ODC FORM Anna

ST.
PAUL COLLEGE OF ILOCOS SUR

Member: St. Paul University System (SPUS)
2727 St. Paul Avenue, Bantay, Ilocos Sur
www.spcis.edu.com
ODC Form 1A
ACTUAL DELIVERY FORM
ACTUAL DELIVERY in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Prepared by: ANNA LIZA A. CORPUZ
Date Performed Patient’s Name PROCEDURE PERFORMED ACTUAL

D.R. Nurse On Duty SUPERVISED BY
and DELIVERY Clinical Instructor
Time Started Case Number
October 11, 2019 C.T.S

11:31 am 1900091773 Normal Spontaneous Delivery Zenaida Ragasa, RN Mr. Melanio Rojas Jr., RN, MSN
October 11, 2019 S.M.T

October 10, 2019 M.S.A

10:32 am 1900099075 Normal Spontaneous Delivery Zenaida Ragasa, RN Ms. Rowena E. Quitorino, RN, MSN
Noted by: KATHLEEN R. PAREL, RN, MAN Approved by: SR. CAROLINA S. AGRAVANTE, RN, PhD
Clinical Coordinator, PRC I.D No.0311633 Valid Until: March 10, 2025 Dean, PRC I.D. No. 0022675 Valid Until: June 23, 2023
Date document is signed: ______________ Time:________ Date document is signed: ______________ Time:________
Highest Nursing Degree Earned: Master of Arts in Nursing Highest Nursing Degree Earned: Doctor of Philosophy
ST. PAUL COLLEGE OF ILOCOS SUR
www.spcis.edu.com
ODC Form 1B
ASSISTED DELIVERY FORM
ASSISTED DELIVERY in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name PROCEDURE PERFORMED

and ASSISTED DELIVERY Clinical Instructor
February 26, 2020 L.R

7:28 am 2000130751 Normal Spontaneous Delivery Donna A. Racaido, RN Ms. Rowena E. Quitorino, RN, MSN
November 28, 2019 J.R.S

October 11, 2019 J.M.R

www.spcis.edu.com ODC Form 1C
CORD CARE FORM
IMMEDIATE NEWBORN CORD CARE in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name Immediate Newborn Cord Care

and PERFORMED Clinical Instructor
November 28, 2019 Bb. Boy T.

1:24 Pm 1900100408 Nursery Analyn Contreras, RN Ms. Rowena E. Quitorino, RN, MSN
November 22, 2019 Bb. Girl B.

3:32 am 1600034843 Nursery Charito Dante, RN Ms. Rowena E. Quitorino, RN, MSN
October 11, 2019 Bb. Boy T.

8:49 am 140006992 Nursery Karen Agapinan, RN Mr. Melanio Rojas Jr., RN, MSN
www.spcis.edu.com
ODC Form 2A
O.R. SCRUB FORM
Major
SURGICAL SCRUB in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name SURGICAL PROCEDURE

and PERFORMED
Case Number Clinical Instructor
Time Started
June 3, 2022 V.U

1:46 pm 2200121563 Locking Plate Tibia and Fibula Left Rizza Abero, RN Ms. Rowena E. Quitorino, RN, MSN
May 28, 2022 A.K.T

Low Transverse Cesarean Section and
1:16 pm 1500021577 John Vincent Pajas, RN Ms. Rowena E. Quitorino, RN, MSN
Bilateral Tubal Ligation
May 20, 2022 R.C.C

Transurethral Resection of Bladder
6:12 pm 2200121412 John Vincent Pajas, RN Ms. Rowena E. Quitorino, RN, MSN
Tumor
www.spcis.edu.com
ODC Form 2B
O.R. MINOR FORM

and PERFORMED
Time Started
June 10, 2022 J.D.B.B

Appendectomy
6:48 am 2200721034 Charlene Arcano, RN, MAN Ms. Rowena E. Quitorino, RN, MSN
www.spcis.edu.com
D.R. Form
ACTUAL DELIVERY FORM
ACTUAL DELIVERY in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name PROCEDURE PERFORMED ACTUAL

