University of the Cordilleras ODC Form 1B

Governor Pack Road, Baguio City, Philippines 2600 ASSISTED DELIVERY

(+6374) 442-3316, 442-2564, 442-8219, 442-8256 FORM

e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

ASSISTED DELIVERY in __________________________________________________________

San Fernando, La Union

Prepared by: ________________________________

SUPERVISED BY
Date Performed PROCEDURE PERFORMED D.R. Nurse / Midwife
Clinical Instructor
and On Duty
Case Name and Signature
Time Started ASSISTED DELIVERY
Number

Noted:________________________________________________________
Approved by: _______________________________________________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Date document is signed: _________________ Time: _____________
Date document is signed: ____________ Time: _________________________
Highest Nursing Degree Earned: _______________________________
Highest Nursing Degree Earned: ______________________________________
 University of the Cordilleras
Governor Pack Road, Baguio City, Philippines 2600 ODC Form 1C
(+6374) 442-3316, 442-2564, 442-8219, 442-8256 CORD CARE FORM
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

IMMEDIATE NEWBORN CORD CARE in ____________________________________________________

Prepared by: ___________________________

Date Performed SUPERVISED BY

Immediate Newborn Cord Care Nurse/Midwife On Duty
and Clinical Instructor
Time Started Case Number
PERFORMED Name and Signature

Noted:________________________________________________________
Approved by: _______________________________________________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Date document is signed: _________________ Time: _____________
Date document is signed: ____________ Time: _________________________
Highest Nursing Degree Earned: _______________________________
Highest Nursing Degree Earned: ______________________________________
 ODC Form 2A
O.R. SCRUB FORM
University of the Cordilleras MAJOR
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MAJOR SURGICAL SCRUB in ___________________________________________________

Prepared by: ___________________________________

SUPERVISED BY
Date Performed and Clinical Instructor
Time Started Case
SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty
Name and Signature
Number

Approved by: _______________________________________________________

Noted:________________________________________________________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Date document is signed: ____________ Time: _________________________
Date document is signed: _________________ Time: _____________
Highest Nursing Degree Earned: ______________________________________
Highest Nursing Degree Earned: _______________________________
 CIRCULATING
O.R. MAJOR FORM
University of the Cordilleras
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MAJOR SURGICAL CIRCULATING in ___________________________________________________

Prepared by: ___________________________________

SUPERVISED BY
Date Performed and Clinical Instructor
Time Started Case
SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty
Name and Signature
Number

Approved by: _______________________________________________________

Noted:________________________________________________________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Date document is signed: ____________ Time: _________________________
Date document is signed: _________________ Time: _____________
Highest Nursing Degree Earned: ______________________________________
Highest Nursing Degree Earned: _______________________________
 University of the Cordilleras ODC Form 1A
Governor Pack Road, Baguio City, Philippines 2600 ACTUAL DELIVERY
FORM
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

ACTUAL DELIVERY__________________________________________________

Prepared by: ______________________________

SUPERVISED BY
Date Performed D.R. Nurse/Midwife On
Clinical Instructor
and
Case
PROCEDURE PERFORMED Duty
Name and Signature
Time Started
Number

Noted:________________________________________________________
Approved by: _______________________________________________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Date document is signed: _________________ Time: _____________
Date document is signed: ____________ Time: _________________________
Highest Nursing Degree Earned: _______________________________
Highest Nursing Degree Earned: ______________________________________
 University of the Cordilleras CIRCULATING
O.R. MINOR FORM
Governor Pack Road, Baguio City, Philippines 2600
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MINOR SURGICAL CIRCULATING _____________________________________________________

Prepared by: ______________________________

SUPERVISED BY
Date Performed
Clinical Instructor
and
Case
SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty
Name and Signature
Time Started
Number

Noted:________________________________________________________
Approved by: _______________________________________________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Date document is signed: _________________ Time: _____________
Date document is signed: ____________ Time: _________________________
Highest Nursing Degree Earned: _______________________________
Highest Nursing Degree Earned: ______________________________________
 University of the Cordilleras ODC Form 2B
O.R. SCRUB FORM
Governor Pack Road, Baguio City, Philippines 2600 MINOR
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MINOR SURGICAL SCRUB _____________________________________________________

Prepared by: ______________________________

SUPERVISED BY
Date Performed
Clinical Instructor
and
Case
SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty
Name and Signature
Time Started
Number

Noted:________________________________________________________
Approved by: _______________________________________________________
Clinical Coordinator, PRC I.D. No. :__________ Valid Until: ________
Dean, PRC I.D. No._____________________Valid Until: ___________________
Date document is signed: _________________ Time: _____________
Date document is signed: ____________ Time: _________________________
Highest Nursing Degree Earned: _______________________________
Highest Nursing Degree Earned: ______________________________________