LA SALLE UNIVERSITY
VALCONCHA STREET, 7200 OZAMIZ CITY, MISAMIS OCCIDENTAL, PHILIPPINES
PHONE (88) 521-0342/registrar@lsu.edu.ph/lsu.edu.ph
ODC Form 2
ACTUAL DELIVERY
FORM
ACTUAL DELIVERY in Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital, Ozamiz City, Misamis Occidental
Hospital, Municipality/City/Province
Prepared by:
Name of Student: JOBERT P. ROSILLOSA
Signature of Student
PATIENT’S INITIALS
DATE PERFORMED AND TIME
STARTED
CASE NUMBER
(not applicable for birthing/lyingin clinics/homes)
PROCEDURE PERFORMED
June 10, 2022
3:43 P.M
B. E.
39-26-28
HANDLED DELIVERY
April 24, 2023
7:00 A.M.
P. M.
24-57-83
HANDLED DELIVERY
April 25, 2023
12:43 P.M.
S. L.
09-92-04
HANDLED DELIVERY
D.R. NURSE/MIDWIFE ON DUTY
(Name Only)
ROLYN VIDAO, MN
ELSIE C. CABUG, RM
JOANNA MARIE P. QUIÑONES,
RM
SUPERVISED BY:
Clinical Instructor
Name and Signature
HARRIET C. JIMENEZ, MN
MARY VIC REGALADO, MN
MARY VIC REGALADO, MN
Noted by: HARRIET C. JIMENEZ, RN, MN,
Clinical Coordinator
Approved by: ARLENE D. APAO, RN, MN, MAN
Dean
PRC I.D No.
0622114
Valid Until: JUNE 25, 2024
PNA No.
Valid Until
Date document is signed:
Time:
Please specify Highest Nursing Degree Earned:
MN
PRC I.D No.
0205619
Valid Until
March 20, 2024
PNA No.
Valid Until
______________________
ADPCN No.
20-818__
Valid Until
May 31, 2023_________
Date document is signed:
Time
Please specify Highest Nursing Degree Earned:
MAN
LA SALLE UNIVERSITY
VALCONCHA STREET, 7200 OZAMIZ CITY, MISAMIS OCCIDENTAL, PHILIPPINES
(88) 521-0342/registrar@lsu.edu.ph/lsu.edu.ph
ODC Form 4
D.R. IMMEDATE NEWBORN
CORD CARE FORM
IMMEDIATE NEWBORN CORD CARE in Mayor Hilarion A. Ramiro Sr. Regional Training and Teaching Hospital, Ozamiz City, Misamis Occidental
Hospital, Municipality/City/Province
Prepared by:
Name of Student: JOBERT P. ROSILLOSA
Signature of Student
PATIENT’S INITIALS
DATE PERFORMED AND TIME
STARTED
CASE NUMBER
(not applicable for birthing/lyingin clinics/homes)
PROCEDURE PERFORMED
D.R. NURSE/MIDWIFE ON DUTY
(Name Only)
SUPERVISED BY:
Clinical Instructor
Name and Signature
June 10, 2022
8:52 A.M
L. A.
39-39-19
IMMEDIATE NEWBORN CARE
NOREYLIN P. BATION, RM
HARRIET C. JIMENEZ, MN
December 15, 2022
3:25 P.M.
M. J.
40-91-63
IMMEDIATE NEWBORN CARE
NOREYLIN P. BATION, RM
HARRIET C. JIMENEZ, MN
April 24, 2023
7:46 A.M
A. N.
42-21-21
IMMEDIATE NEWBORN CARE
ELSIE C. CABUG, RM
MARY VIC REGALADO, MN
Noted by: HARRIET C. JIMENEZ, RN, MN
Clinical Coordinator
Approved by: ARLENE D. APAO, RN, MN, MAN
Dean
PRC I.D No.
0622114
Valid Until: JUNE 25, 2024
PNA No.
Valid Until
Date document is signed:
Time:
Please specify Highest Nursing Degree Earned:
MN
PRC I.D No.
0205619
Valid Until
March 20, 2024
PNA No.
Valid Until
______________________
ADPCN No.
20-818__
Valid Until
May 31, 2023_________
Date document is signed:
Time
Please specify Highest Nursing Degree Earned:
MAN