SILLIMAN UNIVERSITY COLLEGE OF NURSING Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines Tel. No.

(035) 422-6002 LOCAL 500 or 501/Fax No. (035) 422-3652/ E-mail: sucn@su.edu.ph PHILIPPINE ACCREDITING ASSOCIATION OF SCHOOLS, COLLEGES, AND UNIVERSITIES, LEVEL III, 2009-2014 ACTUAL DELIVERIES in Negros Oriental Provincial Hospital, Dumaguete City 6200, Negros Oriental Prepared by:

ODC FORM 1A ACTUAL DELIVERYFORM

Date Performed and Time Started

Patients Initials Case Number

Procedure Performed Handled

D.R Nurse On Duty (Name and signature)

Supervised By Clinical Instructor (Name and signature)

Handled Handled Handled Handled

Noted by: ASST. PROF. TITA Q. DUMALAG Clinical Coordinator, PRC No.: 0041761 Valid Until: Jan. 31, 2013 Date document is signed: Time: Please specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.

Approved by: PROF. FLORENDA F. CABATIT Dean, PRC No.: 0087492 Valid Until: July 2, 2013 Date document is signed: Time: Please Specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.
ODC FORM 1B ASSISTED DELIVERY FORM

SILLIMAN UNIVERSITY COLLEGE OF NURSING

Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines Tel. No. (035) 422-6002 LOCAL 500 or 501/Fax No. (035) 422-3652/ E-mail: sucn@su.edu.ph PHILIPPINE ACCREDITING ASSOCIATION OF SCHOOLS, COLLEGES, AND UNIVERSITIES, LEVEL III, 2009-2014 ASSISTED DELIVERIES in Negros Oriental Provincial Hospital, Dumaguete City 6200, Negros Oriental Prepared by:

Date Performed and Time Started

Patients Initials Case Number

Procedure Performed Assisted

D.R Nurse On Duty (Name and signature)

Supervised By Clinical Instructor (Name and signature)

Assisted

Assisted

Assisted

Assisted

Noted by: ASST. PROF. TITA Q. DUMALAG Clinical Coordinator, PRC No.: 0041761 Valid Until: Jan. 31, 2013 Date document is signed: Time: Please specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.

Approved by: PROF. FLORENDA F. CABATIT Dean, PRC No.: 0087492 Valid Until: July 2, 2013 Date document is signed: Time: Please Specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N. ODC FORM 1C CORD CARE FORM

SILLIMAN UNIVERSITY COLLEGE OF NURSING

Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines Tel. No. (035) 422-6002 LOCAL 500 or 501/Fax No. (035) 422-3652/ E-mail: sucn@su.edu.ph PHILIPPINE ACCREDITING ASSOCIATION OF SCHOOLS, COLLEGES, AND UNIVERSITIES, LEVEL III, 2009-2014 IMMEDIATE NEWBORN CORD CARE in Negros Oriental Provincial Hospital, Dumaguete City 6200, Negros Oriental Prepared by:

Date Performed and Time Started

Patients Initials Case Number

Procedure Performed Cord Care

D.R Nurse On Duty (Name and signature)

Supervised Clinical Instructor (Name and signature)

Cord Care

Cord Care

Cord Care

Cord Care

Noted by: ASST. PROF. TITA Q. DUMALAG Approved by: PROF. FLORENDA F. CABATIT Clinical Coordinator, PRC No.: 0041761 Valid Until: Jan. 31, 2013 Dean, PRC No.: 0087492 Valid Until: July 2, 2013 Date document is signed: Time: Date document is signed: Time: FORM 2A ODC Please specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N. Please Specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N. O.R. SCRUB FORM SILLIMAN UNIVERSITY COLLEGE OF NURSING MAJOR Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines

Tel. No. (035) 422-6002 LOCAL 500 or 501/Fax No. (035) 422-3652/ E-mail: sucn@su.edu.ph PHILIPPINE ACCREDITING ASSOCIATION OF SCHOOLS, COLLEGES, AND UNIVERSITIES, LEVEL III, 2009-2014 SURGICAL SCRUBS in Silliman Medical Center Dumaguete City 6200, Negros Oriental Prepared by:

Date Performed and Time Started

Patients Initials Case Number

Surgical Procedure Performed

O.R Nurse On Duty (Name and signature)

Supervised By Clinical Instructor (Name and signature)

Noted by: ASST. PROF. TITA Q. DUMALAG Clinical Coordinator, PRC No.: 0041761 Valid Until: Jan. 31, 2013 Date document is signed: Time: Please specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.

Approved by: PROF. FLORENDA F. CABATIT Dean, PRC No.: 0087492 Valid Until: July 2, 2013 Date document is signed: Time: Please Specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N. ODC FORM 2B O.R. SCRUB FORM MINOR

SILLIMAN UNIVERSITY COLLEGE OF NURSING Hibbard Avenue, Dumaguete City 6200, Negros Oriental, Philippines

Tel. No. (035) 422-6002 LOCAL 500 or 501/Fax No. (035) 422-3652/ E-mail: sucn@su.edu.ph PHILIPPINE ACCREDITING ASSOCIATION OF SCHOOLS, COLLEGES, AND UNIVERSITIES, LEVEL III, 2009-2014 SURGICAL SCRUBS in Silliman Medical Center, Dumaguete City 6200, Negros Oriental Prepared by:

Date Performed and Time Started

Patients Initials Case Number

Surgical Procedure Performed

O.R Nurse On Duty (Name and signature)

Supervised By Clinical Instructor (Name and signature)

Noted by: ASST. PROF. TITA Q. DUMALAG Clinical Coordinator, PRC No.: 0041761 Valid Until: Jan. 31, 2013 Date document is signed: Time: Please specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.

Approved by: PROF. FLORENDA F. CABATIT Dean, PRC No.: 0087492 Valid Until: July 2, 2013 Date document is signed: Time: Please Specify Highest Nursing Degree Earned: B.S.N.,R.N., M.A.N.