As adopted by Far Eastern University- Dr.
Nicanor Reyes Medical Foundation School of Nursing
ODC Form 1C Cord Care Form
Far Eastern University- Dr. Nicanor Reyes Medical Foundation
Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: [Link] with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229-2007) IMMEDIATE NEWBORN CORD CARE in FAR EASTERN UNIVERSITY- DR. NICANOR REYES MEDICAL FOUNDATION/ REGALADO AVE., WEST FAIRVIEW, QUEZON CITY
Prepared by: IANNE JUNE ABUD MACAPUGAS (Printed Name and Signature of Student)
Student Number: __ 2010AN085_ _
Patients Initial Only Date Performed and Time Started September 22, 2012 6:17 PM Case Number M.P.S.E 74202 Immediate New Born Cord Care Performed
(Indicate where performed eg. D.R., Nursery, NICU, or Home)
Nurse On Duty
(If Midwife on Duty, signature not required)
Signature
Supervised by
Signature
Cord Dressing Performed in Neonatal Intensive Care Unit
Lorraine G. Blanco, R.N.
Mary Ann Q. Bayani, R.N., M.A.N.
Noted by:
Approved by:
CONCEMARCIA V. BACON,R.N., M.A.N. Level Coordinator PRC ID. No.__0124297__ Valid Until __November 27, 2016___ Date Documented is signed: ___________________________ Please specify Highest Nursing Degree Earned: M.A.N.
TITA YAP- CRUZ, R.N., M.A.N., Ed.D. Dean, School of Nursing PRC ID. No. ___38788___ Valid Until __ September 29, 2014____ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: M.A.N., Ed. D.
As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing
ODC Form 2A O.R. SCRUB FORM MAJOR
Far Eastern University- Dr. Nicanor Reyes Medical Foundation
Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: [Link] with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229-2007) SURGICAL SCRUB in FAR EASTERN UNIVERSITY- DR. NICANOR REYES MEDICAL FOUNDATION/ REGALADO AVE., WEST FAIRVIEW, QUEZON CITY
Prepared by:
IANNE JUNE ABUD MACAPUGAS (Printed Name and Signature of Student)
Student Number: _ 2010AN085 _
Patients Initial Only Date Performed and Time Started September 21, 2012 2:05 PM Case Number PROCEDURE PERFORMED Nurse On Duty Signature Supervised by Signature
C.Q.L 74135
Laparoscopic Cholecystectomy
Ma. Cecilia T. Collado, R.N.
Mary Ann Q. Bayani, R.N., M.A.N.
Noted by:
Approved by:
CONCEMARCIA V. BACON, RN, MAN Level Coordinator PRC ID. No._ 0124297 _ Valid Until _November 27, 2013__ Date Documented is signed: ____________________________ Please specify Highest Nursing Degree Earned: MAN
TITA YAP- CRUZ, RN, MAN, Ed. D. Dean, School of Nursing PRC ID. No. ___38788____ Valid Until _September 29, 2014_ Date Documented is signed: _____________________________
As adopted by Far Eastern University- Dr. Nicanor Reyes Medical Foundation School of Nursing
ODC Form 1C Cord Care Form
Far Eastern University- Dr. Nicanor Reyes Medical Foundation
Regalado Avenue, near Dahlia Street, West Fairview, Quezon City, Philippines 1118 Tel. 427- 0213 Loc. 1147/ Website: [Link] with Government Recognition No. 046 Series OF 2007, CHED (Per CEB Resolution Number 229- 2007) IMMEDIATE NEWBORN CORD CARE in Kamuning Lying-in Clinic/19 T. Gener St., Kamuning, Quezon City
Prepared by: IANNE JUNE ABUD MACAPUGAS (Printed Name and Signature of Student)
Student Number: __ 2010AN085_ _
Patients Initial Only Date Performed and Time Started September 13, 2012 4:25 PM Case Number M.V.B 74202 Immediate New Born Cord Care Performed
(Indicate where performed eg. D.R., Nursery, NICU, or Home)
Nurse On Duty
(If Midwife on Duty, signature not required)
Signature
Supervised by
Signature
Cord Dressing Performed in Delivery Room
Erlina P. Punzalan, R.M
Emcil C. Agustin, R.M., R.N., M.A.N.
Noted by:
Approved by:
CONCEMARCIA V. BACON,R.N., M.A.N. Level Coordinator PRC ID. No.__0124297__ Valid Until __November 27, 2016___ Date Documented is signed: ___________________________ Please specify Highest Nursing Degree Earned: M.A.N.
TITA YAP- CRUZ, R.N., M.A.N., Ed.D. Dean, School of Nursing PRC ID. No. ___38788___ Valid Until __ September 29, 2014____ Date Documented is signed: _____________________________ Please specify Highest Nursing Degree Earned: M.A.N., Ed. D.