MANILA TYTANA COLLEGES

Formerly Manila Doctors College

A Partner of the Metrobank Group

Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City

Tel. No. (02)859-0812/Fax No. (02)859-0875
PAASCU Level II Re-Accredited Status, November 2011 - November 2016

ACTUAL DELIVERY IN______ __STA. ANA HOSPITAL __________

Hospital/Home/Lying-In Clinic, Municipality/City/Province
D.R. FORM
Prepared by: ACTUAL DELIVERY FORM
Printed Name with Signature of Student__ Skye Dana Jebunan Mercado
Date Performed Patient’s INITIAL (only) D.R. Nurse on Duty SUPERVISED BY:
PROCEDURE (Name and Signature)
and Case Number (not applicable for Clinical Instructor
PREFORMED (If Midwife on Duty, Signature Not
Time Started Birthing/Lying-in Clinics/Home) Required) Name and Signature

January 21, 2015 5:45pm 25252 A.C.V. Normal Spontaneous Delivery

Katherine S. Yap, RN Aurea Tiangco RN, MAN

IMMEDIATE NEWBORN CORD CARE IN__ STA. ANA HOSPITAL ________

Hospital/Home/Lying-In Clinic, Municipality/City/Province
ICNB FORM IMMEDIATE CARE
Prepared by: OF THE NEWBORN FORM
Printed Name with Signature of Student___ Skye Dana Jebunan Mercado ______________
Patient’s INITIAL (only) IMMEDIATE NEWBORN D.R. Nurse on Duty
Date Performed SUPERVISED BY:
CORD CARE PERFORMED (Name and Signature)
and Case Number (not applicable for Clinical Instructor
Performed e.g. DR, Nursery, (If Midwife on Duty, Signature Not
Time Started Birthing/Lying-in Clinics/Home) Required) Name and Signature
NICU or Home
January 21, 2015 6:40pm 252233 Baby Girl Delivery Room
Katherine S. Yap, RN Aurea Tiangco RN, MAN

(STRICTLY NO DESIGNATES)
st
(This Form must be printed at the back of the 1 page of the Competency-Based Performance Evaluation Checklist prescribed by the BoN)