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WEST VISAYAS STATE UNIVERSITY

LUNA STREET, LA PAZ, ILOILO CITY Tel. No. (033) 320 0870 Local 143, Fax (033) 320 2623, con@wvsu.edu.ph, www.wvsu.edu.ph (Level III Re-Accredited Status by AACCUP, December 2006) IMMEDIATE NEWBORN CORD CARE in ANGEL SALAZAR MEMORIAL GENERAL HOSPITAL, SAN JOSE, ANTIQUE Prepared by: Printed Name and Signature of Student

ODC Form 1C CORD CARE FORM

JAN NIO ARDAMIL ESTRELLA

Date Performed and Time Started 4-13-11 10:30 P.M. 4-14-11 10:41 P.M.

Patient's INITIAL Only Case Number

Immediate Newborn Cord Care

PERFORMED
(Indicate area performed)

D.R. Nurse on Duty (Name and Signature)

SUPERVISED BY Clinical Instructor Name and Signature

Baby Girl Q. 85 Baby Boy D. 99

Cord Care Delivery Room Cord Care Delivery Room Julie G. Osunero, R.N. Alexis V. Escarza, R.N. Dinafe F. Cervera, R.N. Alexis V. Escarza, R.N.

Noted by: VIRGINIA F. FEDERISO, R.N.,M.A.N. Clinical Coordinator, PRC I.D. No. 160176 Valid Until: _May 21, 2012____ Date document is signed: ____________________ Time:____________________ Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DAISY C. VILLAROSA, R.N., M.S.N.____________ Dean, PRC I.D. No. 0043891_____________ Valid Until: July 2, 2014__ Date document is signed: _______________ Time: ________________ Highest Nursing Degree Earned: Master of Science in Nursing_______