PERPETUAL SUCCOUR HOSPITAL

DEPARTMENT OF PEDIATRICS

NAME:
GROUP #:
HOSPITAL:

NURSERY ROTATION DATE RESIDENT’S SIGNATURE

BCG
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

BALLARD’S SCORE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

DELIVERY ASSIST/RECEIVING
1.
2.
3.
4.
5.

OTHER PROCEDURES (IV INSERTION/OGT INSERTION/GASTRIC

LAVAGE, etc.)
1.
2.
3.
4.
5.
 PERPETUAL SUCCOUR HOSPITAL
DEPARTMENT OF PEDIATRICS

NAME:
GROUP #:
HOSPITAL:

WARDS ROTATION DATE RESIDENT’S SIGNATURE

HISTORY and PE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

IV INSERTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

OTHERS (NGT/OGT/LAVAGE/MANTOUX TEST/ABG etc.)

1.
2.
3.
4.
5.