Olivarez College Tagaytay College of Nursing

E. Aguinaldo Hi-way Brgy. San Jose, Tagaytay City, Cavite Tel # (046) 860-2301

ODC Form 2 ACTUAL DELIVERY

ACTUAL DELIVERY in Dra. Olivia Salamanca Memorial Hospital Cavite City, Cavite

Prepared by: Name of Student _Ganuelas, Alvin, Malabanan_____________________ Signature of Student____________________________________________

No. 1 2 3

Date of Operation 1-1-2012

Time Started 12:00am

Case # 00123

Name of Patient GMA

TYPE OF DELIVERY
NORMAL SPONTANOUS VAGINAL DELIVERY

D.R. Nurse/Midwife on Duty

(Name Only)

Clinical Instructor

Supervised by:
( Name and Signature )

Laila s. Delima, RN

Winifredo Licop, RN

Concurred by:

Noted by:

Approved by:
Dean

Highest Nursing Degree Earned: ________________________ PRC No. _________ PNA No. ________ Date Signed : ________________ Valid Until ________ Valid Until ________ Time : __________________

linical Coordinator

__________________________________ (Signature Over Printed Name) Chief Nurse

Alvin M. Ganuelas, RN (Signature Over Printed Name) Highest Nursing Degree Earned: BSN, MAN PRC No. 1234567_ Valid Until 02-16-08 PNA No. ________ Valid Until ________ Date Signed : Time : ________________ __________________

Jean Rizza A. Dela Cruz, RN (Signature Over Printed Name) Highest Nursing Degree Earned: BSN, MAN PRC No. 1234567_ Valid Until 02-16-08 ADPCN No. 123__ Valid Until ________ PNA No. 12345___ Valid Until ________ Date Signed : ________________ Time : __________________