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Laguna Northwestern College ODC Form

This document is a form from Laguna Northwestern College tracking 5 deliveries or procedures performed by a student. It includes the date, time, patient initials, case number, type of procedure, the supervising clinical instructor and their signature, the nurse or midwife on duty and their signature, and approvals from the clinical coordinator and dean of the college. It documents that the student participated in 3 normal spontaneous deliveries, 1 partial breech extraction, and 1 partial breech extraction under supervised experience.

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Pat Vierneza-Calalang
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170 views1 page

Laguna Northwestern College ODC Form

This document is a form from Laguna Northwestern College tracking 5 deliveries or procedures performed by a student. It includes the date, time, patient initials, case number, type of procedure, the supervising clinical instructor and their signature, the nurse or midwife on duty and their signature, and approvals from the clinical coordinator and dean of the college. It documents that the student participated in 3 normal spontaneous deliveries, 1 partial breech extraction, and 1 partial breech extraction under supervised experience.

Uploaded by

Pat Vierneza-Calalang
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

ODC Form

LAGUNA NORTHWESTERN COLLEGE


A. M abini St., San Antonio, San Pedro, Laguna

Tel.: (02) 869-0738


ACTUAL DELIVERY in RIZAL MEDICAL CENTER
Prepared by
Printed Name and Signature of Student:

Date Performed
and
Time Started
November 23 2010
3:15pm
November 24 2010
7:00pm
November 29 2010
6:30pm
November 30 2010
9:30pm
August 9 2011
3:00pm

Patient's INITIAL
Only
Case Number
(not applicable for
Birthing/Lying-In
Clinics/Homes)
M.G.
A-092464
M.F.
A-088233
O.I.
A-075738
N.C.
A-091861
R.Z.
50771

Patrick V. Calalang

PROCEDURE PERFORMED

Please specify Highest Nursing Degree Earned:

SUPERVISED BY
Clinical Instructor
Name and Signature

Normal Spontaneous Delivery

Mary Jean Panes, RN

Ms. Ingrid Caspillo, RN,RM,MSN

Normal Spontaneous Delivery

Casbel Crisostomo, RN

Ms. Ingrid Caspillo, RN,RM,MSN

Partial Breech Extraction

Cecile De Leon, RN

Ms. Ingrid Caspillo, RN,RM,MSN

Partial Breech Extraction

Casbel Crisostomo, RN

Ms. Ingrid Caspillo, RN,RM,MSN

Normal Spontaneous Delivery

Mary Jean Panes, RN

Ms. Ingrid Caspillo, RN,RM,MSN

Noted by:
(Printed Name and Signature)
Clinical Coordinator, PRC ID No.
Date document is signed:

D.R. Nurse On Duty


(Name and Signature)
(If Midwife On Duty,
Signature Not Required)

Valid Until:
Time:

Approved by: ELSA E. GUMIRAN, RN,MAN, Ed.D


(Printed Name and Signature)
Dean, PRC ID No. : 0064097
Valid Until: November 29, 2012
Date document is signed:
Time:
Please specify Highest Nursing Degree Earned: RN, MAN, Ed. D.

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