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Nursing Student Delivery Log

The document is an ODC Form 1A for actual delivery from the University of the Cordilleras. It requires information such as the name of the hospital or location of delivery, the initials and case number of the patient, the procedure performed, and signatures of the student, notetaker, nurse on duty, clinical instructor, clinical coordinator, and dean to verify and approve the actual delivery.

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EricAfidchao
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39 views1 page

Nursing Student Delivery Log

The document is an ODC Form 1A for actual delivery from the University of the Cordilleras. It requires information such as the name of the hospital or location of delivery, the initials and case number of the patient, the procedure performed, and signatures of the student, notetaker, nurse on duty, clinical instructor, clinical coordinator, and dean to verify and approve the actual delivery.

Uploaded by

EricAfidchao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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University of the Cordilleras

Governor Pack Road, Baguio City, Philippines 2600


(+6374) 442-3316, 442-2564, 442-8219, 442-8256
e-mail: [email protected]
website: www.bcf.edu.ph

ODC Form 1A
ACTUAL DELIVERY
FORM

ACTUAL DELIVERY in _______________________________________________________


Hospital/Home/Lying-In Clinic, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student: _____________________________________________________
Date Performed
and
Time Started

Patients INITIAL Only


Case Number

(not applicable for Birthing/Lyingin Clinics/Homes)

PROCEDURE PERFORMED

Noted by: _________________________________________


(Print Name and Signature)
Clinical Coordinator, PRC I.D. No. :___________ Valid Until: ________
Date document is signed: _________________ Time: _____________
Please specify Highest Nursing Degree Earned:
_________________________

D.R. Nurse On Duty


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

SUPERVISED BY
Clinical Instructor
Name and Signature

Approved by: ________


___________________________________________
(Print Name and Signature)
Dean, PRC I.D. No. _____________ Valid Until: __________________________
Date document is signed: ____________ Time: _________________________
Specify Highest Nursing Degree Earned:
_______________________________
(STRICTLY NO DESIGNATES)

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