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J.M.

J Marist Brothers
Notre Dame of Kidapawan College
Kidapawan City
DELIVERY ROOM
HANDLE/ASSIST
Name of Patient:
Address:
Gravida:
Labor started at:
BOW ruptured at:
Placenta expelled at:
Date Delivered:
Admitting Diagnosis:
Post-Partum Diagnosis:

Age:
Para:

Status:

Abortion:
Date:
Date:
Date:
Time Delivered:

Attending Physician:
Nurse on Duty:
Handled by (student):
Assisted by (student):
Cord Dress by (student):
School:

Case No:
Living:

Gender of NB:

Midwife:

Clinical Instructor:

Confirmed by:
Signature over Printed Name

Signature over Printed Name


OR/DR Nurse on Duty

J.M.J Marist Brothers


Notre Dame of Kidapawan College
Kidapawan City
DELIVERY ROOM
HANDLE/ASSIST
Name of Patient:
Address:
Gravida:
Labor started at:
BOW ruptured at:
Placenta expelled at:
Date Delivered:
Admitting Diagnosis:
Post-Partum Diagnosis:

Age:
Para:

Status:

Abortion:
Date:
Date:
Date:
Time Delivered:

Attending Physician:
Nurse on Duty:
Handled by (student):
Assisted by (student):
Cord Dress by (student):
School:
Clinical Instructor:

Case No:
Living:

Gender of NB:

Midwife:

Confirmed by:
Signature over Printed Name

Signature over Printed Name


OR/DR Nurse on Duty

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