COLLEGE OF NURSING

GUIDELINES IN THE USE OF

Intra-Partal, Immediate Care of the Newborn and
Intra-Operative Forms

DESCRIPTION OF FORMS
The completed Intra-Partal, Immediate Care of the Newborn and Intra-Operative Forms
shall be submitted to CHED as evidence of obtaining Intra-Partal, Immediate Care of the
Newborn and Intra-Operative competencies and for purposes of securing “special orders” for
graduation together with other CHED requirements:
1. Summary Performance Evaluation for Intra-Partal Care Competency
2. Summary Performance Evaluation for Immediate Care of the Newborn
Competency
3. Summary Performance Evaluation for Intra-Operative Care Competency

Source: PRC-BON Memo Circular No. 01 Series 2009

GUIDELINES IN KEEPING AND FILLING – UP THE OR/DR FORMS

KEEPING THE FORMS

1. A student will be given three copies of the form by the Clinical Coordinator at the
beginning of the 1st semester of Level II and must maintain the triplicate copies (1 copy
for the College Registrar; 1 copy for CHED; 1 copy for the student) in the entire stay of
the college.
The copies must be placed:
 Reg.’s copy and CHED’s copy in a short, green, clear envelope
 Student’s copy in a short, clear book( any color of choice)
All three copies must be brought always whenever assigned in Operating Room,
Delivery Room and Nursery. At the start of the rotation, the group leader gets the
forms from the Clinical Coordinator and at the end of the rotation, the group
leader returns the Registrar’s copy and CHED’s copy to the Clinical Coordinator
for safekeeping.

2. The student is responsible in keeping the forms and filling up the necessary
information. The forms is part of the clearance requirement per semester of the
Clinical Coordinator.

3. The forms must always be readily available for checking of the Board of Nursing, Dean
and Clinical Coordinator.

FILLING – UP THE OR/DR FORMS

1. The form must be filled-up using the handwritten of the students and in printed format
and using the black sign pen.
2. Avoid alterations in accomplishing the form. Any alteration must bear the signature of
the C.I. or the Clinical Coordinator.
3. It must be filled-up right after any case was performed.

Failure to comply with the guidelines may mean delay in the application of Special
Order for Graduation.

rev.Jan.2010