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Final Final

The document is a form from Lorma Colleges documenting a student's assisted deliveries. It includes tables with the patient's initials and case number, date and time of delivery, procedure performed, and supervising nurse and their highest degree. The form documents three assisted deliveries by the student at Lorma Medical Center and three at the City Health Office, all of which were normal spontaneous deliveries. The form is signed by the clinical coordinator and dean.

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78 views

Final Final

The document is a form from Lorma Colleges documenting a student's assisted deliveries. It includes tables with the patient's initials and case number, date and time of delivery, procedure performed, and supervising nurse and their highest degree. The form documents three assisted deliveries by the student at Lorma Medical Center and three at the City Health Office, all of which were normal spontaneous deliveries. The form is signed by the clinical coordinator and dean.

Uploaded by

SimeonDelaRosa
Copyright
© Attribution Non-Commercial (BY-NC)
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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ODC Form 1A

ACTUAL DELIVERY FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU-AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

ACTUAL DELIVERY in Lorma Medical Center, Carlatan,City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student_____________________________


Student

Date Performed and Patient’s INITIAL Only PROCEDURE D.R. Nurse On Duty SUPERVISED BY
Time Started Case Number PERFORMED

___________________ ______________________________
July 26, 2010 M.C.L. Normal Spontaneous
Maureen D. Casuga, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
6:43 AM 18-23-09 Delivery
October 18, 2010 M.M.T. Normal Spontaneous ___________________ _______________________________
1:30 PM 30-39-92 Delivery Nico S. De la Cuesta, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No.0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: _________ Date document is signed: ____________________ Time: _________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1A
ACTUAL DELIVERY FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Date Performed and Patient’s INITIAL Only PROCEDURE D.R. Nurse On Duty SUPERVISED BY
Time Started Case Number PERFORMED

___________________ ______________________________
September 28, 2010 J.C.R. Normal Spontaneous
Emily M. Laroya, RN Jennifer L. Mohammed, RN, MANc
2:45 PM Emergency Medical Service Delivery
October 16, 2010 B.M. Normal Spontaneous ___________________ ______________________________
5:52 PM Emergency Medical Service Delivery Emily M. Laroya, RN Jennifer L. Mohammed, RN, MANc
December 4, 2010 L.G. Normal Spontaneous ___________________ ______________________________
9:35 PM Emergency Medical Service Delivery Perla Pacada, RM Jennifer L. Mohammed, RN, MANc

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 20122011
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2A
O.R. SCRUB FORM
Major

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

SURGICAL SCRUB in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Date Performed and Patient’s INITIAL SURGICAL O.R. Nurse on Duty SUPERVISED BY
Time Started Only PROCEDURE
Case Number PERFORMED

Pelvic Laparotomy,
_____________________ _____________________________
April 22, 2010 E.B.M. Oophorectomy, Right
Glorifina G. Dacumos, RN Nida C. Camat, RN, MAN(Thesis I)
1:35 PM 30-88-34
_____________________
April 23, 2010 X.A.P. ______________________________
Palatoplasty Mary Jane P. Advincula,
11:10 AM 25-48-56 Fe M. Nisperos, RN, MAN(Thesis II)
RN
August 3, 2010 C.C.M. Vitrectomy, Change of ______________________ _______________________________
9:30 AM 18-24-45 Intraoccular Lens, Right Glorifina G. Dacumos, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

August 3, 2010 R.N.D. Exploratory Laparotomy, _____________________ ________________________________


12:00 NN 31-78-24 Appendectomy with lavage Glorifina G. Dacumos, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

August 4, 2010 C.C.B. Pelvic Laparotomy, ___________________ _______________________________


1:15 PM 16-84-06 Adhesiolysis Rodel L. Novales, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1B
ASSISTED DELIVERY
LORMA COLLEGES FORM
Carlatan City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628, Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27, 2009-January 26,2012)

ACTUAL DELIVERY in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Patient’s INITIAL PROCEDURE


Date Performed Only PERFORMED D.R. Nurse on Duty SUPERVISED BY
and Time Started Case Number

__________________
August 2, 2010 S.D.A. ___________________
Normal Spontaneous Delivery Mary Jane P. Advincula,
10:15 AM 30-42-24 Jonalyn D. Padilla, RN, MAN(Thesis I)
RN

