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 BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City
San Fernando, La Union

Prepared by:

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

Noted by: 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 1C
Governor Pack Road, Baguio City, Philippines 2600 CORD CARE FORM
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

IMMEDIATE NEWBORN CORD CARE in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City

Prepared by:

Date Performed SUPERVISED BY

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

Noted by: 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 1A
Governor Pack Road, Baguio City, Philippines 2600 ACTUAL DELIVERY
(+6374) 442-3316, 442-2564, 442-8219, 442-8256 FORM

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

ACTUAL DELIVERY BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City

Prepared by:

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

Noted by: 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
Governor Pack Road, Baguio City, Philippines 2600 O.R. MINOR FORM
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MINOR SURGICAL CIRCULATING in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City

Prepared by:

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

Noted by: 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
Governor Pack Road, Baguio City, Philippines 2600 O.R. MAJOR FORM
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MAJOR SURGICAL CIRCULATING in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City
San Fernando, La Union

Prepared by:

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

Noted by: 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 2A
Governor Pack Road, Baguio City, Philippines 2600 O.R. SCRUB FORM
MAJOR
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MAJOR SURGICAL SCRUB in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City

Prepared by:

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

Noted by: 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
Governor Pack Road, Baguio City, Philippines 2600 O.R. SCRUB FORM
MINOR
(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

MINOR SURGICAL SCRUB in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City

Prepared by:

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

Noted by: 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: