Final Final

ODC Form 1A
ACTUAL DELIVERY FORM
LORMA COLLEGES
Carlatan, City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628,Lorma.org
(ACSCU-AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)
ACTUAL DELIVERY in Lorma Medical Center, Carlatan,City of San Fernando, La Union
Prepared by: Vanessa May Apellido De Guzman Signature of student_____________________________

Student
Date Performed and Patient’s INITIAL Only PROCEDURE D.R. Nurse On Duty SUPERVISED BY
Time Started Case Number PERFORMED
___________________ ______________________________
July 26, 2010 M.C.L. Normal Spontaneous
Maureen D. Casuga, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
6:43 AM 18-23-09 Delivery
October 18, 2010 M.M.T. Normal Spontaneous ___________________ _______________________________
1:30 PM 30-39-92 Delivery Nico S. De la Cuesta, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Clinical Coordinator Dean
PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No.0186484 Valid until: August 05, 2012
Date document is signed: ____________________ Time: _________ Date document is signed: ____________________ Time: _________
Highest Nursing Degree Earned: MAN Highest Nursing Degree Earned: MAN
ODC Form 1A
ACTUAL DELIVERY FORM
LORMA COLLEGES
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27,2009-January 26,2012)
ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union
Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

Student
Date Performed and Patient’s INITIAL Only PROCEDURE D.R. Nurse On Duty SUPERVISED BY
Time Started Case Number PERFORMED
___________________ ______________________________
September 28, 2010 J.C.R. Normal Spontaneous
Emily M. Laroya, RN Jennifer L. Mohammed, RN, MANc
2:45 PM Emergency Medical Service Delivery
October 16, 2010 B.M. Normal Spontaneous ___________________ ______________________________
5:52 PM Emergency Medical Service Delivery Emily M. Laroya, RN Jennifer L. Mohammed, RN, MANc
December 4, 2010 L.G. Normal Spontaneous ___________________ ______________________________
9:35 PM Emergency Medical Service Delivery Perla Pacada, RM Jennifer L. Mohammed, RN, MANc

PRC I.D. No. 0165388 Valid Until: December 6, 2011 PRC I.D. No. 0186484 Valid until: August 05, 20122011
Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ________
ODC Form 2A
O.R. SCRUB FORM
Major
LORMA COLLEGES
SURGICAL SCRUB in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Student
Date Performed and Patient’s INITIAL SURGICAL O.R. Nurse on Duty SUPERVISED BY
Time Started Only PROCEDURE
Case Number PERFORMED
Pelvic Laparotomy,
_____________________ _____________________________
April 22, 2010 E.B.M. Oophorectomy, Right
Glorifina G. Dacumos, RN Nida C. Camat, RN, MAN(Thesis I)
1:35 PM 30-88-34
_____________________
April 23, 2010 X.A.P. ______________________________
Palatoplasty Mary Jane P. Advincula,
11:10 AM 25-48-56 Fe M. Nisperos, RN, MAN(Thesis II)
RN
August 3, 2010 C.C.M. Vitrectomy, Change of ______________________ _______________________________
9:30 AM 18-24-45 Intraoccular Lens, Right Glorifina G. Dacumos, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
August 3, 2010 R.N.D. Exploratory Laparotomy, _____________________ ________________________________

12:00 NN 31-78-24 Appendectomy with lavage Glorifina G. Dacumos, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
August 4, 2010 C.C.B. Pelvic Laparotomy, ___________________ _______________________________

1:15 PM 16-84-06 Adhesiolysis Rodel L. Novales, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: ___________
ODC Form 1B
ASSISTED DELIVERY
LORMA COLLEGES FORM
Carlatan City of San Fernando, La Union
(072) 888-2616, Fax Number 242-3628, Lorma.org
(ACSCU- AAI Level III Accredited 2010-2012; ISO AJA 09.0414A January 27, 2009-January 26,2012)
ACTUAL DELIVERY in Lorma Medical Center, Carlatan, City of San Fernando, La Union

Student
Patient’s INITIAL PROCEDURE

Date Performed Only PERFORMED D.R. Nurse on Duty SUPERVISED BY
and Time Started Case Number
__________________
August 2, 2010 S.D.A. ___________________
Normal Spontaneous Delivery Mary Jane P. Advincula,
10:15 AM 30-42-24 Jonalyn D. Padilla, RN, MAN(Thesis I)
RN
October 19, 2010 E.T.C. ___________________ _________________

Normal Spontaneous Delivery
10:05 AM 10-46-18 Melanie A. Marron, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

ODC Form 1B
ASSISTED DELIVERY
FORM
LORMA COLLEGES
ACTUAL DELIVERY in Ilocos Training and Regional Medical Center, Parian, City of San Fernando, La Union

Student
Patient’s INITIAL Only PROCEDURE

Date Performed PERFORMED D.R. Nurse on Duty SUPERVISED BY
Case Number
and Time Started
September 10, 2010

L.P. __________________ ___________________
5:05 PM Normal Spontaneous Delivery
2005-0011024 Michelle T. Nitura, RN Germelina A. Tabios, RN, MAN(Thesis I)
September 10, 2010 E.A. __________________ ___________________
10:41 PM 2003-0111338 Michelle T. Nitura, RN Germelina A. Tabios, RN, MAN(Thesis I)

ODC Form 1B
ASSISTED DELIVERY
FORM
LORMA COLLEGES
ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union

