Handle Exhibit Forms (Cuizon, Daisy J.)

DAVAO DOCTORS COLLEGE
Gen. Malvar St., Davao City

Tel. Nos. (082) 222-0850- 53
Telefax No. (082) 221- 1074
Name of Student: CUIZON, DAISY JASMIN_____________________

Name and Address of School: Davao Doctors College, Gen. Malvar St., Davao City
Accreditation Level: ________________________________________________ Year Granted: _______________
Date School/Program was recognized: 1975_ BSN Government Recognition: No. 057 S. 1983
First Course (if any): Not Applicable_____ School Graduated From: Not Applicable___ Year: Not Applicable____
Year of Admission in the Bachelor of Science in Nursing Program: __2006__________________________________
Year Graduated (Bachelor of Science in Nursing Program):_2010_________________________________________
III. ACTUAL DELIVERY
NO. CASE NO. DIAGNOSIS NAME OF AGE DATE OF TIME OF GENDER NAME OF TYPE OF Supervised by:
MOTHER DELIVERY DELIVERY OF HOSPITAL DELIVERY NAME & SIGNATURE
BABY OF QUALIFIED CI
Pregnancy Uterine Full Term, 38 Weeks and Belleza Family

Normal Rose Vida L.
6 Days Age of Gestation, Cephalic Presentation, Amy S. 27 Years September 6, Planning and
1 2009-7321 9:31 AM Female Spontaneous Barza, RT, RN, MAN
Delivered Spontaneously to a Live Baby Girl, with Silverio Old 2009 Maternity
Vaginal Delivery
APGAR Score of 9 and 10, Gravida 2 Parity 2 Clinic
Prepared by:
CUIZON, DAISY JASMIN __

Signature over Printed Name of Student
Noted by: Concurred by: Approved by:
LEALITA A. ARRANGUEZ, RN, MN_____________ _____________________________________ LINELL G. MALIMBAG, RN, MAN, PhD
Signature Over Printed Name of Clinical Coordinator Signature Over Printed Name of Chief Nurse Signature Over Printed Name of Dean
Date Signed : _________________________________ Date Signed : _______________________ Date Signed : _____________________________
Degree : Master in Nursing___________________ Degree : _______________________ Degree : Master of Arts in Nursing_________
a.) PRC No. : 0215490__________________________ a.) PRC No. : _______________________ : Doctor of Philosophy in Management
Valid Until : August 25, 2012____________________ Valid Until : _______________________ a.) PRC No. : 0115500_______________________
b.) PNA No. : 19222____________________________ b.) PNA No. : _______________________ Valid Until : January 11, 2013________________
Valid until : Lifetime___________________________ Valid until : _______________________ b.) PNA Lifetime ID No.: 7697__________________
c.) ANSAP No. : _______________________ Issued : March 19,1990_________________
Valid until : _______________________ c.) ADPCN Membership No.: 0583______________
Expiration Date: 2010_____________________
Tel. Nos. (082) 222-0850- 53
Telefax No. (082) 221- 1074

Accreditation Level: ________________________________________________ Year Granted: ___________
III. ACTUAL DELIVERIES
NO. CASE NO. DIAGNOSIS NAME OF AGE DATE OF TIME OF GENDER NAME OF TYPE OF Supervised by:
MOTHER DELIVERY DELIVERY OF BABY HOSPITAL DELIVERY NAME & SIGNATURE OF
QUALIFIED CI
Pregnancy Uterine Full Term, 39 Weeks

Guisok Normal
and 2 Days Age of Gestation, Cephalic
Arlene T. 30 Years November Domicillary and Spontaneous
1 01839 Presentation, Delivered Spontaneously 12:15 PM Male Domingo T. So, Jr., RN
Colita Old 22, 2009 Obstetrical Vaginal
to a Live Baby Boy, with APGAR Score
Clinic Delivery
of 8 and 9, Gravida 3 Parity 3
Pregnancy Uterine Full Term, 38 Weeks

and 3 Days Age of Gestation, Cephalic Guisok Normal
Presentation, Delivered Spontaneously Rosalyn A. 28 Years November Domicillary and Spontaneous
2 01854 10:15 AM Male Domingo T. So, Jr., RN
to a Live Baby Boy, with APGAR Score Tiongco Old 30, 2009 Obstetrical Vaginal
of 8 and 9, Gravida 3 Parity 3 Clinic Delivery
Prepared by:

