LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
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HANDLED DELIVERY
Name of Patient: __________________________________________ Age:__________
Case Number: ___________________________________
Name of Hospital:_______________________________________________________
Date of Delivery:___________________________ Time of Delivery: ______________
Type of Delivery:___________________________ Gender of Baby: ______________
Post Partum Diagnosis:
______________________________________________________________________________
Name of Student:________________________________________________________
Name and Signature of DR Nurse on Duty: ___________________________________
Name and Signature of Clinical Instructor: ___________________________________
Name Signature of DR Nurse Supervisor: ____________________________________
LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
ASSISTED DELIVERY
Name of Patient: __________________________________________ Age:__________
Case Number: ___________________________________
Name of Hospital:_______________________________________________________
Date of Delivery:___________________________ Time of Delivery: ______________
Type of Delivery:___________________________ Gender of Baby: ______________
Post Partum Diagnosis:
______________________________________________________________________________
Name of Student:________________________________________________________
Name and Signature of DR Nurse on Duty: ___________________________________
Name and Signature of Clinical Instructor: ___________________________________
Name Signature of DR Nurse Supervisor: ____________________________________
LICEO DE CAGAYAN UNIVERSITY
Paseo del Rio Campus, Macasandig, Cagayan de Oro City
COLLEGE OF NURSING
IMMEDIATE NEWBORN CARE
Name of Baby: __________________________________________ Age:__________
Case Number: ___________________________________
Name of Hospital:_______________________________________________________
Date of Delivery:___________________________ Time of Delivery: ______________
Type of Delivery:___________________________ Gender of Baby: ______________
Vital Measurements:
Weight: ________________ Kg.
Temperature: ________________ ºC
Head Circumference: ______________ cm
Abdominal Circumference: ___________ cm
Length: ___________ cm
Apgar Score: ___________
Name of Student:________________________________________________________
Name and Signature of DR/NICU Nurse on Duty: _____________________________
Name and Signature of Clinical Instructor: ___________________________________
Name Signature of DR/NICU Nurse Supervisor: _______________________________