and DELIVERY Clinical Instructor
October 11, 2019 C.T.S

October 11, 2019 S.M.T

October 10, 2019 M.S.A

10:32 am 1900099075 Normal Spontaneous Delivery Zenaida Ragasa, RN Ms. Rowena E. Quitorino, RN, MSN
www.spcis.edu.com
D.R. Form
ASSISTED DELIVERY FORM
ASSISTED DELIVERY in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name PROCEDURE PERFORMED

and ASSISTED DELIVERY Clinical Instructor
February 26, 2020 L.R

November 28, 2019 J.R.S

October 11, 2019 J.M.R

www.spcis.edu.com ICNB Form
IMMEDIATE CARE OF THE
NEWBORN FORM
IMMEDIATE NEWBORN CORD CARE in ILOCOS SUR PROVINCIAL HOSPITAL-GABRIELA SILANG, Tamag, Vigan City, Ilocos Sur
Date Performed Patient’s Name Immediate Newborn Cord Care

November 28, 2019 Bb. Boy T.

1:24 Pm 1900100408 Nursery Analyn Contreras, RN Ms. Rowena E. Quitorino, RN, MSN
November 22, 2019 Bb. Girl B.

3:32 am 1600034843 Nursery Charito Dante, RN Ms. Rowena E. Quitorino, RN, MSN
October 11, 2019 Bb. Boy T.

8:49 am 140006992 Nursery Karen Agapinan, RN Mr. Melanio Rojas Jr., RN, MSN
www.spcis.edu.com
O.R Form
O.R. SCRUB FORM
Major

and PERFORMED
Time Started
June 11, 2022 R.A.L

10:40 am Exploratomy Laparotomy John Vincent Pajas, RN Ms. Rowena E. Quitorino, RN, MSN
June 10, 2022

L.P.A Partial Hip Arthroplasty, Right
10:03 Rizza Abellero, RN Ms. Rowena E. Quitorino, RN, MSN
May 21, 2022

E.R.R
3:29 pm Low Transverse Cesarean section John Vincent Pajas, RN Ms. Rowena E. Quitorino, RN, MSN
www.spcis.edu.com O.R Form
O.R. CIRCULATING
FORM

June 10, 2022 E.A

7:52 am Low Transverse Cesarean Section Rizza Abero, RN Ms. Rowena E. Quitorino, RN, MSN
May 21, 2022 J.Q

4:53 pm pm Low Transverse Cesarean Section Janice De Marie Olivas, RN Ms. Rowena E. Quitorino, RN, MSN
May14, 2022
J.R.P Dilation and Curettage Charles Arcano, RN
10:03 am Ms. Rowena E. Quitorino, RN, MSN

ODC FORM Anna

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ST.

PAUL COLLEGE OF ILOCOS SUR

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name PROCEDURE PERFORMED ACTUAL

October 11, 2019 C.T.S

October 11, 2019 S.M.T

October 10, 2019 M.S.A

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name PROCEDURE PERFORMED

February 26, 2020 L.R

November 28, 2019 J.R.S

October 11, 2019 J.M.R

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name Immediate Newborn Cord Care

November 28, 2019 Bb. Boy T.

November 22, 2019 Bb. Girl B.

October 11, 2019 Bb. Boy T.

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name SURGICAL PROCEDURE

June 3, 2022 V.U

May 28, 2022 A.K.T

May 20, 2022 R.C.C

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name SURGICAL PROCEDURE

June 10, 2022 J.D.B.B

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name PROCEDURE PERFORMED ACTUAL

October 11, 2019 C.T.S

October 11, 2019 S.M.T

October 10, 2019 M.S.A

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name PROCEDURE PERFORMED

February 26, 2020 L.R

November 28, 2019 J.R.S

October 11, 2019 J.M.R

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name Immediate Newborn Cord Care

November 28, 2019 Bb. Boy T.

November 22, 2019 Bb. Girl B.

October 11, 2019 Bb. Boy T.

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name SURGICAL PROCEDURE

June 11, 2022 R.A.L

June 10, 2022

May 21, 2022

Prepared by: ANNA LIZA A. CORPUZ

Date Performed Patient’s Name SURGICAL PROCEDURE

June 10, 2022 E.A

May 21, 2022 J.Q

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