BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING & MIDWIFERY

Capitol Compound, Tenejero, City of Balanga, Bataan
(047) 237-5477, bpsu.cnm.2018@gmail.com
D. R. Form
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP ) ACTUAL DELIVERY
Level : 4 - PHASE 1
Date of Accreditation: November 1, 2018 – October 31, 2019

Bataan General Hospital and Medical Center

( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : Santos, Zyra Mel A.
( Printed Name & Signature of Student )

Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BY
and Case Number PERFORMED ( Name & Signature ) Clinical Instructor
( not applicable for Birthing/Lying-In
Time started Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature

12-03-18 / 7:50 AM MRCY / 29-72-33 Normal Spontaneous Delivery

Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN

12-03-18 / 8:20 AM RCD / 27-35-55 Normal Spontaneous Delivery

Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN

12-05-18 / 10:47 AM EI / 29-41-47 Normal Spontaneous Delivery

Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN

04-24-19 / 11:51 AM CA / 30-10-22 Normal Spontaneous Delivery

Hazel A. Perez, RN Jocelyn F. Villanueva, EdD, RN

04-30-19 / 7:42 AM ACC / 30-96-13 Normal Spontaneous Delivery

Hazel A. Perez, RN Jocelyn F. Villanueva, EdD, RN

Noted by: Concurred by: Approved by:

Program Head Chief Nurse Dean

PRC I.D. No. : PRC I.D. No. : PRC I.D. No. :
Valid Until: Valid Until: Valid Until:
PNA No. : PNA No. : PNA No. :
Valid Until: Valid Until: Valid Until:
Highest Degree Earned: Highest Degree Earned: Highest Degree Earned:
 BATAAN PENINSULA STATE UNIVERSITY
COLLEGE OF NURSING & MIDWIFERY
Capitol Compound, Tenejero, City of Balanga, Bataan
(047) 237-5477, bpsu.cnm.2018@gmail.com
D. R. Form
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP ) ASSISTED DELIVERY
Level : 4 - PHASE 1
Date of Accreditation: November 1, 2018 – October 31, 2019

Bataan General Hospital and Medical Center

( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : Santos, Zyra Mel A.
( Printed Name & Signature of Student )

Date Performed Patient's INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BY
and Case Number PERFORMED ( Name & Signature ) Clinical Instructor
( not applicable for Birthing/Lying-In
Time started Clinics/Homes) ( if Midwife on Duty, Signature not required ) Name & Signature

12-03-18 / 7:40 AM MIC / 29-98-44 Normal Spontaneous Delivery

Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN

12-04-18 / 12:23 PM RDR / 29-20-47 Normal Spontaneous Delivery

12-05-18 / 8:15 AM
04-24-19 / 12:48 PM
05-14-19 / 9:52 AM
Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN
MMB / 29-43-47 Normal Spontaneous Delivery
Lucina Salmorin, RN Jocelyn F. Villanueva, EdD, RN
SSL / 30-11-12 Normal Spontaneous Delivery
Hazel A. Perez, RN Jocelyn F. Villanueva, EdD, RN
JMU / 30-83-31 Normal Spontaneous Delivery
Raña, Estrella, RN Jocelyn F. Villanueva, EdD, RN

Noted by: Concurred by: Approved by:

Program Head Chief Nurse Dean

PRC I.D. No. : PRC I.D. No. : PRC I.D. No. :
Valid Until: Valid Until: Valid Until:
PNA No. : PNA No. : PNA No. :
Valid Until: Valid Until: Valid Until:
Highest Degree Earned: Highest Degree Earned: Highest Degree Earned:

BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING & MIDWIFERY
Capitol Compound, Tenejero, City of Balanga, Bataan
(047) 237-5477, bpsu.cnm.2018@gmail.com ICNB Form
IMMEDIATE CARE OF THE
NEWBORN
Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. ( AACCUP )
Level : 4 - PHASE 1
Date of Accreditation: NOVEMBER 1, 2018 – OCTOBER 31, 2019

Bataan General Hospital and Medical Center

( Hospital/ Home / Lying- In -Clinic, Municipality/ City/ Province )
Prepared by:
Name of Student : Santos, Zyra Mel A.
( Printed Name & Signature of Student )

Date Performed Patient's INITIAL Only Immediate Newborn Cord Care D.R. Nurse on Duty SUPERVISED BY
and Case Number PERFORMED ( Name & Signature ) Clinical Instructor
Time started ( not applicable for Birthing/Lying-In Clinics/Homes) Indicate where performed e.g. D.R., Nursery, NICU, or Home ( if Midwife on Duty, Signature not required ) Name & Signature

11-27-18 / 10:21 AM Boy AAM / 29-42-43A Neonatal Intensive Care Unit

Ana Kamil Aporongao, RN Norma R. Pantaleon, RN, MAN

12-04-18 / 7:00 AM Girl JAMC / 25-62-58A Delivery Room

12-05-18 / 8:36 AM
04-24-19 / 9:13 AM
04-29-19 / 12:04 PM
Connie Quiamco, RN Norma R. Pantaleon, RN, MAN
Boy BMDR / 22-16-62A Delivery Room
Connie Quiamco, RN Norma R. Pantaleon, RN, MAN
Boy MADG / 30-08-22A Delivery Room
Abegail J. Samson, RN Maria Elinor Soriano, RN, MAN
Girl RSJPD / 30-19-23A Delivery Room
Maria Lyzanil Rabena, RN Maria Elinor Soriano, RN, MAN

Noted by: Concurred by: Approved by:

Program Head Chief Nurse Dean

PRC I.D. No. : PRC I.D. No. : PRC I.D. No. :
Valid Until: Valid Until: Valid Until:
PNA No. : PNA No. : PNA No. :
Valid Until: Valid Until: Valid Until:
Highest Degree Earned: Highest Degree Earned: Highest Degree Earned: