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Prepared by: Printed Name with Signature of Student Date Performed and Time Started Marry Joy D. Pardico SUPERVISED BY Clinical Instructor (Name and Signature)
Layoso Perez
Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
SURGICAL SCRUB in Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico JPRMH Hospital, Municipality/City/ Province
D&C
Ricarte, L
Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
ASSISTED DELIVERY in
Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico
Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) PROCEDURE PERFORMED ASSISTED DELIVERY
D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)
DE CN: 1155618
Samoza, Jayson
Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
IMMEDIATE NEWBORN CORD CARE in JPRMH Hospital, Municipality/City/ Province
Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico
Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes)
IMMEDIATE NEWBORN CORD CARE PERFORMED Indicate where performed e.g. D.R., Nursery, NICU, or Home
D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)
Cord dressing DR
Ricarte, L
Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
CALAMBA DOCTORS COLLEGE Km. 49 National Highway Parian, Calamba City, Laguna Telephone No. (049) 545 9921
IMMEDIATE NEWBORN CORD CARE in Calamba Doctors Hospital Hospital, Municipality/City/ Province
Prepared by: Printed Name with Signature of Student Marry Joy D. Pardico
Patient's INITIALS (only) Case Number (not applicable for Birthing/Lying-In Clinics/Homes) PROCEDURE PERFORMED ASSISTED DELIVERY
D.R. Nurse On Duty (Name and Signature) (If Midwife on Duty, Signature Not Required)
Villanueva, J
Noted by: (Print Name and Signature) Clinical Coordinator, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time
Approved by: (Print Name and Signature) Dean, PRC I.D. No. Date document is signed: Please specify Highest Nursing Degree Earned: Valid Until Time