Cebu Normal University

ODC Form 2B
O.R. Circulating FORM

College of Nursing
Osmeña Boulevard Cebu City 6000
254 – 4837 / cnucollegeofnursing@live.com.ph
Level III RE-ACCREDITED STATUS, AACUP

Deliveries Assisted in Cebu City Medical Center

Prepared by:
Printed Name with Signature of Student REYES, JACOB C.

Patient’s Initials (only) Supervised by

D.R. Nurse on Duty
Date and Time of Delivery Type of Delivery Clinical Instructor
Case Number (Name and Signature)
Name and Signature
09/21/2009 L.M.F. Normal Spontaneous
7:38 pm 008239 Vaginal Delivery Ma. Arnil C.Arceo, RN Miriam B. Nayon, RN
09/26/2009 R.L.E. Normal Spontaneous
7:11 pm 197789 Vaginal Delivery Joy N. Milan, RN Miriam B. Nayon, RN
07/14/2010 A.R.T. Normal Spontaneous
Estrelieta L. Rabasano, RN Lagrimas G. Elizon, RN
7:39 am 202807 Vaginal Delivery

Noted by: __ Julius C. Daño_______ Approved by: _____Daisy R. Palompon_____

Supervised by:__ _Aida A. Inabangan___
(Print Name and Signature)
DR Coordinator, PRC I.D. No. 0065350 Valid until: 2013
Date Document is signed: _____________ Time _________
Highest Nursing Degree Earned: Masters in Nursing with
Doctoral units
(Print Name and Signature)
Clinical Coordinator, PRC I.D. No. 0155912
Valid Until July 1,2012
Date Document is signed: _____________ Time ___________
Please specify Highest Nursing Degree Earned: MAEd, MPHC,
RN
(Print Name and Signature)
Dean, PRC I.D. No. 0253183 Valid Until July 3, 2011
Date Document is signed: ____________ Time ___________
Please specify Highest Nursing Degree Earned: Ph.D, MAN,
RN
 Cebu Normal University
ODC Form 2B
O.R. Circulating FORM

College of Nursing
Osmeña Boulevard Cebu City 6000
254 – 4837 / cnucollegeofnursing@live.com.ph
Level III RE-ACCREDITED STATUS, AACUP

Actual Deliveries in Cebu Puericulture Center and Maternity House Incorporated

Prepared by:
Printed Name with Signature of Student REYES, JACOB C.

Patient’s Initials (only) Supervised by

D.R. Nurse on Duty
Date and Time of Delivery Type of Delivery Clinical Instructor
Case Number (Name and Signature)
Name and Signature
04/15/2010 M.G.T. Normal Spontaneous
8:51 pm 058546 Vaginal Delivery Rosejune L. Ortega, RN Jerald S. Ugdoracion, RN

08/01/2010 P.C.M.C.V. Normal Spontaneous

8:44 am 061420 Vaginal Delivery Maria Teresa R.
Dugaduga, RN Jose B. Bantugan, RN
08/01/2010 G.D.A. Normal Spontaneous
Maria Teresa R.
11:11 am 061424 Vaginal Delivery
Dugaduga, RN Jose B. Bantugan, RN

Noted by: ____ Julius C. Daño______

Supervised by:__ Aida A. Inabangan___
(Print Name and Signature)
DR Coordinator, PRC I.D. No. 0065350 Valid until: 2013
Date Document is signed: _____________ Time _________
Highest Nursing Degree Earned: Masters in Nursing with
Doctoral units
(Print Name and Signature)
Clinical Coordinator, PRC I.D. No. 0155912
Valid Until July 1,2012
Date Document is signed: _____________ Time ___________
Please specify Highest Nursing Degree Earned: MAEd, MPHC,
RN
Approved by: ____ Daisy R. Palompon______
(Print Name and Signature)
Dean, PRC I.D. No. 0253183 Valid Until July 3, 2011
Date Document is signed: ____________ Time ___________
Please specify Highest Nursing Degree Earned: Ph.D, MAN,
RN
 Cebu Normal University
ODC Form 2B
O.R. Circulating FORM

College of Nursing
Osmeña Boulevard Cebu City 6000
254 – 4837 / cnucollegeofnursing@live.com.ph
Level III RE-ACCREDITED STATUS, AACUP

Cord Dressing in Cebu Puericulture Center and Maternity House Incorporated

Prepared by:
Printed Name with Signature of Student REYES, JACOB C.

Patient’s Initials (only) Supervised by

D.R. Nurse on Duty
Date and Time of Delivery Type of Delivery Clinical Instructor
Case Number (Name and Signature)
Name and Signature
01/22/2010 D.B.O.P. Low Segment Transverse
9:19 pm 056527 Cesarean Section Lyner P. Molinas, RN Vincent C. Pananganan, RN
01/24/2010 S.A.V. Normal Spontaneous
10:51 am 056553 Vaginal Delivery Rosejune L. Ortega, RN Vincent C. Pananganan, RN
04/16/2010 S.V.S.S. Normal Spontaneous
4:42 pm 058581 Vaginal Delivery Lyner P. Molinas, RN Jerald S. Ugdoracion, RN

Supervised by:___ Aida A. Inabangan____
(Print Name and Signature)
DR Coordinator, PRC I.D. No. 0065350 Valid until: 2013
Date Document is signed: _____________ Time _________
Highest Nursing Degree Earned: Masters in Nursing with
Doctoral units
Noted by: _____Julius C. Daño ______ Approved by: ____ Daisy R. Palompon_____
(Print Name and Signature)
Dean, PRC I.D. No. 0253183 Valid Until July 3, 2011
(Print Name and Signature)
Date Document is signed: ____________ Time ___________
Clinical Coordinator, PRC I.D. No. 0155912
Please specify Highest Nursing Degree Earned: Ph.D, MAN,
Valid Until July 1,2012
RN
Date Document is signed: _____________ Time ___________
Please specify Highest Nursing Degree Earned: MAEd, MPHC,
RN