UNIVERSITY OF SOUTHERN PHILIPPINES ODC FORM

FOUNDATION ACTUAL DELIVERY

College of Nursing FORM
Salinas Drive, Lahug, Cebu City
Telephone No.: 414-8773 local 112, Fax No.: 414-7772

ACTUAL DELIVERIES HANDLED

Date Patients
performed INITIALS Only Procedure Performed Name of Hospital Clinical Instructor
Time of Case Number (Name and Signature)
Delivery

January 22, 2016 M.I. Normal Spontaneous Vaginal Vicente Sotto Memorial Medical Mrs.Erlinda M. Guzman
7:43am 2015800275 Delivery Center R.N.M.A.N.

Mrs.Erlinda M. Guzman
December M.S. Normal Spontaneous Vaginal Vicente Sotto Memorial Medical R.N.M.A.N.
21,2016 2015933988 Delivery Center
7:30am
December 22, Mrs.Erlinda M. Guzman
2016 M.C. Normal Spontaneous Vaginal Vicente Sotto Memorial Medical R.N.M.A.N.
7:44am 201577388 Delivery Center

Prepared by: Noted by: Approved by:

AL GINO. B. BORINAGA
Mrs.Maria Virginia J. Tundag R.N.M.A.N.
D.R. Coordinator
PRC ID No.0188642 Valid Until: Jan. 6 2018
Date:_____________ Time:___________
Merlyn A. Ouano R.N., M.N.
Dean
PRC ID No. 0151708 Valid Until: Sept.15, 2017
Date:_____________ Time:___________

Noted by:

Ranilo A. Sabellano R.N., M.A.N.