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PRC-BON Memorandum Order No. 2-b Series of 2009
Case Forms of the Revised Guidelines on Deliveries (Intra-Partal), Cord Care ...
UNIVERSITY OF SAN CARLOS
COLLEGE OF NURSING, NASIPIT, TALAMBAN, CEBU CITY 6000 PHILIPPINESPHONE: 032 3433005; FAX: 032 3433006; nursdean@usc.edu.ph; www.usc.edu.phPAASCU ACCREDITED, LEVEL II, MAY 5, 2008 – MAY 2011IMMEDIATE NEWBORN CORD CARE in _____________________________________________________Hospital/Home/Lying-in Clinic, Municipality/City/ProvincePrepared by:Printed Name with Signature of Student: ____________________________________
Date Performed and TimeStartedPatient’s INITIALS (only)Case Number (not applicable for Birthing Home/Lying-in Clinics/ Names)IMMEDIATE NEWBORN CORD CARE PERFORMED(Indicate where performed e.g. D.R., Nursery, or Home)O.R. Nurse On Duty(Name and Signature)(If midwife on Duty, Signature NotRequired)SUPERVISED BYClinical Instructor (Name and Signature)
Noted by: __________________________________________________________ Approved by: _______________________________________________(Print Name and Signature) (Print Name and Signature)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___________________Please Specify Highest Nursing Degree Earned_________________________________ Specify Highest Nursing Degree Earned_____________________________
(STRICTLY NO DESIGNATES)
ODC Form 1CCORD CARE FORM
UNIVERSITY OF SAN CARLOS
COLLEGE OF NURSING, NASIPIT, TALAMBAN, CEBU CITY 6000 PHILIPPINESPHONE: 032 3433005; FAX: 032 3433006; nursdean@usc.edu.ph; www.usc.edu.phPAASCU ACCREDITED, LEVEL II, MAY 5, 2008 – MAY 2011 ACTUAL DELIVERY in _____________________________________________________Hospital/Home/Lying-in Clinic, Municipality/City/ProvincePrepared by:Printed Name with Signature of Student: ____________________________________
Date Performed and TimeStartedPatient’s INITIALS (only)Case Number (not applicable for Birthing Home/Lying-in Clinics/ Names)PROCEDURE PERFORMEDASSISTED DELIVERYD.R. Nurse On Duty(Name and Signature)(If midwife on Duty, Signature NotRequired)SUPERVISED BYClinical Instructor (Name and Signature)
Noted by: __________________________________________________________ Approved by: _______________________________________________(Print Name and Signature) (Print Name and Signature)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___________________Please Specify Highest Nursing Degree Earned_________________________________ Specify Highest Nursing Degree Earned_____________________________
(STRICTLY NO DESIGNATES)
ODC Form 1BASSISTED DELIVERY FORM
UNIVERSITY OF SAN CARLOS
COLLEGE OF NURSING, NASIPIT, TALAMBAN, CEBU CITY 6000 PHILIPPINESPHONE: 032 3433005; FAX: 032 3433006; nursdean@usc.edu.ph; www.usc.edu.phPAASCU ACCREDITED, LEVEL II, MAY 5, 2008 – MAY 2011 ACTUAL DELIVERY in _____________________________________________________Hospital/Home/Lying-in Clinic, Municipality/City/ProvincePrepared by:Printed Name with Signature of Student: ____________________________________
Date Performed and TimeStartedPatient’s INITIALS (only)Case Number (not applicable for Birthing Home/Lying-in Clinics/ Names)PROCEDURE PERFORMEDD.R. Nurse On Duty(Name and Signature)(If midwife on Duty, Signature NotRequired)SUPERVISED BYClinical Instructor (Name and Signature)
Noted by: __________________________________________________________ Approved by: _______________________________________________(Print Name and Signature) (Print Name and Signature)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___________________Please Specify Highest Nursing Degree Earned_________________________________ Specify Highest Nursing Degree Earned_____________________________
(STRICTLY NO DESIGNATES)
ODC Form 1AACTUAL DELIVERY FORM
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Prc Forms Final
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| Upload Date: | 12/08/2009 |
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