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DR Cases Form

The document is a form from St. Joseph's College of Quezon City Institute of Nursing documenting immediate newborn cord care performed in the delivery room of Pasay City General Hospital. It records the initials of the patient, date, time and location that cord care was performed, and is signed by the clinical instructor and clinical coordinator verifying the documentation.

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Cyrus Garcia
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112 views3 pages

DR Cases Form

The document is a form from St. Joseph's College of Quezon City Institute of Nursing documenting immediate newborn cord care performed in the delivery room of Pasay City General Hospital. It records the initials of the patient, date, time and location that cord care was performed, and is signed by the clinical instructor and clinical coordinator verifying the documentation.

Uploaded by

Cyrus Garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

ST.

JOSEPH'S COLLEGE OF QUEZON CITY


Institute of Nursing
295 E. Rodriquez Sr. Blvd, Quezon City
Tel. No. 725-8386

IMMEDIATE NEWBORN CORD CARE in Pasay City Ge

Prepared by:

Villamor, Karl Adrian


Name and Signature of Student

Patient's INITIAL Only


Date Performed Immediate Newborn Cord Care PERFORMED
and Case Number Indicate where
(not applicable for perfomed e.g. D.R., Nusery,
Time Started birthing/lying-in NICU or home
clinics/homes
4/12/2022 F.V.
Delivery Room
10:25 AM

Delivery Room

Delivery Room

Noted by: MANUEL PRIMITIVO R. LIMON, RN, MAN, MSN Noted by:
Clinical Coordinator
PRC ID No. 405410 Valid Until: June 10, 2024 PRC ID No.
Date Document is Signed:____________________ Time:________________ Date Document is Signed:__
Highest Nursing Degree Earned: Master of Arts In Nursing Highest Nursing Degree Earn
EGE OF QUEZON CITY
of Nursing
Sr. Blvd, Quezon City ODC FORM IC
Cord Care Form
725-8386

ARE in Pasay City General Hospital

D.R. Nurse on Duty


(Name
and Signature) SUPERVISED BY:
(If Clinical Instructor
midwife on duty, signature not (Name and Signature)
required)

Marjon L. Gonzales, RN

Marjon L. Gonzales, RN

Marjon L. Gonzales, RN

AGNETIA C. NAVAL, SFIC


Dean, Institute of Nursing
34501 Valid Until: July 6, 2024
e Document is Signed:____________________ Time:________________
hest Nursing Degree Earned: PhD
ST. JOSEPH'S COLLEGE OF QUEZON CITY
Institute of Nursing
295 E. Rodriquez Sr. Blvd, Quezon City D.R. FORM
Actual Delivery Form
Tel. No. 725-8386

ACTUAL DELIVERY in Pasay City General Hospital

Prepared by:

Villamor, Karl Adrian


Name and Signature of Student

Patient's INITIAL Only


D.R. Nurse on Duty
Date Performed (Name and Signature) SUPERVISED BY:
and Case Number PROCEDURE PERFORMED (If midwife on Clinical Instructor
Time Started (not applicable for duty, signature not required) (Name and Signature)
birthing/lying-in
clinics/homes
4/5/2022
C.M. Normal Spontaneous Delivery
7:25 AM Marjon L. Gonzales, RN

Normal Spontaneous Delivery


Marjon L. Gonzales, RN

Normal Spontaneous Delivery


Marjon L. Gonzales, RN

Noted by: MANUEL PRIMITIVO R. LIMON, RN, MAN, MSN Noted by: AGNETIA C. NAVAL, SFIC
Clinical Coordinator Dean, Institute of Nursing
PRC ID No. 405410 Valid Until: June 10, 2024 PRC ID No. 34501 Valid Until: July 6, 2024
Date Document is Signed:____________________ Time:________________ Date Document is Signed:____________________ Time:________________
Highest Nursing Degree Earned: Master of Arts In Nursing Highest Nursing Degree Earned: PhD

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