Lyceum of the Philippines University

Capitol Site, Batangas City

(043) 723-0706 local 109-110/www.lyceumbatangas.edu.ph
PACUCOA ACCREDITED, LEVEL IV, Accredited Status
ACTUAL DELIVERY in Batangas Provincial Hospital/LEMERY, BATANGAS

DR Form
ACTUAL DELIVERY

Prepared by: _Jacinto, Sandra E._

Date Performed Patient’s INITIAL Only

and PROCEDURE PERFORMED DR Nurse on Duty SUPERVISED BY
Time Started Case Number

November 18, 2019 MG Normal Spontaneous Delivery Mrs. Maricel Magboo

10:00 am

Concurred by: Approved by:

LIZA I. VERGARA, RN, MAN

____________________________ Cecilia C. Pring, RN, MAN, PhD
Chief Nurse Dean, College of Nursing
 Lyceum of the Philippines University
Capitol Site, Batangas City
(043) 723-0706 local 109-110/www.lyceumbatangas.edu.ph
PACUCOA ACCREDITED, LEVEL IV, Accredited Status
Immediate Care of the Newborn in Batangas Provincial Hospital/LEMERY, BATANGAS

ICNB Form
Immediate Care of
the Newborn
Prepared by: _Jacinto, Sandra E._

Date Performed Patient’s INITIAL Only

Immediate Newborn Cord Care
and DR Nurse on Duty SUPERVISED BY
Case Number PERFORMED
Time Started

November 18, 2019 Baby Girl AG Delivery Room Mrs. Maricel Magboo
10:20 am

Concurred by:
Approved by:
LIZA I. VERGARA, RN, MAN
____________________________ Cecilia C. Pring, RN, MAN, PhD
Chief Nurse Dean, College of Nursing