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Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T.

Lim Boulevard, Zamboanga City

ODC Form 1C CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE in__LABUAN PUBLIC HOSPITAL_____ Prepared by: Printed Name and Signature of Student: _ANNA WINLYN BERIBO BARIDJI_ Patients INITIAL Only _____________________ Case Number (Not applicable for Birthing/Lying-In Clinics/Homes) Immediate Newborn Cord Care PERFORMED (Indicate where performed e.g. D.R., Nursery, NICU, or Home)

Date Performed and Time Started

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

March 28, 2011 12:35 pm

B.G.C. 069469

NICU

Bernardo D. Orpiano V, R.N.

Annabelle V. Ramirez, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing_____________

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

ODC Form 1C CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE in__LABUAN PUBLIC HOSPITAL_____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI__ Patients INITIAL Only _____________________ Case Number (Not applicable for Birthing/Lying-In Clinics/Homes) Immediate Newborn Cord Care PERFORMED (Indicate where performed e.g. D.R., Nursery, NICU, or Home)

Date Performed and Time Started

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

September 30, 2010 7:00 pm

B.G.A. 067481 NICU Ruben U. Rodriguez, R.N. Annabelle V. Ramirez, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing_____________

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

ODC Form 2A O.R. SCRUB FORM Major

SURGICAL SCRUBS in BRENT HOSPITAL AND COLLEGES INCORPORATED____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI_

Date Performed and Time Started

Patients INITIAL Only _________________ Case Number

Surgical Procedure Performed

O.R. Nurse On Duty (Name & Signature)

Supervised by Clinical Instructor (Name & Signature)

August 12, 2010 3:20 pm

G.C. 237188

Small Incision, Cataract Surgery

Michelle P. Arbonida, R.N.

Randolf P. Garcia, R.N.,R.M.,M.N

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________

Highest Nursing Degree Earned: __Master in Nursing______________

Highest Nursing Degree Earned: __Master of Arts in Nursing______________ ODC Form 2A O.R. SCRUB FORM Major

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

SURGICAL SCRUBS in ZAMBOANGA PEURICULTURE MATERNAL LYING-IN HOSPITAL ____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI_

Date Performed and Time Started

Patients INITIAL Only _________________ Case Number

Surgical Procedure Performed

O.R. Nurse On Duty (Name & Signature)

Supervised by Clinical Instructor (Name & Signature)

October 21, 2010

D.D. 29037

Repeat Cesarian Section Low Transverse Cervical

Christoper Miranda, R.N.

Mary Anne M. Occo R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

ODC Form 1C CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE in__SINUNUC HEALTH CENTER_____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI_ Patients INITIAL Only _____________________ Case Number (Not applicable for Birthing/LyingIn Clinics/Homes) Immediate Newborn Cord Care PERFORMED (Indicate where performed e.g. D.R., Nursery, NICU, or Home)

Date Performed and Time Started

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

July 10, 2009 3:25 pm December 25, 2009 9:00 am

B.G.M.

Health Center

Hazel D. Fernandez, R.M.

Claudette Leen A. Torrefranca, R.N..

B.B.U.

Health Center

Hazel D. Fernandez, R.M.

Claudette Leen A. Torrefranca, R.N..

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing_____________ ODC Form 2A O.R. SCRUB FORM Major

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

SURGICAL SCRUBS in BRENT HOSPITAL AND COLLEGES INCORPORATED____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI_ O.R. Nurse On Duty (Name & Signature) Supervised by Clinical Instructor (Name & Signature)

Date Performed and Time Started

Patients INITIAL Only _________________ Case Number S.H. 234964 R.L. 236583

Surgical Procedure Performed

January 31, 2010 11:00 am

Total Thyroidectomy Right Lobe with Isthmusectomy

Joseph A. Bonel, R.N.

Randolf P. Garcia, R.N.,R.M.,M.N

July 03, 2010 7:55 pm

Partial Mastectomy Right with Axillary node Dissection

Michelle P. Arbonida, R.N.

