Puting Kahoy, Silang, Cavite

P.O.Box 1834, Manila, 1099 Philippines

Tel. # (049) 5411211, Fax # (049) 5411228, Web-site: www.aup.edu.ph
Accredited by: Association of Christian Schools, Colleges and Universities Accrediting Agency, Inc./Federation of Accrediting Agencies of the Philippines
Level IV Re-accreditation Status (August 2012 - December 2015, December 2016-December 2021)
Re-accreditation Autonomous Status (October 2003-October 2008; March 2009-December 2015; April 1, 2016-May 31, 2019)

GENERAL EMILIO AGUINALDO MEMORIAL HOSPITAL- Trece Martires City, Cavite

IMMEDIATE NEWBORN CORD CAREin ____________________________________________________________________________________________
Hospital, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student: ARPON, MARY DOIND LLYRA B.
Date Performed and Patient’s Name D.R. Nurse on Duty SUPERVISED BY
Time Started Case Number PROCEDURE
(Name and Signature) Clinical Instructor
(not applicable for Birthing Homes Lying-in PERFORMED (If Midwife on Duty, Signature not required) Name and Signature
Clinics/Homes)
September 22, 2019
4:22 PM Baby Girl of Kimberly Revelleza Francisco Immediate Newborn Care Maria S. Bustonera, RN Analisa L. Pepito RN, MN
337678

September 23, 2019

4:06 PM Baby Girl of Princess Corona Sartin Immediate Newborn Care Gizelle L. Legaspi, RN Analisa L. Pepito RN, MN
337721

Noted by: ____________Joyosthie B. Orbe RN, Ph.D Approved by: ______________Susy A. Jael RN, Ph.D
(Signature over printed name) (Signature over printed name)
Clinical Coordinator, PRC I.D. NO. ___0245891 Valid Until ___October 29, 2022 Dean, PRC I.D. No. ____0182103 Valid Until __February 12, 2020
Date document is signed: ________________________ Time ____________________ Date document is signed: _______________ Time: ___________________________
Please specify Highest Nursing Degree Earned: ___Doctor of Philosophy in Nursing Specify Highest Nursing Degree Earned: ____Doctor of Philosophy in Nursing