XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc.

. 2132/2134 /www.xu.edu.ph ACTUAL DELIVERY IN NORTHERN MINDANAO MEDICAL CENTER Prepared by :

ODC Form 1A ACTUAL DELIVERY FORM

DANDEROSE SUNDAY DELFIN OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS only Case Number
(not applicable for Birthing/lyingin Clinics/Homes) September 8, 2010 4:38 pm JF 765622 Normal Spontaneous Vaginal Delivery

PROCEDURE PERFORMED

D.R. Nurse on Duty (Name and Signature) (If Midwife on Duty, Signature not Required)

SUPERVISED BY Clinical Instructor Name and Signature

Ms. Emilyn G.Dadang, RN

Ms. Ivy R. Go RN, MAN/ Mrs. Nora B. Fabria RN, MN

September 8, 2010 5:07 pm

AR 661884

Normal Spontaneous Vaginal Delivery

Ms. Emilyn G. Dadang, RN

Ms. Ivy R. Go RN, MAN/ Ms. Nora B. Fabria RN MN

September 22, 2010 8:50 pm

ELB 491796

Normal Spontaneous Vaginal Delivery

Ms. Gracel V. Colita, RN

Ms. Ivy R. Go RN, MAN/ Mrs. Nora B. Fabria RN MN

Noted by: MS. IVY R. GO RN, MAN Clinical Coordinator PRC I.D. No. 0222293 Valid Until: April 21, 2016 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed:_______________Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph IMMEDIATE CARE OF THE NEWBORN IN NORTHERN MINDANAO MEDICAL CENTER Prepared by :

ODC Form 1C IMMEDIATE CARE OF THE NEWBORN FORM

DANDEROSE SUNDAY DELFIN OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS only Case Number
(not applicable for Birthing/lyingin Clinics/Homes) September 8, 2010 8:24 pm Baby Girl H 765073

Immediate Newborn Cord Care PERFORMED

Indicate where performed e.g. D.R. Nursery, NICU, or Home

D.R. Nurse on Duty (Name and Signature) (If Midwife on Duty, Signature not Required)

SUPERVISED BY Clinical Instructor Name and Signature

Delivery Room Nursery

Ms. Imelda G. Baguhin, RN

Ms. Ivy R. Go RN, MAN/ Mrs. Nora B. Fabria RN MN

September 8, 2010 10:40 pm

Baby Girl A 765077

Delivery Room Nursery

Ms. Imelda G. Baguhin, RN

Ms. Ivy R. Go RN, MAN/ Mrs. Nora B. Fabria, RN MN

Noted by: MS. IVY R. GO RN MAN Clinical Coordinator PRC I.D. No. 0222293 Valid Until: April 21, 2016 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed:_______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph IMMEDIATE CARE OF THE NEWBORN IN CAGAYAN DE ORO MATERNITY AND CHILDREN S HOSPITAL AND PERICULTURE CENTER Prepared by :

ODC Form 1C IMMEDIATE CARE OF THE NEWBORN FORM

DANDEROSE SUNDAY DELFIN OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS only Case Number
(not applicable for Birthing/lyingin Clinics/Homes) March 6, 2012 8:45 am Baby Boy V 09831

Immediate Newborn Cord Care PERFORMED

Indicate where performed e.g. D.R. Nursery, NICU, or Home

D.R. Nurse on Duty (Name and Signature) (If Midwife on Duty, Signature not Required)

SUPERVISED BY Clinical Instructor Name and Signature

Delivery Room Nursery

Ms. Milcah M. Bancayin, RN

Ms. Ivy R. Go RN, MAN/ Mr. Lemuel G. Salvaa RN MN

Noted by: MS. IVY R. GO RN, MAN Clinical Coordinator PRC I.D. No. 0222293 Valid Until: April 21, 2016 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed:_______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

