NOTRE DAME OF TACURONG COLLEGE

COLLEGE OF NURSING
Lapu-Lapu St., Tacurong City, Sultan Kudarat, Philippines
Contact No. : (064) 200-3631 FAX No. : (064) 200-4131
Case No:
Patients Name:
Address:
Gravida:
Labor Started at:
Placenta Delivery:
Date Delivered:
of NB:
Weight of NB:
AC:
Temperature:

Date:
Age:
Parity:

Abortion:
BOW Ruptured at:
Time:
Time delivered:

Length:

Living:
Date:
Gender

HC:

CC:

Physician of NB:

Physician on Duty:

Handled by:

Nurse on Duty:

Midwife:

Diagnosis:

Handled by (student):
Assisted by (student):
Cord Dressed by (student):
Clinical Instructor:

PRC No:

Confirmed By:

PRC No:
DR NURSE ON DUTY
Signature over printed name

Verified by:
PRC No:
CLINICAL COORDINATOR
PRC No:
DEAN