BUKIDNON STATE UNIVERSITY

COLLEGE OF NURSING
CITY OF MALAYBALAY

DELIVERY ROOM CASE RECORD

Name of Student: ____________________________________________ Date: ________________

Hospital / Agency: _______________________________________________________________________
Name of Patient: ____________________________________________ Age: ________________
Case Number: _____________ Time:________________

Ō ASSIST
Ō HANDLE
Ō CORD CARE

Type of Delivery:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Admitting Diagnosis:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Final Diagnosis:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Other Procedure Performed:

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Name of Obstetrician: ___________________________________________________________________

Name of Pediatrician: ___________________________________________________________________
Anesthesia Used: _______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Staff’s Name / Signature:

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

CI’s Name / Signature: ___________________________________________________________________