October 19, 2010 E.T.C. ___________________ _________________


Normal Spontaneous Delivery
10:05 AM 10-46-18 Melanie A. Marron, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1B
ASSISTED DELIVERY
FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

ACTUAL DELIVERY in Ilocos Training and Regional Medical Center, Parian, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Patient’s INITIAL Only PROCEDURE


Date Performed PERFORMED D.R. Nurse on Duty SUPERVISED BY
Case Number
and Time Started

September 10, 2010


L.P. __________________ ___________________
5:05 PM Normal Spontaneous Delivery
2005-0011024 Michelle T. Nitura, RN Germelina A. Tabios, RN, MAN(Thesis I)
September 10, 2010 E.A. __________________ ___________________
Normal Spontaneous Delivery
10:41 PM 2003-0111338 Michelle T. Nitura, RN Germelina A. Tabios, RN, MAN(Thesis I)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1B
ASSISTED DELIVERY
FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Patient’s INITIAL Only PROCEDURE


Date Performed PERFORMED D.R. Nurse on Duty SUPERVISED BY
Case Number
and Time Started

November 26,2010 F.L. __________________ ______________________________________


Normal Spontaneous Delivery
11:30 PM Emergency Medical Service Dolores Salazar, RN Jennifer L. Mohammed, RN, MANc

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2B
O.R. CIRCULATING FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

SURGICAL SCRUB in City Health Office, City of San Fernando, La Union

Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY


Time Started Only PROCEDURE
Case Number PERFORMED

J.Q. ___________________
May 8, 2010 ________________________________
Emergency Medical Circumcision Emily M. Laroya, RN
9:00 AM Jennifer L. Mohammed, RN, MANc
Service
B.G.
September 29, 2010 Suturing of Lacerated ___________________ ___________________________
Emergency Medical
8:40 AM Wound, Lower Lip Left Teodora A.Gonzales, RN Jennifer L. Mohammed, RN, MANc
Service

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: _________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 2B
O.R. CIRCULATING FORM

LORMA COLLEGES
Carlatan City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

SURGICAL SCRUB in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY


Time Started Only PROCEDURE
Case Number PERFORMED

July 28,2010 Debridement of infected


E.E.V ________________________________
6:30 AM wound, left ankle ___________________
31-73-35 Jonalyn D. Padilla, RN, MAN(Thesis I)
Glorifina G. Dacumos, RN
August 3, 2010 O.P.A. Excision of Mass, Left ___________________ ________________________________
11:45 AM 14-84-25 Shoulder and Back Mark Francis Sison, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
Completion Curettage of
August 4, 2010 K.F.L. ___________________ ________________________________
the uterus
9:25 AM 31-23-59 Khritchie Lagarto, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1C
CORD CARE FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628, Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

IMMEDIATE NEWBORN CORD CARE in Ilocos Training and Regional Medical Center, Parian, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________


Student

Date Performed and Patient’s INITIAL Immediate Newborn Nurse on Duty SUPERVISED BY
Time Started Only Cord Care
Case Number PERFORMED

May 13, 2010 A.M.T. _______________ ____________________________


3:34 PM 2010-0010727 Operating Room Dianne L. Estigoy, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)

_______________ ____________________________
May 22, 2010 D.A.L. Delivery Room Dianne L. Estigoy, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)
3:25 PM Well Baby
February 10,2011 R.C.D Operating Room ___________________ ____________________________
4:10 PM Well Baby. Maria Lalaine Rivera, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator, Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1C
CORD CARE FORM

LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628, Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)

IMMEDIATE NEWBORN CORD CARE in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student ________________________


Student

Date Performed and Patient’s INITIAL Immediate Newborn Nurse on Duty SUPERVISED BY
Time Started Only Cord Care
Case Number PERFORMED

October 18,2010 L.B.L _______________ ____________________________


10:40 AM 32-39-81 Operating Room Ma. Cecilia H. Galon, RN Jonalyn D. Padilla, RN, MAN, (Thesis I)

B.B.G _______________ ____________________________


March 2, 2011 47-47-92 Operating Room Ma. Cecilia H. Galon, RN Jonalyn D. Padilla, RN, MAN, (Thesis I)
2:52 PM

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali


Clinical Coordinator, Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0128096 Valid until: August 05, 2012
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN

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