You are on page 1of 4

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 BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER.
BAGUIO CITY
Prepared by:
University of the Cordilleras
COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

RINA B. DECALAN

University of the Cordilleras
COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

Date Performed
Patient’s INITIAL Only
SUPERVISED BY
IMMEDIATE NEWBORN CARE CASE SLIP Immediate Newborn
IMMEDIATE NEWBORN
CARE CASE SLIP
Nurse/Midwife
On Duty
and
Agency: Baguio General Hospital and Medical Center
Agency: Baguio General Hospital and Medical Center Clinical Instructor
Cord Care PERFORMED
Time Started Hospital ( /) Case
Name
Number
Home ( ) Birthing/ Lying-in ( )
Hospital ( /)
Home ( ) Birthing/ Lying-in
( ) and Signature
Address: Baguio City
Name of Mother: Avyn G. Dawayen
Name of Baby: Baby Girl G. Dawayen
Date of Delivery: July 03, 2014
Time: 07:52 AM
03-18-14
JR.R.A
Case Number: 788780
Gender: Boy
12:45
PM Newborn Care Performed
763701
Immediate
at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
03-19-14
Others _____________________________________
J.Z.M
01:23
NamePM
of Performing Nurse: Rina B. Decalan
763855
Name of DR/ Nursery Nurse /Midwife: Maria Emma M.
Pangilinan, RN

Address: Baguio City
Name of Mother: Marie Z. Madayag
Name of Baby: James Z. Madayag
Date of Delivery: March 03, 2014
Time: 01:23 PM
Case
Number
:
763855
Gender:
Boy
DELIVERY ROOM
MYRNA D. SALIO-AN, RN
HUMBELINE F. SOKKONG, RN, MAN
Immediate Newborn Care Performed at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
Others _____________________________________
Performing
Nurse:
Rina B. Decalan
DELIVERY ROOM Name of MARIA
EMMA
M. PANGILINAN,
RN
HUMBELINE F. SOKKONG, RN, MAN
Name of DR/ Nursery Nurse /Midwife: Maria Emma M.
Pangilinan, RN

07-03-14
07:52 AM

DELIVERY ROOM

BG.G.D

SHEILA MARIA G.
BATOON, RN, MAN
788780
Clinical Instructor’s full Name and signature

PRC Number 0232434
Validity May 18, 2018
PNA Number _______________ Regular ( / ) Life Time ( )

SHEILA MARIA G. BATOON, RN,
HUMBELINE
F. SOKKONG,RN
RN, MAN
MARIA
EMMA M. PANGILINAN,
MAN
Clinical Instructor’s full Name and signature
PRC Number 0160939
Validity April 14, 2018
PNA Number _______________ Regular ( / ) Life Time ( )

Noted By: JULIET V. AVENA RN, MAN
Approved By: JUDITH ODANEE G. MAGWILANG RN, MAEd-Nsg, MAN
CI:
Clinical Coordinator,
PRC I.D. No: 0157672
Valid Until: November 09, 2016 CI:
Dean, PRC I.D. No: 0213569
Valid Until: March 07, 2018
No erasures
No erasures
Date document
is
signed:
_________________Time:
_________________
Date
document
is
signed:
___________________
Time: _____________
Complete and correct data
Complete and correct data
Highest Nursing
Degree
Earned
:
______________________________________________
Highest
Nursing
Degree
Earned
:
______________________________________
Sign in blue pen
Sign in blue pen
UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

2018 PNA Number _______________ Regular ( / ) Life Time ( ) CI: No erasures Complete and correct data Sign in blue pen UC-VPAA-CON-FORM-20d JUNE 2012 REV:00 . Aguilar Date of Delivery: March 18. 2014 Time: 12:45 PM Case Number: 763701 Gender: Boy Immediate Newborn Care Performed at: Delivery Room ( / ) Home ( ) Nursery ( ) Others _____________________________________ Name of Performing Nurse: Rina B.University of the Cordilleras COLLEGE OF NURSING Gov. MAN Clinical Instructor’s full Name and signature PRC Number 0160939 Validity April 14. 2600 Baguio City ========================================= ===== IMMEDIATE NEWBORN CARE CASE SLIP Agency: Baguio General Hospital and Medical Center Hospital ( /) Home ( ) Birthing/ Lying-in ( ) Address: Baguio City Name of Mother: Jenilyn R. SOKKONG. RN. RN HUMBELINE F. Salio-an. Decalan Name of DR/ Nursery Nurse /Midwife: Myrna D. Aguilar Name of Baby: John Renz R. Pack Road.

RN MEDIATRIX M. Baguio City. RN. Segundo Name of Baby: Xyrene Antheia S. Philippines 2600 ODC Form 1C CORD CARE FORM . Pack Road. Decalan Name of DR/ Nursery Nurse /Midwife: Elena A. Segundo Date of Delivery: February 16. 2600 Baguio City ========================================= ===== IMMEDIATE NEWBORN CARE CASE SLIP Agency: Benguet General Hospital Hospital ( /) Home ( ) Birthing/ Lying-in ( ) Address: KM5 La Trinidad Benguet Name of Mother: Roxy B. 2018 PNA Number _______________ Regular ( / ) Life Time ( ) CI: No erasures Complete and correct data Sign in blue pen UC-VPAA-CON-FORM-20d JUNE 2012 REV:00 University of the Cordilleras Governor Pack Road. 2015 Time: 03:56 PM Case Number: 479264 Gender: Girl Immediate Newborn Care Performed at: Delivery Room ( / ) Home ( ) Nursery ( ) Others _____________________________________ Name of Performing Nurse: Rina B. Comissing. MAN Clinical Instructor’s full Name and signature PRC Number 0400013 Validity February 18. LEE.University of the Cordilleras COLLEGE OF NURSING Gov.

2018 Date document is signed: _________________Time: _________________ Date document is signed: ___________________ Time: _____________ Highest Nursing Degree Earned: ______________________________________________ Highest Nursing Degree Earned: ______________________________________ . PRC I. LEE. 442-8219.ph IMMEDIATE NEWBORN CORD CARE IN BENGUET GENERAL HOSPITAL ECONOMIC ENTERPRISE KM5 LA TRINIDAD BENGUET Prepared by: RINA B. MAN Noted By: JULIET V.S. COMISSING. MAGWILANG RN.D. 442-2564. MAN Approved By: JUDITH ODANEE G. MAN Clinical Coordinator. RN SUPERVISED BY Clinical Instructor Name and Signature MEDIATRIX M.ph website: www. MAEd-Nsg. No: 0157672 Valid Until: November 09.D. PRC I. DECALAN Date Performed and Time Started Patient’s INITIAL Only 02-16-15 03:56 PM XA. No: 0213569 Valid Until: March 07. 2016 Dean.S 479264 Case Number Immediate Newborn Cord Care PERFORMED Nurse/Midwife On Duty DELIVERY ROOM ELENA A.bcf.(+6374) 442-3316. 442-8256 e-mail: webmaster@bcf. AVENA RN.edu.edu. RN.