𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
ODC Form 1C
CORD CARE FORM
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
IMMEDIATE CARE OF NEWBORN in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
Immediate Newborn Cord Care
PERFORMED
Indicate where performed e.g., D.R.,
Nursery, NICU, or Home
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
N.I.C.U. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature NOT
Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2023, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
ODC Form 1C
CORD CARE FORM
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
IMMEDIATE CARE OF NEWBORN in MOTHER BLES BIRTHING CLINIC, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
October 27, 2023
2:14 AM
Bb. Girl H.
November 8, 2023
11:30 AM
Bb. Boy P.
Immediate Newborn Cord Care
PERFORMED
Indicate where performed e.g., D.R.,
Nursery, NICU, or Home
N.I.C.U. Nurse on Duty (Name
and Signature)
(If Midwife on Duty, Signature
NOT Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Delivery Room – Essential
Intrapartum Newborn Care,
Anthropometrics, Vaccines
DOROTEA T. AISO, RM, BSM
JEAN A. PEÑARANDA, RN, MAN
Delivery Room – Essential
Intrapartum Newborn Care,
Anthropometrics, Vaccines
DOROTEA T. AISO, RM, BSM
JEAN A. PEÑARANDA, RN, MAN
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
ODC Form 1C
CORD CARE FORM
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
IMMEDIATE CARE OF NEWBORN in GOVERNOR BENJAMIN T. ROMUALDEZ GENERAL HOSPITAL AND SCHISTOSOMIASIS CENTER, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
Immediate Newborn Cord Care
PERFORMED
Indicate where performed e.g., D.R.,
Nursery, NICU, or Home
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
N.I.C.U. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature NOT
Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2023, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
ODC Form 1A
ACTUAL DELIVERY
FORM
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
ACTUAL DELIVERY in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
January 26, 2024
3:25 AM
Patient’s INITIALS (only)
PROCEDURE PERFORMED
Case Number
(Not applicable for Birthing/Lying-In
Clinic/Homes)
S. M
2189129
Normal Spontaneous Vaginal Delivery to
An Alive Baby Boy in Cephalic
Presentation, Weight: 2.95 kilograms,
Meconium-Stained Amniotic Fluid,
APGAR Score of 8
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
D.R. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature
NOT Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
IDERLINE T. BODO, RN
JEAN A. PEÑARANDA, RN, MAN
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
ODC Form 1A
ACTUAL DELIVERY
FORM
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
ACTUAL DELIVERY in MOTHER BLES BIRTHING CLINIC, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
October 26, 2023
2:15 AM
October 30, 2023
3:16 PM
Patient’s INITIALS (only)
PROCEDURE PERFORMED
Case Number
(Not applicable for Birthing/Lying-In
Clinic/Homes)
C. J
Normal Spontaneous Vaginal Delivery to an
Alive Baby Boy in Cephalic Presentation;
Weight: 2.7 Kilograms, Clear Amniotic Fluid,
APGAR Score of 8
J.P
Normal Spontaneous Vaginal Delivery to an
Alive Baby Boy in Cephalic Presentation;
Weight: 2.7 Kilograms, Clear Amniotic Fluid,
APGAR Score of 8
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
D.R. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature
NOT Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
DOROTEA T. AISO, RM, BSM
JEAN A. PEÑARANDA, RN, MAN
DOROTEA T. AISO, RM, BSM
JEAN A. PEÑARANDA, RN, MAN
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
ODC Form 1B
ASSISTED DELIVERY
FORM
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
ASSISTED DELIVERY in LEYTE PROVINCIAL HOSPITAL, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
January 24, 2024
12:48 PM
January 26, 2024
10:41 AM
January 27, 2024
8:55 AM
Patient’s INITIALS (only)
PROCEDURE PERFORMED
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
D.J
2188634
P.M
2132933
R.M
2189166
G1P1 (1001 Pregnancy Uterine 39 Weeks AOG
Via Normal Spontaneous Vaginal Delivery to An
Alive Baby Girl in Cephalic Presentation; Weight:
2.82 Kilograms, Clear Amniotic Fluid, APGAR
Score of 9
G3P3(3003 Pregnancy Uterine 39 Weeks AOG
Via Normal Spontaneous Vaginal Delivery to An
Alive Baby Girl in Cephalic Presentation; Weight:
2.73 Kilograms, Clear Amniotic Fluid, APGAR
Score of 9
G6P5(5005 Pregnancy Uterine 42 Weeks AOG
Via Normal Spontaneous Vaginal Delivery to An
Alive Baby Boy in Cephalic Presentation; Weight:
2.91 Kilograms, Meconium-Stained Amniotic
Fluid, APGAR Score of 8
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
D.R. Nurse on Duty (Name
and Signature)
(If Midwife on Duty,
Signature NOT Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
JOYETH O. LINDE, RN
JEAN A. PEÑARANDA, RN, MAN
IDERLINE T. BODO, RN
JOYETH O. LINDE, RN
JEAN A. PEÑARANDA, RN, MAN
JEAN A. PEÑARANDA, RN, MAN
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned:
Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
ODC Form 1B
ASSISTED DELIVERY
FORM
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
ASSISTED DELIVERY in GOVERNOR BENJAMIN T. ROMUALDEZ GENERAL HOSPITAL AND SCHISTOSOMIASIS CENTER, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
PROCEDURE PERFORMED
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
D.R. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature NOT
Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2023, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
ODC Form 1B
ASSISTED DELIVERY
FORM
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
ASSISTED DELIVERY in MOTHER BLES BIRTHING CLINIC, PALO, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
PROCEDURE PERFORMED
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
D.R. Nurse on Duty (Name and
Signature)
(If Midwife on Duty, Signature NOT
Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2023, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
ODC Form 2A
O.R. SCRUB FORM
MAJOR
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
SURGICAL SCRUB in DIVINE WORD HOSPITAL, TACLOBAN CITY, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
SURGICAL PROCEDURE
PERFORMED
SUPERVISED BY
Clinical Instructor
(Name and Signature)
June 13, 2023
3:29 P.M.
