COLEGIO DE KIDAPAWAN

Quezon Boulevard, Kidapawan City

E-mail: [email protected] Website: http/www.cdk.edu.ph

ACTUAL DELIVERY in __________________________________________

Prepared by:
_____________________________ _____________
ODC FORM 1A
Printed Name and Signature of Student ACTUAL Delivery Form

Date Performed Patient’s INITIAL Only PROCEDURE D.R Nurse On Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number (if Midwife on Duty, Name and Signature
(not applicable for Signature not
birthing/Lying-In required)
Clinics/homes)

Normal Spontaneous
Vaginal Delivery

Normal Spontaneous
Vaginal Delivery

Normal Spontaneous
Vaginal Delivery

Noted by: _____________________________ ________________________ Approved by : ______________________________________________

Clinical Coordinator, PRC I.D No. _________ Valid Until: ______________ Dean, PRC I.D No: __________ Valid Until:__ _________________
Date Document is Signed:_________________ Time: __________________ Date Document is Signed:_________________ Time: _____________
Please Specify Highest Nursing Degree Earned: _______________________ Specify Highest Nursing Degree Earned: _________________________
 COLEGIO DE KIDAPAWAN
Quezon Boulevard, Kidapawan City
E-mail: [email protected] Website: http/www.cdk.edu.ph

ACTUAL DELIVERY in ________________________________________________

Prepared by:
ODC FORM 1B
_____________________________ _____________ ASSISTED Delivery Form
Printed Name and Signature of Student

Date Performed and Patient’s INITIAL Only PROCEDURE D.R Nurse On Duty SUPERVISED BY
Time Started PERFORMED (Name and Signature) Clinical Instructor
Case Number (if Midwife on Duty, (Name and Signature)
(not applicable for Signature not
birthing/Lying-In ASSISTED DELIVERY required)
Clinics/homes)

Normal Spontaneous Vaginal

Delivery

Normal Spontaneous Vaginal

Delivery

Normal Spontaneous Vaginal

Delivery

Noted by: _____________________________ ________________________ Approved by : ______________________________________________

Clinical Coordinator, PRC I.D No. _________ Valid Until: ______________ Dean, PRC I.D No: __________ Valid Until:__ _________________
Date Document is Signed:_________________ Time: __________________ Date Document is Signed:_________________ Time: _____________
Please Specify Highest Nursing Degree Earned: _______________________ Specify Highest Nursing Degree Earned: _________________________
 COLEGIO DE KIDAPAWAN
Quezon Boulevard, Kidapawan City
E-mail: [email protected] Website: http/www.cdk.edu.ph

ACTUAL DELIVERY in ___________________________________________________

Prepared by:
_____________________________ _____________
Printed Name and Signature of Student ODC FORM 1C
Immediate Newborn Cord
Care Form
Date Performed Patient’s INITIAL Only Immediate Newborn Cord D.R Nurse On Duty SUPERVISED BY
and Care (Name and Signature) Clinical Instructor
Time Started Case Number PERFORMED (if Midwife on Duty, Name and Signature
(not applicable for Signature not
birthing/Lying-In Indicate where performed required)
Clinics/homes) e.g. D.R.,
Nursery, NICU, or Home

Cord Care
Delivery Room

Cord Care
Delivery Room

Cord Care
Delivery Room

Noted by: _____________________________ ________________________ Approved by : ______________________________________________

Clinical Coordinator, PRC I.D No. _________ Valid Until: ______________ Dean, PRC I.D No: __________ Valid Until:__ _________________
Date Document is Signed:_________________ Time: __________________ Date Document is Signed:_________________ Time: _____________
Please Specify Highest Nursing Degree Earned: _______________________ Specify Highest Nursing Degree Earned: _________________________
 COLEGIO DE KIDAPAWAN
Quezon Boulevard, Kidapawan City
E-mail: [email protected] Website: http/www.cdk.edu.ph

_______________________________________________________________
Prepared by:
_____________________________ _____________
ODC FORM 2A
Printed Name and Signature of Student O.R SCRUB Form
Major
Date Performed Patient’s INITIAL Only SURGICAL PROCEDURE O.R Nurse On Duty SUPERVISED BY
and PERFORMED Clinical Instructor
Time Started Case Number Name and Signature

Noted by: _____________________________ ________________________ Approved by : ______________________________________________

Clinical Coordinator, PRC I.D No. _________ Valid Until: ______________ Dean, PRC I.D No: __________ Valid Until:__ _________________
Date Document is Signed:_________________ Time: __________________ Date Document is Signed:_________________ Time: _____________
Please Specify Highest Nursing Degree Earned: _______________________ Specify Highest Nursing Degree Earned: _________________________
 COLEGIO DE KIDAPAWAN
Quezon Boulevard, Kidapawan City
E-mail: [email protected] Website: http/www.cdk.edu.ph

_________________________________________________________________

Prepared by:
ODC FORM 2B
_____________________________ _____________ O.R CIRCULATING Form
Printed Name and Signature of Student Major

Date Performed and Patient’s INITIAL Only SURGICAL PROCEDURE O.R Nurse On Duty SUPERVISED BY
Time Started PERFORMED Clinical Instructor
Case Number Name and Signature

Noted by: _____________________________ ________________________ Approved by : ______________________________________________

Clinical Coordinator, PRC I.D No. _________ Valid Until: ______________ Dean, PRC I.D No: __________ Valid Until:__ _________________
Date Document is Signed:_________________ Time: __________________ Date Document is Signed:_________________ Time: _____________
Please Specify Highest Nursing Degree Earned: _______________________ Specify Highest Nursing Degree Earned: _________________________