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  • PRC normal delivery records

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    Raven Orlino
    92 views2 pages
    This document is a form for recording normal deliveries handled by an applicant. It includes spaces to record 20 cases, including the date and time of delivery, name and address of the facility where the delivery took place, the patient's name and diagnosis, and lines for the signature of the licensed supervisor who observed the applicant. Notes at the bottom specify that the clinical instructor should ensure the applicant's competence before signing, and that midwives supervising must have expanded midwifery training certification.

    Original Description:

    Original Title

    PRBSEC-49 Actual Deliveries Form

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    This document is a form for recording normal deliveries handled by an applicant. It includes spaces to record 20 cases, including the date and time of delivery, name and address of the facility where the delivery took place, the patient's name and diagnosis, and lines for the signature of the licensed supervisor who observed the applicant. Notes at the bottom specify that the clinical instructor should ensure the applicant's competence before signing, and that midwives supervising must have expanded midwifery training certification.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    92 views2 pages

    PRC normal delivery records

    Uploaded by

    Raven Orlino
    This document is a form for recording normal deliveries handled by an applicant. It includes spaces to record 20 cases, including the date and time of delivery, name and address of the facility where the delivery took place, the patient's name and diagnosis, and lines for the signature of the licensed supervisor who observed the applicant. Notes at the bottom specify that the clinical instructor should ensure the applicant's competence before signing, and that midwives supervising must have expanded midwifery training certification.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Professional Regulation Commission

    RECORD OF NORMAL DELIVERIES HANDLED G

    Please Check:
    Name of Applicant: _________________________________________ School: __________________________________________

    Supervised by:
    Date & Full Name,
    Name and Address of Case License No./
    Time Address of Facility Printed Name Position/
    Patient No. Complete Diagnosis Signature Expiration
    Performed & Contact Number & Contact Designation
    Date
    No.
    1.

    2.

    3.

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    10.

    (Continued at the Back)

    PRBSEC-49
    Rev. 00
    January 24, 2020
    Page 1 of 1
    Supervised by:
    Date & Full Name,
    Name and Address of Case License No./
    Time Address of Facility Printed Name Position/
    Patient No. Complete Diagnosis Signature Expiration
    Performed & Contact Number & Contact Designatio
    Date
    No. n
    11.

    12.

    13.

    14.

    15.

    16.

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    19.

    20.

    Note: 1) The Clinical Instructor should ensure the competence of the students in the performance of actual deliveries before signing this form.
    2) Registered Midwives/Clinical Instructors who supervise Students/Graduate Midwives/Registered Nurses and affix their signature in this Form must present a
    Certificate of Training on Expanded Functions of Midwife (R.A. 7392) pursuant to Board Resolution No. 07, Series of 2017, dated September 8, 2017.

    CERTIFIED CORRECT:

    Signature: Date:
    Printed Name:
    Designation: ___________________________
    License Number: Expiry Date:

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