Date Signed : _________________________________ Date Signed : _______________________ Date Signed :_____________________________
Valid Until : August 25, 2012____________________ Valid Until : _______________________ a.) PRC No. : 0115500______________________
b.) PNA No. : 19222____________________________ b.) PNA No. : _______________________ Valid Until : January 11, 2013_______________
Valid until : Lifetime___________________________ Valid until : _______________________ b.) PNA Lifetime ID No.: 7697_________________
c.) ANSAP No. : _______________________ Issued : March 19,1990________________
Valid until : _______________________ c.) ADPCN Membership No.: 0583_____________
Expiration Date: 2010____________________
Tel. Nos. (082) 222-0850- 53
Telefax No. (082) 221- 1074

Accreditation Level: ________________________________________________ Year Granted: ___________
III. ACTUAL DELIVERIES

Supervised by:
NO. CASE NO. DIAGNOSIS NAME OF AGE DATE OF TIME OF GENDER NAME OF TYPE OF NAME & SIGNATURE
MOTHER DELIVERY DELIVERY OF HOSPITAL DELIVERY OF QUALIFIED CI
BABY
Pregnancy Uterine Full Term, 38 Weeks and 2 Days EUP Family Normal
Age of Gestation, Cephalic Presentation, Delivered Christine G. 19 Years January 20, Care and Spontaneous Rose Vida L.
1 02290 11:20AM Male
Spontaneously to a Live Baby Boy, with APGAR Zamora Old 2010 Maternity Vaginal Barza, RT, RN, MAN
Score of 8 and 9, Gravida 2 Parity 1 Abortion 1 Clinic Delivery
Pregnancy Uterine Full Term, 39 Weeks Age of EUP Family Normal

Rose Vida L.
Gestation, Cephalic Presentation, Delivered Rudith C. 36 Years February 3, Care and Spontaneous
2 02297 10:25AM Male Barza, RT, RN, MAN
Spontaneously to a Live Baby Boy, with APGAR Esdrelon Old 2010 Maternity Vaginal
Score of 8 and 9, Gravida 4 Parity 4 Clinic Delivery
Prepared by:

Date Signed : _________________________________ Date Signed : _______________________ Date Signed : _____________________________
Valid Until : August 25, 2012____________________ Valid Until : _______________________ a.) PRC No. : 0115500______________________
b.) PNA No. : 19222____________________________ b.) PNA No. : _______________________ Valid Until : January 11, 2013_______________
Valid until : Lifetime___________________________ Valid until : _______________________ b.) PNA Lifetime ID No.: 7697_________________
c.) ANSAP No. : _______________________ Issued : March 19,1990________________
Valid until : _______________________ c.) ADPCN Membership No.: 0583_____________
Expiration Date: 2010____________________

Handle Exhibit Forms (Cuizon, Daisy J.)

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DAVAO DOCTORS COLLEGE

Gen. Malvar St., Davao City

Name of Student: CUIZON, DAISY JASMIN_____________________

III. ACTUAL DELIVERY

Pregnancy Uterine Full Term, 38 Weeks and Belleza Family

CUIZON, DAISY JASMIN __

Noted by: Concurred by: Approved by:

Name of Student: CUIZON, DAISY JASMIN_____________________

III. ACTUAL DELIVERIES

Pregnancy Uterine Full Term, 39 Weeks

Pregnancy Uterine Full Term, 38 Weeks

CUIZON, DAISY JASMIN __

Noted by: Concurred by: Approved by:

Name of Student: CUIZON, DAISY JASMIN_____________________

III. ACTUAL DELIVERIES

Pregnancy Uterine Full Term, 39 Weeks Age of EUP Family Normal

CUIZON, DAISY JASMIN __

Noted by: Concurred by: Approved by:

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