Mindanao Sanitarium & Hospital College

School of Nursing
Barangay San Miguel, Iligan City 9200
Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com
Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated
Accreditation Level: Level II, April 29, 2011 April 2014
Accredited By: Adventist Accrediting Association
Accreditation Level: Level II, October 4, 2010-December 31, 2012

ACTUAL DELIVERY in: Adventist Medical Center, Barangay San Miguel, Iligan City
Gregorio T. Lluch Memorial Hospital, Palao, Iligan City
Hospital/Home/Lying-in, Municipality/City/Province

Prepared by:
Printed name and Signature of Student: CRISTINA L. JAYSON


Date Performed
and
Time Started

Patients INITIAL Only

Case Number
(not applicable for Birthing/Lying-in
Clinics/Homes)

Type of Delivery

D. R. Nurse on Duty
(Name and Signature)
(If Midwife on Duty, Signature Not
Required)

SUPERVISED BY
Clinical Instructor
Name and Signature

January 6, 2012
4:09 AM


ND
203287

Normal Spontaneous Vaginal
Delivery

Dyan Marie L. Villaver, RN
PRC Number: 0411677
Valid Until: November 1, 2015

Lucy May L. Bucayan, MN, RN
PRC Number: 0193232
Valid Until: May 25, 2016

October 12, 2012
7: 25 AM

EG
154393


Normal Spontaneous Vaginal
Delivery

Cheryl S. Epe, RN
PRC Number: 0318137
Valid Until: September 10, 2016

Daverly M. Caeda, MN, RN
PRC Number: 0364265
Valid Until: April 28, 2016

July 19, 2013
6:00 PM

JT
79256

Normal Spontaneous Vaginal
Delivery

Merlita B. Omlero, RM
PRC Number: 0101442
Valid Until: June 5, 2015

Daverly M. Caeda, MN, RN
PRC Number: 0364265
Valid Until: April 28, 2016

Noted by: EVALYN M. LECCIONES, MN, RN Approved by: GTER G, GAID, PhD, MAN, RN N
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015
Date document is signed: ________ Time:______________ Date document is signed: Time: ____________________
Please specify Highest Nursing Degree Earned: Master in Nursing Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
D.R. Form
ACTUAL DELIVERY FORM