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LastName - FirstName - Actual Delivery Form

The document is an Actual Delivery Form from Riverside College for use at the Bacolod City Lying-In and Birthing Home Center. It includes sections for patient information, procedures performed, and signatures from nursing staff and clinical instructors. The form is part of the clinical documentation required for nursing students and is overseen by the Clinical Coordinator and Dean of the College of Nursing.

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Amber Mae L. Deocampo
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17 views1 page

LastName - FirstName - Actual Delivery Form

The document is an Actual Delivery Form from Riverside College for use at the Bacolod City Lying-In and Birthing Home Center. It includes sections for patient information, procedures performed, and signatures from nursing staff and clinical instructors. The form is part of the clinical documentation required for nursing students and is overseen by the Clinical Coordinator and Dean of the College of Nursing.

Uploaded by

Amber Mae L. Deocampo
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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RIVERSIDE COLLEGE

Dr. Pablo O. Torre St., Bacolod City, Negros Occidental, Philippines


D.R. Form
Tel. No. (034) 4337331; 705000 / www.riverside.edu.ph
ACTUAL DELIVERY
FORM

BACOLOD CITY LYING-IN AND BIRTHING HOME CENTER


ACTUAL DELIVERY in  Bacolod City, Negros Occidental
Hospital/Home/Lying – In Clinic,
Municipality/City/Province

Prepared by:
Printed Name and Signature of the Student 

Date Performed Patient’s INITIALS (only) D.R. Nurse on Duty SUPERVISED BY:
and Case Number PROCEDURE PERFORMED (Name and Signature) Clinical Instructor
(If Midwife on Duty, Signature Not
Time Started (not applicable for Birthing/Lying-In
Required)
Name and Signature
Clinics/Homes)

Noted by: _________________________________________________________ Approved by: _________________________________________________________


LAARNI MAE L. SOTOMIL, RN, MN JOSELITO L. MURILLO, RN, MN
Clinical Coordinator Dean, College of Nursing

PRC No  0286079 Valid Until  October 20, 2026 PRC No  0202022 Valid Until  January 11, 2028
Date document is signed  Time  Date document is signed  Time 
Highest Nursing Degree Earned  Master in Nursing Highest Nursing Degree Earned  Master in Nursing

(STRICTLY NO DESIGNATES)

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