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 1C
CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE IN BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER.
BAGUIO CITY
Prepared by:
University of the Cordilleras
COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

RINA B. DECALAN

University of the Cordilleras

COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

Date Performed
Patients INITIAL Only
SUPERVISED BY
IMMEDIATE NEWBORN CARE CASE SLIP Immediate Newborn
IMMEDIATE NEWBORN
CARE CASE SLIP
Nurse/Midwife
On Duty
and
Agency: Baguio General Hospital and Medical Center
Agency: Baguio General Hospital and Medical Center Clinical Instructor
Cord Care PERFORMED
Time Started Hospital ( /) Case
Name
Number
Home ( ) Birthing/ Lying-in ( )
Hospital ( /)
Home ( ) Birthing/ Lying-in
( ) and Signature
Address: Baguio City
Name of Mother: Avyn G. Dawayen
Name of Baby: Baby Girl G. Dawayen
Date of Delivery: July 03, 2014
Time: 07:52 AM
03-18-14
JR.R.A
Case Number: 788780
Gender: Boy
12:45
PM Newborn Care Performed
763701
Immediate
at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
03-19-14
Others _____________________________________
J.Z.M
01:23
NamePM
of Performing Nurse: Rina B. Decalan
763855
Name of DR/ Nursery Nurse /Midwife: Maria Emma M.
Pangilinan, RN

Address: Baguio City

Name of Mother: Marie Z. Madayag
Name of Baby: James Z. Madayag
Date of Delivery: March 03, 2014
Time: 01:23 PM
Case
Number
:
763855
Gender:
Boy
DELIVERY ROOM
MYRNA D. SALIO-AN, RN
HUMBELINE F. SOKKONG, RN, MAN
Immediate Newborn Care Performed at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
Others _____________________________________
Performing
Nurse:
Rina B. Decalan
DELIVERY ROOM Name of MARIA
EMMA
M. PANGILINAN,
RN
HUMBELINE F. SOKKONG, RN, MAN
Name of DR/ Nursery Nurse /Midwife: Maria Emma M.
Pangilinan, RN

07-03-14
07:52 AM

DELIVERY ROOM

BG.G.D

SHEILA MARIA G.
BATOON, RN, MAN
788780
Clinical Instructors full Name and signature

PRC Number 0232434

Validity May 18, 2018
PNA Number _______________ Regular ( / ) Life Time ( )

SHEILA MARIA G. BATOON, RN,

HUMBELINE
F. SOKKONG,RN
RN, MAN
MARIA
EMMA M. PANGILINAN,
MAN
Clinical Instructors full Name and signature
PRC Number 0160939
Validity April 14, 2018
PNA Number _______________ Regular ( / ) Life Time ( )

Noted By: JULIET V. AVENA RN, MAN

Approved By: JUDITH ODANEE G. MAGWILANG RN, MAEd-Nsg, MAN
CI:
Clinical Coordinator,
PRC I.D. No: 0157672
Valid Until: November 09, 2016 CI:
Dean, PRC I.D. No: 0213569
Valid Until: March 07, 2018
No erasures
No erasures
Date document
is
signed:
_________________Time:
_________________
Date
document
is
signed:
___________________
Time: _____________
Complete and correct data
Complete and correct data
Highest Nursing
Degree
Earned
:
______________________________________________
Highest
Nursing
Degree
Earned
:
______________________________________
Sign in blue pen
Sign in blue pen
UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

University of the Cordilleras

COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

IMMEDIATE NEWBORN CARE CASE SLIP

Agency: Baguio General Hospital and Medical Center

Hospital ( /)
Home ( ) Birthing/ Lying-in ( )
Address: Baguio City
Name of Mother: Jenilyn R. Aguilar
Name of Baby: John Renz R. Aguilar
Date of Delivery: March 18, 2014
Time: 12:45 PM
Case Number: 763701
Gender: Boy
Immediate Newborn Care Performed at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
Others _____________________________________
Name of Performing Nurse: Rina B. Decalan
Name of DR/ Nursery Nurse /Midwife: Myrna D. Salio-an, RN

HUMBELINE F. SOKKONG, RN, MAN

Clinical Instructors full Name and signature
PRC Number 0160939
Validity April 14, 2018
PNA Number _______________ Regular ( / ) Life Time ( )
CI:
No erasures
Complete and correct data
Sign in blue pen
UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

University of the Cordilleras

COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
=====

IMMEDIATE NEWBORN CARE CASE SLIP

Agency: Benguet General Hospital

Hospital ( /)
Home ( ) Birthing/ Lying-in ( )
Address: KM5 La Trinidad Benguet
Name of Mother: Roxy B. Segundo
Name of Baby: Xyrene Antheia S. Segundo
Date of Delivery: February 16, 2015
Time: 03:56 PM
Case Number: 479264
Gender: Girl
Immediate Newborn Care Performed at:
Delivery Room ( / )
Home
(
)
Nursery
(
)
Others _____________________________________
Name of Performing Nurse: Rina B. Decalan
Name of DR/ Nursery Nurse /Midwife: Elena A. Comissing, RN

MEDIATRIX M. LEE, RN, MAN

Clinical Instructors full Name and signature
PRC Number 0400013
Validity February 18, 2018
PNA Number _______________ Regular ( / ) Life Time ( )
CI:
No erasures
Complete and correct data
Sign in blue pen
UC-VPAA-CON-FORM-20d
JUNE 2012
REV:00

University of the Cordilleras

Governor Pack Road, Baguio City, Philippines 2600

ODC Form 1C
CORD CARE FORM

(+6374) 442-3316, 442-2564, 442-8219, 442-8256

e-mail: webmaster@bcf.edu.ph
website: www.bcf.edu.ph
IMMEDIATE NEWBORN CORD CARE IN BENGUET GENERAL HOSPITAL ECONOMIC ENTERPRISE
KM5 LA TRINIDAD BENGUET
Prepared by:
RINA B. DECALAN
Date Performed
and
Time Started

Patients INITIAL Only

02-16-15
03:56 PM

XA.S.S
479264

Case Number

Immediate Newborn
Cord Care PERFORMED

Nurse/Midwife On Duty

DELIVERY ROOM

ELENA A. COMISSING, RN

SUPERVISED BY
Clinical Instructor
Name and Signature

MEDIATRIX M. LEE, RN, MAN

Noted By: JULIET V. AVENA RN, MAN

Approved By: JUDITH ODANEE G. MAGWILANG RN, MAEd-Nsg, MAN
Clinical Coordinator, PRC I.D. No: 0157672
Valid Until: November 09, 2016
Dean, PRC I.D. No: 0213569
Valid Until: March 07, 2018
Date document is signed: _________________Time: _________________
Date document is signed: ___________________ Time: _____________
Highest Nursing Degree Earned: ______________________________________________
Highest Nursing Degree Earned: ______________________________________