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ANTHONY’S COLLEGE
NURSING DEPARTMENT ODC Form 1A
ACTUAL DELIVERY FORM
San Jose, Antique
(036) 540-9196/540-9237/ Fax. No. (036) 540-9971/info@sac.edu.ph/www.sac.edu.ph
ACTUAL DELIVERY in: ANGEL SALAZAR MEMORIAL GENERAL HOSPITAL/ SAN JOSE, ANTIQUE
Prepared by:
Printed Name and Signature of Student: LORRAINE NICOLNE B. CORTEJO
Date Performed Patient’s INITIALS (only) D.R. NURSE ON DUTY SUPERVISED BY
and Case Number PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
Time Started (not applicable for Birthing/Lying-In Clinics/Homes) (If Midwife on Duty, Signature Not Required) Name and Signature
JANUARY 9, 2019 A.R.N.S. NORMAL SPONTANEOUS VAGINAL DELIVERY GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
11:38 AM CASE NUMBER 91
JANUARY 9, 2019 G.M.S.J. NORMAL SPONTANEOUS VAGINAL DELIVERY GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
1:50 PM CASE NUMBER 92
JANUARY 15, 2019 D.M.M.F. NORMAL SPONTANEOUS VAGINAL DELIVERY GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
7:50 AM CASE NUMBER 151
IMMEDIATE NEWBORN CARE in: ANGEL SALAZAR MEMORIAL GENERAL HOSPITAL/ SAN JOSE, ANTIQUE
Prepared by:
Printed Name and Signature of Student: LORRAINE NICOLNE B. CORTEJO
Date Performed Patient’s INITIALS (only) D.R. Nurse On Duty SUPERVISED BY
PROCEDURE PERFORMED
and (Name and Signature) Clinical Instructor
Time Started
Case Number ASSISTED DELIVERY
(not applicable for Birthing/Lying-In Clinics/Homes) (If Midwife on Duty, Signature Not Required) Name and Signature
SEPTEMBER 28, 2017 BABY BOY E. IMMEDIATE NEW BORN CARE GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
9:33 AM CASE NUMBER 285
JANUARY 09, 2019 BABY GIRL L. IMMEDIATE NEW BORN CARE GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
9:15AM CASE NUMBER 89
AUGUST 1, BABY BOY B. IMMEDIATE NEW BORN CARE GERALYN ELENA H. PAGTANAC R.N.,R.M HELEN GRACE J. SALVADO R.N.,M.N
2019 CASE NUMBER 3
9:36 AM