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Mindanao Sanitarium & Hospital College

School of Nursing
Barangay San Miguel, Iligan City 9200
Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshnet@yahoo.com
Accredited By: Association of Christian Schools, Colleges and Universities Accrediting Agency, Incorporated
Accreditation Level: Level II, April 29, 2011 April 2014
Accredited By: Adventist Accrediting Association
Accreditation Level: Level II, October 4, 2010-December 31, 2012

IMMEDIATE NEWBORN CORD CARE in:Adventist Medical Center, Barangay San Miguel, Iligan City
Lanao del Norte Provincial Hospital, Baroy, Lanao del Norte
Hospital/Home/Lying-in, Municipality/City/Province

Prepared by:
Printed name and Signature of Student: CRISTINA L. JAYSON


Date Performed
and
Time Started

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

Nurse on Duty
(Name and Signature)
(If Midwife on Duty, Signature Not
Required)

SUPERVISED BY
Clinical Instructor
Name and Signature

September 21, 2011
12:09 AM

Baby Boy M
199353

Cord Care
Neonatal Intensive Care Unit

Cristine Faith G. Damas, RN
PRC Number: 0441143
Valid Until: July 7, 2016

Lucy May L. Bucayan, MN, RN
PRC Number: 0193232
Valid Until: May 25, 2016

September 26, 2012
10:00 AM


Baby Boy L
211834

Cord Care
Neonatal Intensive Care Unit

Eunice Lan S. Ardiente, RN
PRC Number: 0714486
Valid Until: October 19, 2017

Lucy May L. Bucayan, MN, RN
PRC Number: 0193232
Valid Until: May 25, 2016

October 2, 2013
9:46 PM

Baby Girl F
074557

Cord Care
Neonatal Intensive Care Unit

Nia Mae D. Abarquez, RN
PRC Number: 0651914
Valid Until: January 1, 2016

Daverly M. Caeda, MN, RN
PRC Number: 0364265
Valid Until: April 28, 2016


Noted by: EVALYN M. LECCIONES, MN, RN Approved by: GTER G, GAID, PhD, MAN, RN N
(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D No.: 0245303 Valid Until:May 9, 2015 Dean, PRC I.D. No.:0302269 Valid Until: September 13, 2015
Date document is signed: ________ Time:______________ Date document is signed: Time: ____________________
Please specify Highest Nursing Degree Earned: Master in Nursing Please specify Highest Nursing Degree Earned: Master of Arts in Nursing
INCB Form
IMMEDIATE CARE OF THE
NEWBORN FORM