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University of the Cordilleras Governor Pack Road, Baguio City, Philippines 2600 (+6374) 442-3316, 442-2564, 442-8219, 442-8256

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

ODC Form 1C
CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE in ____ Ilocos Training and Regional Medical Center, San Fernando City La Union ___ Prepared by: Paul Melan G. Pangilinan ____________________
Date Performed and Time Started October 14, 2010 12:32 PM October 14, 2010 1:28 PM October 14, 2010 3:24 PM Patients INITIALS Case Number Baby Boy D. Nursery Editha Balancio Sheila Maria Batoon SUPERVISED BY Clinical Instructor

Immediate Newborn Cord Care PERFORMED

Nurse On Duty

Baby Boy P.

Nursery

Editha Balancio Editha Balancio

Sheila Maria Batoon Sheila Maria Batoon

Baby Boy L.

Nursery

Noted by: __________ Judith Odanee G. Magwilang__________ Clinical Coordinator, PRC I.D. No.: 0213569 Valid Until: March/07/2012 Date document is signed: _________________ Time: _____________ Highest Nursing Degree Earned: Master of Arts in Education, Major in Maternal and Child Nursing, MANc

Approved by: __________ Marian Grace A. Gascon__________ Dean, PRC I.D. No. 0058389 Valid Until: February/01/2012 Date document is signed: ____________ Time: _________________________ Highest Nursing Degree Earned: Master of Arts in Nursing

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