse/Midwife On Duty (Name and Signature) (If midwife on Duty signature not required)

SUPERVISED BY: Clinical Instructor (Name and Signature)

May 23, 2012 @ 4:10 A.M

M.T #426

Normal Spontaneous Vaginal Delivery

Ma. Johanna Fer Sakili, R.N, M.N

Noted by: REYNITA BIONG-SAGUBAN, R.N., M.N. Clinical Coordinator, PRC I.D. No. 0311858 PNA I.D. No._______ Date document is signed: ____ Please specify Highest Nursing Degree Earned:

Valid Until: January 24, 2015__ Valid Until: __________________ Time: __________ Master in Nursing

Approved by: HAIDEE T. PACHECO, R.N., M.N. Dean, PRC I.D. No. 0313276 Valid Until: January 12, 2016 PNA I.D. No. _______ Valid Until: _______ _______ Date document is signed: _______ Time: ___________ Specify Highest Nursing Degree Earned: Master in Nursing

UNIVERSIDAD DE ZAMBOANGA
Don Toribio St., Tetuan, Zamboanga City, Philippines
Telephone No. (062) 990-1849 / Fax No. (062) 991-3094 / Web-Site: www.uz.edu.ph

Accredited by: ISO 9001:2008 Certified/CIP/3310/05/03/410 / May 02, 2011 IMMEDIATE NEWBORN CARE in Tetuan Health Center, Zamboanga City Hospital, Municipality / City / Province

ICNB Form IMMEDIATE CARE OF THE NEWBORN FORM

Prepared by: Printed Name with Signature of Student: PELING, ALWIDA SABDANI
Patients INITIALS (only) Case Number
(not applicable for Birthing Homes /Lying In Clinics / Homes)

Date Performed and Time Started

Immediate Newborn Care PERFORMED

Indicate where performed e.g. D.R., Nursery, NICU, or Home

Nurse/Midwife On Duty (Name and Signature) (If midwife on Duty signature not required)

SUPERVISED BY: Clinical Instructor (Name and Signature)

February 15, 2012 @ 3:25 A.M

Baby Girl Gonzales #2812

Cord Care

Ma. Johanna Fer Sakili, R.N, M.N

Noted by: REYNITA BIONG-SAGUBAN, R.N., M.N. Clinical Coordinator, PRC I.D. No. 0311858 PNA I.D. No._______ Date document is signed: ____ Please specify Highest Nursing Degree Earned:

Valid Until: January 24, 2015__ Valid Until: __________________ Time: __________ Master in Nursing

Approved by: HAIDEE T. PACHECO, R.N., M.N. Dean, PRC I.D. No. 0313276 Valid Until: January 12, 2016 PNA I.D. No. _______ Valid Until: _______ _______ Date document is signed: _______ Time: ___________ Specify Highest Nursing Degree Earned: Master in Nursing