Case Number
L. E
525858
Extracapsular Cataract Extraction with
Intraocular Lens
DOJIE G. BAGARINO, RN
ZUSIE B. ABUDA, RN, MAN
June 14, 2023
1:50 P.M.
H. T
288226
Open Reduction and Internal Fixation
Tibial Tubercle, Right
DOJIE G. BAGARINO, RN
ZUSIE B. ABUDA, RN, MAN
June 15, 2023
8:40 P.M.
B. R
288322
DOJIE G. BAGARINO, RN
ZUSIE B. ABUDA, RN, MAN
Emergency Primary Low Segment Cesarean
Section
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
O.R. Nurse on Duty (Name and
Signature)
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
Maharlika Highway, Brgy. Campetic, Palo, Leyte
ODC Form 2B
O.R. SCRUB FORM
MINOR
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
SURGICAL SCRUB in DIVINE WORD HOSPITAL, TACLOBAN CITY, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
Patient’s INITIALS (only)
November 11, 2022
10: 40 A.M.
Case Number
L. N
110322
June 08, 2023
7: 50 P.M.
P. J
288214
June 12, 2023
1:30 PM
A.N
275851
SURGICAL PROCEDURE
PERFORMED
O.R. Nurse on Duty (Name and
Signature)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Sebaceous Cyst Upper Back
Excision
NECHEAL G. DE PAZ, RN
ZUSIE B. ABUDA, RN, MAN
DOJIE G. BAGARINO, RN
ZUSIE B. ABUDA, RN, MAN
DOJIE G. BAGARINO, RN
ZUSIE B. ABUDA, RN, MAN
Debridement and Evaluation of Abscess
Targeted Therapy Chemotherapy
Bone Marrow Aspiration
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
Doc No.
Page No.
Book No.
Series of
𝕾𝖙. 𝕾𝖈𝖍𝖔𝖑𝖆𝖘𝖙𝖎𝖈𝖆’𝖘 𝕮𝖔𝖑𝖑𝖊𝖌𝖊 𝕿𝖆𝖈𝖑𝖔𝖇𝖆𝖓, 𝕴𝖓𝖈.
ODC Form 1C
CORD CARE FORM
Maharlika Highway, Brgy. Campetic, Palo, Leyte
COLLEGE OF NURSING
PAASCU LEVEL 1 (May 2019-May 2022) / CHED Government Recognition No. 7, Series 2003
IMMEDIATE CARE OF NEWBORN in DIVINE WORD HOSPITAL, TACLOBAN CITY, LEYTE
Hospital, Municipality/ City/ Province
Prepared by: VIÑEGAS, JANINA JEAN LETRAN
Printed Name with Signature of Student
Date Performed
and
Time Started
March 29, 2023
2:00 PM
Patient’s INITIALS (only)
Case Number
(Not applicable for
Birthing/Lying-In Clinic/Homes)
Bb. Girl V.
2303059
Immediate Newborn Cord Care
PERFORMED
Indicate where performed e.g., D.R.,
Nursery, NICU, or Home
N.I.C.U. Nurse on Duty (Name
and Signature)
(If Midwife on Duty, Signature
NOT Required)
SUPERVISED BY
Clinical Instructor
(Name and Signature)
Neonatal Intensive Care Unit –
Essential Intrapartum Newborn Care,
Anthropometrics, Vaccines
JOAN V. SERRANO, RN
ZUSIE B. ABUDA, RN, MAN
JEAN A. PEÑARANDA, RN, MAN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0143733 Valid Until: May 30, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Arts in Nursing
Noted by:
Approved by:
SR. FLORENCE C. LAROCO, OSB
(Printed Name and Signature)
Dean, PRC I.D. No. 0158879
Valid Until: March 7, 2025
Date signed:
Time:
Highest Nursing Degree Earned: Master of Science in Nursing
I declare under oath that these cases have been accomplished by me in good faith, verified by me and to the best of my knowledge and belief is true, correct, and complete statement pursuant to the
provisions of pertinent laws, rules, and regulations of the Republic of the Philippines.
Subscribed and sworn before me this
day of
2024, Tacloban City, Philippines.
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