As adopted by Far Eastern University- Dr.

Nicanor Reyes Medical Foundation School of Nursing

Far Eastern University- Dr. Nicanor Reyes Medical Foundation

Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: www.feu-nrmf.edu.ph with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007) Prepared by: ________________________________________ (Printed Name and Signature of Student) Date Performed and Time Started Patients Initial Only Case Number
(not applicable for Birthing Homes, Lying- In Clinics/ Homes)

ODC Form 1A Actual Delivery Form

Student Number: ___________________

PROCEDURE PERFORMED
(Indicate where performed eg. D.R., Nursery, NICU, or Home)

Nurse On Duty
(If Midwife on Duty, signature not required)

Signature

Supervised by (Clinical Instructor)

Signature

Noted by: MA. LIBERTY DG. PASCUAL, RN, MAN, Ph. D. Clinical Coordinator PRC ID. No. ___________ Valid Until _______________________ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN, Ph. D.

Approved by: TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. _______________ Valid Until __________________ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: MAN,

Ed. D.

As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing

Far Eastern University- Dr. Nicanor Reyes Medical Foundation

Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: www.feu-nrmf.edu.ph with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007)

ODC Form 1B Assisted Delivery Form

Prepared by: ________________________________________ (Printed Name and Signature of Student) Date Performed and Time Started Patients Initial Only Case Number
(not applicable for Birthing Homes, Lying- In Clinics/ Homes)

Student Number: ___________________

PROCEDURE PERFORMED
(Indicate where performed eg. D.R., Nursery, NICU, or Home)

Nurse On Duty
(If Midwife on Duty, signature not required)

Signature

Supervised by (Clinical Instructor)

Signature

Noted by: MA. LIBERTY DG. PASCUAL, RN, MAN, Ph. D. Clinical Coordinator PRC ID. No. ___________ Valid Until _______________________ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN, Ph. D. Ed. D.

Approved by: TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. _______________ Valid Until __________________ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: MAN,

As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing

Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: www.feu-nrmf.edu.ph with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007) Prepared by: ________________________________________ (Printed Name and Signature of Student) Patients Initial Student Number: ___________________

Far Eastern University- Dr. Nicanor Reyes Medical Foundation

ODC Form 1C Cord Care

Date Performed and Time Started

Only Case Number

(not applicable for Birthing Homes, Lying- In Clinics/ Homes)

Immediate New Born Cord Care PERFORMED

(Indicate where performed eg. D.R., Nursery, NICU, or Home)

Nurse On Duty
(If Midwife on Duty, signature not required)

Signature

Supervised by (Clinical Instructor)

Signature

Noted by: MA. LIBERTY DG. PASCUAL, RN, MAN, Ph. D. Clinical Coordinator PRC ID. No. ___________ Valid Until _______________________ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN, Ph. D. Ed. D.

Approved by: TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. _______________ Valid Until __________________ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: MAN,

As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing

Far Eastern University- Dr. Nicanor Reyes Medical Foundation

Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: www.feu-nrmf.edu.ph with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007) Prepared by: ________________________________________ (Printed Name and Signature of Student) Date Performed and Time Started Patients Initial Only Case Number SURGICAL PROCEDURE PERFORMED Student Number: ___________________

ODC Form 2A O.R. SCRUB FORM MAJOR

O.R. Nurse On Duty

Signature

Supervised by (Clinical Instructor)

Signature

Noted by: CONCEMARCIA V. BACON, RN, MAN Clinical Coordinator PRC ID. No. ___________ Valid Until _______________________ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN Ed. D.

Approved by: TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. _______________ Valid Until __________________ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: MAN,

As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing

Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: www.feu-nrmf.edu.ph with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007) Prepared by: ________________________________________ (Printed Name and Signature of Student) Date Performed and Time Started Patients Initial Only Case Number SURGICAL PROCEDURE PERFORMED Student Number: ___________________

Far Eastern University- Dr. Nicanor Reyes Medical Foundation

ODC Form 2B O.R. MINOR FORM

O.R. Nurse On Duty

Signature

Supervised by (Clinical Instructor)

Signature

Noted by:

Approved by:

Ed. D.

CONCEMARCIA V. BACON, RN, MAN Clinical Coordinator PRC ID. No. ___________ Valid Until _______________________ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN

TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. _______________ Valid Until __________________ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: MAN,