Scribd
Upload
48 views

Actual Empty)

This document appears to be a record of clinical deliveries for a nursing student. It includes sections for the student's name and school information, as well as a table to record details of actual deliveries supervised by a qualified clinical instructor. The table includes fields for case number, diagnosis, mother's name and age, date and time of delivery, baby's gender and name of hospital, type of delivery, and the clinical instructor's name and signature.

Uploaded by

kazuya143
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
48 views

Actual Empty)

This document appears to be a record of clinical deliveries for a nursing student. It includes sections for the student's name and school information, as well as a table to record details of actual deliveries supervised by a qualified clinical instructor. The table includes fields for case number, diagnosis, mother's name and age, date and time of delivery, baby's gender and name of hospital, type of delivery, and the clinical instructor's name and signature.

Uploaded by

kazuya143
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 1

ARELLANO UNIVERSITY

COLLEGE OF NURSING
Jose Abad Santos
University Seal

NAME OF STUDENT: First Course:


Name and Address of School: Arellano University School Graduated from:
3058 Taft Avenue, Pasay City Year: __________________________________
Accreditation Level (if any): Year Granted: Year of Admission in the BSN Program:
Date of School/Program was recognized: Number: Year: Year Graduated from BSN Program:

III. ACTUAL DELIVERIES


Case DATE of TIME of GENDER of NAME of TYPE of Name and Signature of Qualified
No. DIAGNOSIS NAME of MOTHER AGE
DELIVERY DELIVERY BABY HOSPITAL DELIVERY Clinical Instructor
No.
1

LEGEND:
Concurred by:
Prepared by:
Chief Nurse
Date Signed:
Student Degree:
a.) PRC No. Valid Until:
b.) PNA No. Valid Until:
c.) ANSAP No. Valid Until:

Supervised by: Noted by: Approved by:


Arlene Blaize T. Cortez, Ed.D
Clinical Instructor Clinical Coordinator Dean
Date Signed: ____________________________________________________ Date Signed: _____________________________________________________ Date Signed: _____
Degree: Degree: Degree: __________________________________________________________
a.) PRC No. Valid Until: a.) PRC No. _____ Valid Until: a.) PRC No Valid Until
b.) PNA No. Valid Until: b.) PNA No. Valid Until: b.) PNA No. Valid Until:
c.) ANSAP No. Valid Until: c.) ADPCN No. Valid Until:

You might also like