Student
Patient’s INITIAL Only PROCEDURE

Date Performed PERFORMED D.R. Nurse on Duty SUPERVISED BY
Case Number
and Time Started
November 26,2010 F.L. __________________ ______________________________________

11:30 PM Emergency Medical Service Dolores Salazar, RN Jennifer L. Mohammed, RN, MANc

ODC Form 2B
O.R. CIRCULATING FORM
LORMA COLLEGES
SURGICAL SCRUB in City Health Office, City of San Fernando, La Union
Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________

Student
Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY

J.Q. ___________________
May 8, 2010 ________________________________
Emergency Medical Circumcision Emily M. Laroya, RN
9:00 AM Jennifer L. Mohammed, RN, MANc
Service
B.G.
September 29, 2010 Suturing of Lacerated ___________________ ___________________________
Emergency Medical
8:40 AM Wound, Lower Lip Left Teodora A.Gonzales, RN Jennifer L. Mohammed, RN, MANc
Service

Date document is signed: ____________________ Time: ______________ Date document is signed: ____________________ Time: _________
ODC Form 2B
O.R. CIRCULATING FORM
LORMA COLLEGES
Carlatan City of San Fernando, La Union
SURGICAL SCRUB in Lorma Medical Center, Carlatan, City of San Fernando, La Union
Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________

Student
Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY

July 28,2010 Debridement of infected

E.E.V ________________________________
6:30 AM wound, left ankle ___________________
31-73-35 Jonalyn D. Padilla, RN, MAN(Thesis I)
Glorifina G. Dacumos, RN
August 3, 2010 O.P.A. Excision of Mass, Left ___________________ ________________________________
11:45 AM 14-84-25 Shoulder and Back Mark Francis Sison, RN Jonalyn D. Padilla, RN, MAN(Thesis I)
Completion Curettage of
August 4, 2010 K.F.L. ___________________ ________________________________
the uterus
9:25 AM 31-23-59 Khritchie Lagarto, RN Jonalyn D. Padilla, RN, MAN(Thesis I)

ODC Form 1C
CORD CARE FORM
LORMA COLLEGES
IMMEDIATE NEWBORN CORD CARE in Ilocos Training and Regional Medical Center, Parian, City of San Fernando, La Union

Student
Date Performed and Patient’s INITIAL Immediate Newborn Nurse on Duty SUPERVISED BY
Time Started Only Cord Care
May 13, 2010 A.M.T. _______________ ____________________________

3:34 PM 2010-0010727 Operating Room Dianne L. Estigoy, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)
_______________ ____________________________
May 22, 2010 D.A.L. Delivery Room Dianne L. Estigoy, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)
3:25 PM Well Baby
February 10,2011 R.C.D Operating Room ___________________ ____________________________
4:10 PM Well Baby. Maria Lalaine Rivera, RN Fleederlyn T. Lopez,RN, MAN(Thesis II)

Clinical Coordinator, Dean
ODC Form 1C
CORD CARE FORM
LORMA COLLEGES
IMMEDIATE NEWBORN CORD CARE in Lorma Medical Center, Carlatan, City of San Fernando, La Union
Prepared by: Vanessa May Apellido De Guzman Signature of student ________________________

Student
Date Performed and Patient’s INITIAL Immediate Newborn Nurse on Duty SUPERVISED BY
Time Started Only Cord Care
October 18,2010 L.B.L _______________ ____________________________

10:40 AM 32-39-81 Operating Room Ma. Cecilia H. Galon, RN Jonalyn D. Padilla, RN, MAN, (Thesis I)
B.B.G _______________ ____________________________

March 2, 2011 47-47-92 Operating Room Ma. Cecilia H. Galon, RN Jonalyn D. Padilla, RN, MAN, (Thesis I)
2:52 PM

Clinical Coordinator, Dean

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ODC Form 1A

ACTUAL DELIVERY FORM

ACTUAL DELIVERY in Lorma Medical Center, Carlatan,City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student_____________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

August 3, 2010 R.N.D. Exploratory Laparotomy, _____________________ ________________________________

August 4, 2010 C.C.B. Pelvic Laparotomy, ___________________ _______________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

Patient’s INITIAL PROCEDURE

October 19, 2010 E.T.C. ___________________ _________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

Patient’s INITIAL Only PROCEDURE

September 10, 2010

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

ACTUAL DELIVERY in City Health Office, City of San Fernando, La Union

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

Patient’s INITIAL Only PROCEDURE

November 26,2010 F.L. __________________ ______________________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

SURGICAL SCRUB in City Health Office, City of San Fernando, La Union

Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________

Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by:Vanessa May Apellido De Guzman Signature of student _____________________________

Date Performed and Patient’s INITIAL SURGICAL Nurse on Duty SUPERVISED BY

July 28,2010 Debridement of infected

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by: Vanessa May Apellido De Guzman Signature of student _____________________________

May 13, 2010 A.M.T. _______________ ____________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

Prepared by: Vanessa May Apellido De Guzman Signature of student ________________________

October 18,2010 L.B.L _______________ ____________________________

B.B.G _______________ ____________________________

Noted by: Marie Grace M. Nones Approved by: Ludivina D. Magpali

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August 3, 2010 R.N.D. Exploratory Laparotomy, _ ____________

August 4, 2010 C.C.B. Pelvic Laparotomy, _ _____________

October 19, 2010 E.T.C. ___ _

November 26,2010 F.L. ____________________

May 13, 2010 A.M.T. _ ______________

October 18,2010 L.B.L _ ______________

B.B.G _ ______________