Republic of the Philippines

Department of Health
COTABATO REGIONAL AND MEDICAL CENTER

SURNAME AGE

GIVEN NAME SEX

IVY [ ]M[/]F

DOCTORS ORDER/NURSES COMPLIANCE SHEET

(Authenticated all order)
C- Carried A- administered R- Request made
E- Endorsed D- Discontinue
Date C A R E D Time
Time ORDER Posted
Signature
3/22/2021 -Please admit to NICU / / MPC
9:00am -Consent to care / / MPC
-Oxygen inhalation via facial mask at 6Lpm/min / / / MPC
-Suction mouth and throat for secretions / / / MPC
-Vital signs monitor and record / / MPC
-Do anthropometric data, HC,CC, AC,LC and weighs the / / MPC
infant
-Hook D50.3 NSS 500 cc as venoclysis and place soluset / / / MPC
0f 50 cc IVF at KVO rate
-Insert NGT for feeding. Give 10 cc of breastmilk by / / / MPC
syringe thru NGT every 3 hrs
-Do cord dressing aseptically / / MPC

Dr. Sion Chua, Marielle P./Margallo,V.

NDU BSN 2 NDU CI
03/22/2021 9:00AM