University of the Cordilleras

Governor Pack Road, Baguio City, Philippines 2600

(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph

ODC Form 1A
ACTUAL DELIVERY
FORM

ACTUAL DELIVERY AT BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER

BAGUIO CITY
Prepared by:
RINA B. DECALAN
Date Performed
and
Time Started

Patients INITIAL Only

08-15-14
11:18 AM

AM.P.A
536573

08-16-14
9:38 PM

MK.D.Q
281660

02-01-15
6:19 AM

M.N.F
830831

Case Number

Noted By: JULIET V. AVENA RN, MAN

Clinical Coordinator, PRC I.D. No: 0157672
March 07, 2018
Date document is signed: _________________

SUPERVISED BY
Clinical Instructor
Name and Signature

PROCEDURE
PERFORMED

D.R. Nurse/Midwife On
Duty

NORMAL SPONTANEOUS DELIVERY

LORENZA O. CAPSUYEN RN

NASPER P. ANOD RN, MAN

NORMAL SPONTANEOUS DELIVERY

JOYCE P. BAYENG RN

JANE L. GUZMAN RN, MAN

NORMAL SPONTANEOUS DELIVERY

DAISY M. GODDA RN

GRACE C. ESPINO RN, MAN

Approved By: JUDITH ODANEE G. MAGWILANG RN, MAEd-Nsg, MAN

Valid Until: November 09, 2016
Dean, PRC I.D. No: 0213569
Valid Until:
Time: _________________

Date document is signed: ____________ Time: _____________

Highest Nursing Degree Earned: ______________________________________________

Highest Nursing Degree Earned:

______________________________________
University of the Cordilleras
COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====
DELIVERY CASE SLIP: Actual ( / )
Assist ( )
Agency: Baguio General Hospital and Medical Center
Hospital ( / )
Home ( ) Birthing/ Lying-in ( )
Address: Baguio City
Name of Mother: Apple May P. Abrigo
Case Number: 536573
Age: 22
Type of Delivery Attended: Normal Spontaneous Delivery_______
________________________________________________________
________________________________________________________
Date of Delivery: August 15, 2014
Time of Delivery 11:18 AM
Time Placenta Out:9:48 AM
Actual Nurse: Rina B. Decalan
Assist Nurse: Madeline F. Lopez
Name of DR Nurse/ Midwife: Lorenza O. Capsuyen, RN

NASPER P. ANOD, RN, MAN

Clinical Instructors full Name and signature
PRC Number 0272602
Validity November 25, 2016
PNA Number _______________ Regular ( / ) Life Time ( )
CI:
No erasures
Complete and correct data
Sign in blue pen
UC-VPAA-CON-FORM-20b
JUNE 2012
REV:00

University of the Cordilleras

COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====
DELIVERY CASE SLIP: Actual ( / )
Assist ( )
Agency: Baguio General Hospital and Medical Center
Hospital ( / )
Home ( ) Birthing/ Lying-in ( )
Address: Baguio City
Name of Mother: Monica N. Finez
University
Case Number:
830831 of the Cordilleras
Age: 22
OFNormal
NURSING
Type of DeliveryCOLLEGE
Attended:
Spontaneous Delivery_______
Gov. Pack Road, 2600 Baguio City
________________________________________________________
=========================================
________________________________________________________
=====
Date of Delivery: February
01, 2015
DELIVERY
CASE SLIP:
AssistPlacenta
( )
Time
of Delivery
06:19 Actual
AM ( / )
Time
Out: 06:24
AM
Agency: Actual
Baguio
General
and Medical Center
Nurse:
RinaHospital
B. Decalan
Hospital
( / Primi
)
Home
Birthing/ Lying-in ( )
Assist
Nurse:
Jane( B.) Milanes
Address:Name
Baguio
CityNurse/ Midwife: Daisy M. Godda, RN
of DR
Name of Mother: Maria Kathrina D. Quintos
Case Number: 281660
Age: 26
Type of Delivery Attended: GRACE
NormalC.
Spontaneous
Delivery_______
ESPINO, RN,
MAN
________________________________________________________
Clinical Instructors full Name and signature
________________________________________________________
PRC Number 0164203______ Validity July 12, 2017
Date of Delivery:
August
16, 2014 Regular ( / ) Life Time ( )
PNA Number
_______________
Time of Delivery 9:38 PM
Time Placenta Out:9:48 PM
Actual Nurse:
Rina B. Decalan
CI:
Assist Nurse:
Madeline F. Lopez
No erasures
Name ofComplete
DR Nurse/
Joyce P. Bayeng, RN
and Midwife:
correct data
Sign in blue pen

JANE L. GUZMAN, RN, MAN

UC-VPAA-CON-FORM-20b
Instructors full Name and signature
JUNE Clinical
2012
REV:00
PRC Number 0272772
Validity January 31, 2016
PNA Number _______________ Regular ( / ) Life Time ( )
CI:
No erasures
Complete and correct data
Sign in blue pen
UC-VPAA-CON-FORM-20b
JUNE 2012
REV:00