Capitol University

College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City
(CHED 070: PACUCOA Level ! "une #$! #%&' (anila)
AC*UAL DEL+,E-. in Northern Mindanao Medical Center, Cagayan de Oro City
Hospital, City
Prepared by: EDNAL.N DADAL Year of Admission in te !S" Program: #$ne %&&'
Printed "ame and Signat$re of St$dent: E("A)Y" (A(A) Year *rad$ated in !S" Program: +ar, %&-.
No/ Date Perfor0e1
*i0e
2tarte1
Case No/ Patient3s Na0e P-OCEDU-E PE-4O-(ED
D/-/ Nurse On Duty
(Na0e 5 2ignature)
2upervise1 6y
Na0e an1 2ignature of C/+/
- +ay /, %&-. -%:0. P+ 1-'%// 2ris Cri3 !anian "ormal Spontaneo$s 4aginal (eli5ery
El5ie Cosmiano, 6.+., 6."., +.". 7aren Callangan, 6."., +A".
% "o5ember .&, %&-. 8:./ A+ 19-%8% +arybelle S$daria "ormal Spontaneo$s 4aginal (eli5ery
Aida Amper, 6.". "ean S. Ansale, 6."., +.".
. #an$ary .&, %&-0 -&:8- P+ 19-8'9 )ea :lores "ormal Spontaneo$s 4aginal (eli5ery
Seryl !a$di, 6.". "ean S. Ansale, 6."., +.".
0 #an$ary .-,%&-0 .:8% A+ 1889'8 6$ssel Pabayo "ormal Spontaneo$s 4aginal (eli5ery
Seryl !a$di, 6". "ean S. Ansale, 6."., +.".
8 #an$ary .-, %&-0 8:&& A+ 1'--'1 +i;en )ibres "ormal Spontaneo$s 4aginal (eli5ery
Seryl !a$di, 6". "ean S. Ansale, 6."., +.".
ODC 4or0 #A
AC*UAL DEL+,E-. 4O-(
Capitol University
College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City
(CHED 070: PACUCOA Level ! "une #$! #%&' (anila)
A22+2*ED DEL+,E-. in Northern Mindanao Medical Center, Cagayan de Oro City
Hospital, City
Prepared by: EDNAL.N DADAL Year of Admission in te !S" Program: #$ne %&&'
Printed "ame and Signat$re of St$dent: E("A)Y" (A(A) Year *rad$ated in !S" Program: +ar, %&-.
Note1 6y: <<<<< Honeylou A/ Opon1a! -/N/! (/A/! (/A/N/ < <<<<<
=Print "ame & Signat$re>
Clini7al Coor1inator, P6C 2.(. "o.: 0'#7&%8 4alid ?ntil: "anuary 8! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9

Approve1 6y: <<<<<< 4i1ela :/ Ansale! -/N/! (/A/N/ < <<<<<<
=Print "ame & Signat$re>
Dean, P6C 2.(. "o.: 00&;0$; 4alid ?ntil: 4e6ruary 7! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9
ODC 4or0 #:
A22+2*ED DEL+,E-. 4O-(
No/ Date Perfor0e1
*i0e
2tarte1
Case No/ Patient3s Na0e
P-OCEDU-E PE-4O-(ED
A22+2*ED DEL+,E-.
D/-/ Nurse On Duty
="ame & Signat$re>
2upervise1 6y
"ame and Signat$re of C.2.
- A$g$st -', %&-- 9:.8 A+ /1-%'' #orgine Ann (ala$ta
"$Ae3
"ormal Spontaneo$s 4aginal (eli5ery
#osepine 6omorosa, 6.". !ergris +. P$erto, 6."., +.".
%
A$g$st %1,%&-- -:8% P+ 8.-%1% )olita Salar3a
"ormal Spontaneo$s 4aginal (eli5ery
Alyn 6o5idas, 6.". !ergris +. P$erto, 6."., +.".