Randolf P. Garcia, R.N.,R.M.,M.N

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________ ODC Form 1B ASSISTED DELIVERY FORM

Brent Hospital and Colleges Incorporated Episcopal Diocese of Southern Philippines Justice R.T. Lim Boulevard, Zamboanga City

ACTUAL DELIVERY in __ SINUNUC HEALTH CENTER __ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI___ Patients INITIAL Only _______________________ Case Number (Not applicable for Birthing/LyingIn Clinics/Homes)

Date Performed and Time Started

Procedure Performed ASSISTED DELIVERY

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

July 01, 2009 3:06 pm July 20, 2009 8:00 am

C.A.

Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Hazel D. Fernandez, R.M

Claudette Leen A. Torrefranca, R.N.

J.M.

Hazel D. Fernandez, R.M

Claudette Leen A. Torrefranca, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _______________________ Time ________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master in Nursing______________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________ Brent Hospital and Colleges Incorporated ODC Form 1A Episcopal Diocese of Southern Philippines ACTUAL DELIVERY Justice R.T. Lim Boulevard, Zamboanga City FORM

ACTUAL DELIVERY in

SINUNUC HEALTH CENTER ___

Prepared by: Printed Name and Signature of Student: ANNA WINLYN BERIBO BARIDJI_ Patients INITIAL Only _______________________ Case Number (Not applicable for Birthing/Lying-In Clinics/Homes)

Date Performed and Time Started

Procedure Performed

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

September 02, 2009 6:15 pm September 12, 2009 7:45 pm

C.S. N.A.

Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Hazel D. Fernandez, R.M Hazel D. Fernandez, R.M

Claudette Leen A. Torrefranca, R.N. Claudette Leen A. Torrefranca, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N., M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _______________________ Time ________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master in Nursing______________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________ Brent Hospital and Colleges Incorporated ODC Form 1B Episcopal Diocese of Southern Philippines ASSISTED DELIVERY Justice R.T. Lim Boulevard, Zamboanga City FORM

ACTUAL DELIVERY in __ LABUAN PUBLIC HOSPITAL_____ Prepared by: Printed Name and Signature of Student: _ ANNA WINLYN BERIBO BARIDJI___ Patients INITIAL Only _______________________ Case Number (Not applicable for Birthing/LyingIn Clinics/Homes)

Date Performed and Time Started

Procedure Performed ASSISTED DELIVERY

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

October 17, 2010 3:20 am February 24, 2011 7:05 pm

R.R. 061756 J.Q. 068123

Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Perla Mae R. Villamor, R.N.

Annabelle V. Ramirez, R.N.

Mark Anthony J. Morillo, R.N.

Annabelle V. Ramirez, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N.,M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _______________________ Time ________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master in Nursing______________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________ Brent Hospital and Colleges Incorporated ODC Form 1A Episcopal Diocese of Southern Philippines ACTUAL DELIVERY Justice R.T. Lim Boulevard, Zamboanga City FORM

ACTUAL DELIVERY in

LABUAN PUBLIC HOSPITAL________

Prepared by: Printed Name and Signature of Student: ANNA WINLYN BERIBO BARIDJI_

Date Performed and Time Started

Patients INITIAL Only _______________________ Case Number (Not applicable for Birthing/LyingIn Clinics/Homes) J.C. 066982 N.B. 065265 M.I. 070031

Procedure Performed

D.R. Nurse On Duty (Name & Signature) (If Midwife on Duty, Signature not required)

Supervised by Clinical Instructor (Name & Signature)

October 07, 2010 3:45 pm November 14, 2010 4:30 am March 23, 2011 6:30 pm

Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery Normal Spontaneous Vaginal Delivery

Perla Mae R. Villamor, R.N. Perla Mae R. Villamor, R.N. Ruben U. Rodriguez, R.N.

Annabelle V. Ramirez, R.N. Annabelle V. Ramirez, R.N. Annabelle V. Ramirez, R.N.

Noted by:

RANDOLF P. GARCIA, R.N., R.M., M.N. __________ (Print Name & Signature)

Approved by:

LEOPOLDO M. BERNARDO, R.N., M.A.N.________ (Print Name & Signature)

Clinical Coordinator, PRC I.D. No. __0443877 Valid Until: _April 2013 Date document is signed: _______________________ Time ________ Highest Nursing Degree Earned: __Master in Nursing______________

Dean, PRC I.D. No. __0066218__Valid Until:_____August 2011____________ Date document is signed: _____________ Time _________________________ Highest Nursing Degree Earned: __Master of Arts in Nursing______________