ACTUAL DELIVERY in SOUTHWESTERN UNIVERSITY MEDICAL CENTER

Hospital / Home / Lying-In Clinic, Municipality / City / Province

Prepared by:
Printed Name and Signature of Student HEDI VEE MARIE GARCIANO JANSON

Patient’s INITIAL (only)

SUPERVISED BY
Date Performed and PROCEDURE D.R. Nurse On Duty
Clinical Instructor
Time Started PERFORMED (Name and Signature)
Name and Signature
Case Number

August 19, 2022 J. G. E. Normal Spontaneous JOLIVE CASHMERE E.

9:32am 236519 Vaginal Delivery CAMPOMANES, MAN, RN MARIE CHRISTINE N. MERCADO, Ed.D.,
MAN, RN

Noted by: JILL MARIE C. HERMOGENES Approved by: MICHELLE B. YU

OR/DR Clinical Coordinator, PRC I.D. No. 0226819 Valid Until December 4, 2024 Dean, PRC I.D. No. 0366827 Valid Until November 14, 2024
Date document is signed:________Time____________ Date document is signed:________Time________
Please specify Highest Nursing Degree Earned: RN, MAN, Ed.D. Specify Highest Nursing Degree Earned: RN, MAN, DM