LICEO DE CAGAYAN UNIVERSITY

Paseo del Rio Campus, Macasandig, Cagayan de Oro City

COLLEGE OF NURSING

HANDLED DELIVERY

Name of Patient: __________________________________________ Age:__________

Case Number: ___________________________________

Name of Hospital:_______________________________________________________

Date of Delivery:___________________________ Time of Delivery: ______________

Type of Delivery:___________________________ Gender of Baby: ______________

Post Partum Diagnosis:

______________________________________________________________________________

Name of Student:________________________________________________________

Name and Signature of DR Nurse on Duty: ___________________________________

Name and Signature of Clinical Instructor: ___________________________________

Name Signature of DR Nurse Supervisor: ____________________________________

 LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
ASSISTED DELIVERY

Name of Patient: __________________________________________ Age:__________

Case Number: _______________________

Name of Hospital:______________________________________________

Date of Delivery:___________________________ Time of Delivery: ______________

Type of Delivery:___________________________ Gender of Baby: ______________

Post Partum Diagnosis:

______________________________________________________________________________

Name of Student:________________________________________________________

Name and Signature of DR Nurse on Duty: ___________________________________

Name and Signature of Clinical Instructor: ___________________________________

Name Signature of DR Nurse Supervisor: ____________________________________

 LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
IMMEDIATE NEWBORN CARE

Name of Baby: _______________________________________ Case No. __________

Name of Mother: __________________________________________ Age:__________

Name of Hospital:_______________________________________________________

Date of Delivery: __________________________ Time of Delivery: ______________

Type of Delivery: __________________________ Gender of Baby: ______________

Vital Measurements:

Weight: ___________ Kg.

Temperature: ___________ ºC

Head Circumference: ___________ cm

Chest Circumference ___________ cm

Abdominal Circumference: ___________ cm

Mid-Arm Circumference ___________ cm

Length: ___________ cm

Apgar Score: ___________

Name of Student: ________________________________________________________

Name and Signature of DR/NICU Nurse on Duty: _____________________________

Name and Signature of Clinical Instructor: ___________________________________

Name Signature of DR/NICU Nurse Supervisor: _______________________________