Puting Kahoy, Silang, Cavite

P.O.Box 1834, Manila, 1099 Philippines

Tel. # (049) 5411211, Fax # (049) 5411228, Web-site: www.aup.edu.ph
Accredited by: Association of Christian Schools, Colleges and Universities Accrediting Agency, Inc./Federation of Accrediting Agencies of the Philippines
Level IV Re-accreditation Status (August 2012 - December 2015, December 2016-December 2021)
Re-accreditation Autonomous Status (October 2003-October 2008; March 2009-December 2015; April 1, 2016-May 31, 2019)

STA ROSA COMMUNITY HOSPITAL- Santa Rosa, Laguna

ACTUAL DELIVERY in
Hospital, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student: ARPON, MARY DOIND LLYRA B.

Date Performed and Patient’s Name SUPERVISED BY

PROCEDURE D.R. Nurse on Duty
Time Started Case Number (Name and Signature) Clinical Instructor
(not applicable for Birthing Homes Lying-in PERFORMED
(If Midwife on Duty, Signature not required) Name and Signature
Clinics/Homes)
October 23, 2019
07:10 AM Rosellie Estacio Marzon Normal Spontaneous Delivery
Bianca Louise C. Casis, RN Rhodie mae M. Javier, RN, MAN
19-4865

Noted by: Joyosthie B. Orbe RN,Ph.D Approved by: Susy A. Jael RN, Ph.D
(Signature over printed name) (Signature over printed name)
Clinical Coordinator, PRC I.D. NO. 0245891 Valid Until October 29, 2022 Dean, PRC I.D. No. 0182103 Valid Until February 12, 2020
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Doctor of Philosophy in Nursing Specify Highest Nursing Degree Earned: Doctor of Philosophy in Nursing