Beruflich Dokumente
Kultur Dokumente
ODC Form 1A
ACTUAL DELIVERY FORM
Date Performed
and
Time Started
S
U
P
E
R
V
PROCEDURE
PERFORMED
SUPERVISED BY
Clinical Instructor
Name and Signature
ODC Form
1A Form
ODC1A
Form 1A
ODC
ODC
FormDELIVERY
1A
ACTUAL DELIVERY
FORM
ACTUAL
FORM
ACTUAL
DELIVERY
ODC
FormFORM
1A
ACTUAL
DELIVERY
FORM
ACTUAL DELIVERY FORM
I
S
E
D
B
Y
O
.
R
.
N
u
r
s
e
O
n
D
u
t
y
P
a
t
i
e
n
t
s
I
N
I
T
I
A
L
o
n
l
y
S
U
R
G
I
C
A
L
P
R
O
C
E
D
U
R
E
C
l
i
n
i
c
a
l
I
n
s
t
r
u
c
t
o
r
N
a
m
e
a
n
d
S
i
g
n
a
t
u
r
e
(
N
a
m
e
a
n
d
S
i
g
n
a
t
u
r
e
)
P
E
R
F
O
R
M
E
D
S
A
N
P
E
D
R
O
C
O
L
L
E
G
E
1
2
C
.
ODC Form 2A
O.R. SCRUB FORM
Major
G
u
z
m
a
n
S
t
.
,
8
0
0
0
D
a
v
a
o
C
i
t
y
T
e
l
e
p
h
o
n
e
#
:
2
2
4
1
4
8
1
;
2
2
1
0
6
3
4
;
2
2
1
0
2
5
7
F
a
x
:
2
2
6
4
4
6
1
A
C
C
R
E
D
I
T
E
D
:
P
A
A
S
C
U
_
_
_
_
_
_
_
_
_
_
_
_
S
U
R
G
I
C
A
L
S
C
R
U
B
i
n
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
H
o
s
p
i
t
a
l
,
M
u
n
i
c
i
p
a
l
i
t
y
/
C
i
t
y
/
P
r
o
v
i
n
c
e
P
r
e
p
a
r
e
d
b
y
:
P
r
i
n
t
e
d
N
a
m
e
a
n
d
S
i
g
n
a
t
u
r
e
o
f
S
t
u
d
e
n
t
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
_
D
a
t
e
P
e
r
f
o
r
m
e
d
a
n
d
T
i
m
e
S
t
a
r
t
e
d
C
a
s
e
N
u
m
b
e
r
ODC Form 1B
ASSISTED DELIVERY
FORM
Date Performed
and
Time Started
PROCEDURE
PERFORMED
ASSISTED DELIVERY
SUPERVISED BY
Clinical Instructor
Name and Signature
SURGICAL
SCRUB in
_________
_________
_________
_________
_________
_________
______
Hospital,
Municipality
/City/Provin
ce
Prepared
by:
Printed
O.R.
PROCEDURE Nurse
PERFORMED On
Duty
(Name
and
Signatu
re)
Name and
Signature
of Student
_________
_________
_________
_________
__
Date
Performe
d
and
Time
Started
Case
Number
ODC Form 1C
CORD CARE FORM
Date Performed
and
Time Started
Nurse on Duty
(Name and Signature)
(If Midwife on Duty, signature
not required)
SUPERVISED BY
Clinical Instructor
Name and Signature