. +ay 1, %&-. ':%' A+ &-&..0'1 Perlie Eniola "ormal Spontaneo$s 4aginal (eli5ery
El5ie Cosmiano, 6.+., 6."., +.". 7aren 4. Callangan, 6."., +.A.".
0 +ay /, %&-. 9:./ A+ &-&.800 !elen (ela Salde "ormal Spontaneo$s 4aginal (eli5ery
El5ie Cosmiano, 6.+., 6."., +.". 7aren 4. Callangan, 6."., +.A.".
8 "o5ember .&, %&-. -%:8/ A+ %/'&9' +ari,ar 6aAa "ormal Spontaneo$s 4aginal (eli5ery
Aida Amper, 6.". "ean S. Ansale, 6."., +.".
Note1 6y: Honeylou A/ Opon1a! -/N/! (/A/! (/A/N/ <
=Print "ame & Signat$re>
Clini7al Coor1inator, P6C 2.(. "o.: 0'#7&%8 4alid ?ntil: "anuary 8! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9
Approve1 6y: <<<<<< 4i1ela :/ Ansale! -/N/! (/A/N/ < <<<<<<
=Print "ame & Signat$re>
Dean, P6C 2.(. "o.: 00&;0$; 4alid ?ntil: 4e6ruary 7! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9
ODC 4or0 #C
CO-D CA-E 4O-(
Capitol University
College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City
(CHED 070: PACUCOA Level ! "une #$! #%&' (anila)
+((ED+A*E NE=:O-N CO-D CA-E in Northern Mindanao Medical Center, Cagayan de Oro City
Hospital, City
Prepared by: EDNAL.N DADAL Year of Admission in te !S" Program: #$ne %&&'
Printed "ame and Signat$re of St$dent: E("A)Y" (A(A) Year *rad$ated in !S" Program: +ar, %&-0
No/ Date Perfor0e1
*i0e
2tarte1
Case No/ Patient3s Na0e
+00e1iate Ne>6orn Cor1 Care
PE-4O-(ED
(+n1i7ate >?ere perfor0e1)
Nurse On Duty
="ame & Signat$re>
2upervise1 6y
"ame and Signat$re of C.2.
- A$g$st %1, %&-- -&:0. A+ /10/1- Angelyn Polesti,o (eli5ery 6oom
Andrea +arie 4irt$da3o, 6.". !ergris +. P$erto, 6."., +.".
%
September %, %&-- %:&8 P+ /101'- #on (Bayne En,abo
(eli5ery 6oom
Cerry )o$ *alagnara, 6.". !ergris +. P$erto, 6."., +.".
. +ay 9, %&-. -&:.' A+ &-&.0.'% #$lian )a,io "eonatal 2ntensi5e Care ?nit
#o,elyn Alaba, 6.". 7aren 4. Callangan, 6."., +.A.".
0 +ay 9, %&-. -%:8% A+ &-&.0.1/ !aby !oy Andaleon "eonatal 2ntensi5e Care ?nit
#o,elyn Alaba, 6.". 7aren 4. Callangan, 6."., +.A.".
8 "o5ember .&, %&-. -:-' P+ 19-0.0 Elton Caballeon (eli5ery 6oom
+aila Saba,aCan, 6." "ean S. Ansale, 6."., +.".
Note1 6y: <<<<< Honeylou A/ Opon1a! -/N/! (/A/! (/A/N/ < <<<<
=Print "ame & Signat$re>
Clini7al Coor1inator, P6C 2.(. "o.: 0'#7&%8 4alid ?ntil: "anuary 8! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9
Approve1 6y: <<<<< < 4i1ela :/ Ansale! -/N/! (/A/N/ <<< < <<<
=Print "ame & Signat$re>
Dean, P6C 2.(. "o.: 00&;0$; 4alid ?ntil: 4e6ruary 7! '0#8
(ate (o,$ment is signed: <<<<<<<<<<<< @ime: <<<<<<<<<<<<<<<<<<<<
Higest "$rsing (egree Earned: (A2*E- O4 A-*2 +N NU-2+N9