Republic of the Philippines UNIVERSITY OF NORTHERN PHILIPPINES COLLEGE OF HEALTH SCIENCES Tamag, Vigan City, Ilocos Sur Telefax

No. (077) 722-7198 Accredited: PASUC, LEVEL III, YEAR GRANTED: 2004 IMMEDIATE NEWBORN CORD CARE IN GABRIELA SILANG GENERAL HOSPITAL, VIGAN CITY ILOCOS SUR Hospital/Home/Lying-in-Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student MAUREEN GRACE PEREZ TIU Date Performed and Time Started APRIL 05, 2013 8:35 AM
OCTOBER 11,2013

ODC Form 1C CORD CARE FORM

(not applicable for Birthing/Lying-inClinic/Homes)

Patients INITIAL Only Case Number BBC 08057551 BBJ 08057645

IMMEDIATE NEWBORN CORD CARE PERFORMED

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

Nurse On Duty (Name and Signature)

(If Midwife on Duty, Signature Not Required)

SUPERVISED BY Clinical Instructor Name and Signature ADORA M. VELASCO,MAN ADORA M. VELASCO,MAN

8:15 AM

IMMEDIATE NEWBORN CORD CARE PERFORMED IN NURSERY IMMEDIATE NEWBORN CORD CARE PERFORMED IN NURSERY

MA. CORAZON A. GALINATO,RN MA. CORAZON A. GALINATO,RN

Noted by: MARIA YOLANDA R. AQUINO

(Printed Name and Signature)

Approved by: LARGUITA P. REOTUTAR

(Printed Name and Signature)

Clinical Coordinator, PRC I.D. No.: 0257275 Valid Until: March 15, 2015
Date Document is Signed: _____________________ Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Dean, PRC I.D. No.: 0078616 Valid Until: August 8. 2015

Date Document is Signed: ______________________ Time: ______________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

(STRICTLY NO DESIGNATES)

Republic of the Philippines UNIVERSITY OF NORTHERN PHILIPPINES COLLEGE OF HEALTH SCIENCES Tamag, Vigan City, Ilocos Sur Telefax No. (077) 722-7198 Accredited: PASUC, LEVEL III, YEAR GRANTED: 2004 IMMEDIATE NEWBORN CORD CARE IN CENTRAL ILOCOS SUR DISTRICT HOSPITAL, NARVACAN , ILOCOS SUR Hospital/Home/Lying-in-Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student MAUREEN GRACE PEREZ TIU Date Performed and Time Started APRIL 17, 2013 3:30 PM Patients INITIAL Only Case Number BBV 016092 IMMEDIATE NEWBORN CORD CARE PERFORMED
(Indicate where performed e.g. D.R., Nursery, NICU, or Home)

ODC Form 1C CORD CARE FORM

Nurse On Duty (Name and Signature)

(If Midwife on Duty, Signature Not Required)

(not applicable for Birthing/Lying-inClinic/Homes)

SUPERVISED BY Clinical Instructor Name and Signature

LEILA SYLVIA F. BAUTISTA,MAN

IMMEDIATE NEWBORN CORD CARE PERFORMED IN DELIVERY ROOM

JERRY Q. CABANIT, RN

Noted by: MARIA YOLANDA R. AQUINO

(Printed Name and Signature)

Approved by: LARGUITA P. REOTUTAR

(Printed Name and Signature)

Clinical Coordinator, PRC I.D. No.: 0257275 Valid Until: March 15, 2015
Date Document is Signed: _____________________ Time: ____________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Dean, PRC I.D. No.: 0078616 Valid Until: August 8. 2015

Date Document is Signed: ______________________ Time: ______________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

(STRICTLY NO DESIGNATES)