DR. YANGAS COLLEGES, INC.

(Formerly DR. YANGAS FRANCISCO BALAGTAS COLLEGES) 182 Mc Arthur Highway, Wakas, Bocaue, Bulacan Tel.Nos.(044)692-3097/692-5291/Fax No. (044)920-0289 Website:www.thedycian.com PACUCOALEVEL 1 STATUS, March 2, 2009-March 2011

ODC Form 1A ACTUAL DELIVERY FORM

ACTUAL DELIVERY in ____________________________________________________________

Hospital/Home/Lying-in Clinic, Municipality/City/Province

Prepared by: Printed Name and Signature of Student ___________________________________

Date Performed And Time Started Patients INITIAL Only

PROCEDURE PERFORMED

D.R. Nurse On Duty

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

SUPERVISED BY
Clinical Instructor Name and Signature

Case Number
(not applicable for Birthing/Lying-in Clinical/Homes)

Noted by: ______________________________________________ Print Name and Signature Clinical Coordinator, PRC I.D. No. _________ Valid Until ________ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

Approved by: __PROF. TEODORA M. DELOS REYES, RN, DNS Print Name and Signature Dean, PRC I.D. No. ___0055264__ Valid Until _April 2012______ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

DR. YANGAS COLLEGES, INC.

(Formerly DR. YANGAS FRANCISCO BALAGTAS COLLEGES) 182 Mc Arthur Highway, Wakas, Bocaue, Bulacan Tel.Nos.(044)692-3097/692-5291/Fax No. (044)920-0289 Website:www.thedycian.com PACUCOALEVEL 1 STATUS, March 2, 2009-March 2011

ODC Form 1B ASSISTED DELIVERY FORM

ACTUAL DELIVERY in ____________________________________________________________

Hospital/Home/Lying-in Clinic, Municipality/City/Province

Prepared by: Printed Name and Signature of Student ___________________________________

Date Performed And Time Started Patients INITIAL Only

PROCEDURE PERFORMED
ASSISTED DELIVERY

D.R. Nurse On Duty

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

SUPERVISED BY
Clinical Instructor Name and Signature

Case Number
(not applicable for Birthing/Lying-in Clinical/Homes)

Noted by: ______________________________________________ Print Name and Signature Clinical Coordinator, PRC I.D. No. _________ Valid Until ________ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

Approved by: __PROF. TEODORA M. DELOS REYES, RN, DNS Print Name and Signature Dean, PRC I.D. No. ___0055264__ Valid Until _April 2012______ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

DR. YANGAS COLLEGES, INC.

(Formerly DR. YANGAS FRANCISCO BALAGTAS COLLEGES) 182 Mc Arthur Highway, Wakas, Bocaue, Bulacan Tel.Nos.(044)692-3097/692-5291/Fax No. (044)920-0289 Website:www.thedycian.com PACUCOALEVEL 1 STATUS, March 2, 2009-March 2011

ODC Form 1C CORD CARE FORM

IMMEDIATE NEWBORN CORD CARE in ____________________________________________________

Hospital/Home/Lying-in Clinic, Municipality/City/Province

Prepared by: Printed Name and Signature of Student ___________________________________

Date Performed And Time Started Patients INITIAL Only Immediate Newborn Cord Care Indicate where performed eg. D.R., Nursery, NICU, or Home Case Number
(not applicable for Birthing/Lying-in Clinical/Homes)

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

SUPERVISED BY
Clinical Instructor Name and Signature

PERFORMED

Noted by: ______________________________________________ Print Name and Signature Clinical Coordinator, PRC I.D. No. _________ Valid Until ________ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

Approved by: __PROF. TEODORA M. DELOS REYES, RN, DNS Print Name and Signature Dean, PRC I.D. No. ___0055264__ Valid Until _April 2012______ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

DR. YANGAS COLLEGES, INC.

(Formerly DR. YANGAS FRANCISCO BALAGTAS COLLEGES) 182 Mc Arthur Highway, Wakas, Bocaue, Bulacan Tel.Nos.(044)692-3097/692-5291/Fax No. (044)920-0289 Website:www.thedycian.com PACUCOALEVEL 1 STATUS, March 2, 2009-March 2011

ODC Form 2A O.R. SCRUB FORM Major

SURGICAL SCRUB in ____________________________________________________________

Hospital, Municipality/City/Province

Prepared by: Printed Name and Signature of Student ___________________________________

Date Performed And Time Started Patients INITIAL Only O.R. Nurse On Duty SUPERVISED BY
Clinical Instructor Name and Signature

SURGICAL PROCEDURE PERFORMED

Case Number

(Name and Signature)

Noted by: ______________________________________________ Print Name and Signature Clinical Coordinator, PRC I.D. No. _________ Valid Until ________ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

Approved by: __PROF. TEODORA M. DELOS REYES, RN, DNS Print Name and Signature Dean, PRC I.D. No. ___0055264__ Valid Until _April 2012______ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

DR. YANGAS COLLEGES, INC.

(Formerly DR. YANGAS FRANCISCO BALAGTAS COLLEGES) 182 Mc Arthur Highway, Wakas, Bocaue, Bulacan Tel.Nos.(044)692-3097/692-5291/Fax No. (044)920-0289 Website:www.thedycian.com PACUCOALEVEL 1 STATUS, March 2, 2009-March 2011

ODC Form 2B O.R. CIRCULATING FORM

SURGICAL SCRUB in ____________________________________________________________

Hospital, Municipality/City/Province

Prepared by: Printed Name and Signature of Student ___________________________________

Date Performed And Time Started Patients INITIAL Only O.R. Nurse On Duty SUPERVISED BY
Clinical Instructor Name and Signature

SURGICAL PROCEDURE PERFORMED

Case Number

(Name and Signature)

Noted by: ______________________________________________ Print Name and Signature Clinical Coordinator, PRC I.D. No. _________ Valid Until ________ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________

Approved by: __PROF. TEODORA M. DELOS REYES, RN, DNS Print Name and Signature Dean, PRC I.D. No. ___0055264__ Valid Until _April 2012______ Date document is signed: ________________ Time ____________ Please specify Highest Nursing Degree Earned: ________________