ODC Form 2A XAVIER UNIVERSITY ATENEO DE CAGAYAN O.R. SCRUB FORM Corrales Avenue, Cagayan de Oro City, Philippines Major Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph SURGICAL SCRUB NURSE FUNCTION IN CAGAYAN DE ORO MATERNITY AND CHILDRENS HOSPITAL AND PUERICULTURE CENTER Prepared by :

DANDEROSE SUNDAY DELFIN OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature
Mr. Dexter Dave D. Origines RN, MN/

February 27, 2012 12:25 pm

AS 09-786

Repeat Low Segment Caesarean Section with Right Tubal Ligation

Ms. Allira L. Gaston, RN

Mr. Lemuel G. Salvaa RN, MN

Noted by: MS. MELANIE JOY M. BUSTAMANTE RN, MAN Clinical Coordinator PRC I.D. No. 0308226 Valid Until: February 6, 2017 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph SURGICAL SCRUB NURSE FUNCTION IN NORTHERN MINDANAO MEDICAL CENTER Prepared by : DANDEROSE SUNDAY DELFIN OCULAM Printed Name and Signature of Student
Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)

ODC Form 2A O.R. SCRUB FORM

Major

SUPERVISED BY Clinical Instructor Name and Signature

Mr. Dexter Dave D. Origines RN, MN/

March 22, 2012 9:30 am

AV 926296

Debridement Application of Multiplanar Hybrid External Fixator, Right

Ms. Mary R. Naguita RN, MN

Mr. Lemuel G. Salvaa RN, MN

Mr. Dexter Dave D. Origines RN, MN/

March 22, 2012 1:15pm

CE 401349

Below Knee Amputation, Left

Ms. Kesha Mae E. Chan, RN

Mr. Lemuel G. Salvaa RN, MN

Noted by: MS. MELANIE JOY M. BUSTAMANTE RN, MAN Clinical Coordinator PRC I.D. No. 0308226 Valid Until: February 6, 2017 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph SURGICAL CIRCULATING NURSE FUNCTION IN MARIA REYNA XAVIER UNIVERSITY HOSPITAL Prepared by :

ODC Form 2B O.R. CIRCULATING FORM

DANDEROSE SUNDAY D. OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature

August 11. 2011 8:30 am

JB 12960

Posterior Colporraphy

Mr. Peter Clengen B. Sabandal, RN

Mrs. Jesusa C. Gabule RN, MN

Noted by: MS. MELANIE JOY M. BUSTAMANTE RN, MAN Clinical Coordinator PRC I.D. No. 0308226 Valid Until: February 6, 2017 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

ODC Form 2B XAVIER UNIVERSITY ATENEO DE CAGAYAN O.R. CIRCULATING Corrales Avenue, Cagayan de Oro City, Philippines FORM Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph SURGICAL CIRCULATING NURSE FUNCTION IN CAGAYAN DE ORO MATERNITY AND CHILDRENS HOSPITAL AND PUERICULTURE CE NTER

Prepared by :

DANDEROSE SUNDAY D. OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature
Mr. Dexter Dave D. Origines RN, MN/

February 28, 2012 1:30 pm

AC 09-792

First Degree Low Segment Transverse Caesarean Section

Ms. Azucena M. Maceda, RM/ Ms. Eldridge H. Esmalde, RN

Mr. Lemuel G. Salvaa RN, MN

Noted by: MS. MELANIE JOY M. BUSTAMANTE RN, MAN Clinical Coordinator PRC I.D. No. 0308226 Valid Until: February 6, 2017 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

XAVIER UNIVERSITY ATENEO DE CAGAYAN Corrales Avenue, Cagayan de Oro City, Philippines Tel. Nos. (088)858 3116 loc. 2132/2134 /www.xu.edu.ph SURGICAL CIRCULATING NURSE FUNCTION IN NORTHERN MINDANAO MEDICAL CENTER Prepared by :

ODC Form 2B O.R. CIRCULATING FORM

DANDEROSE SUNDAY D. OCULAM Printed Name and Signature of Student

Date Performed and Time Started Patients INITIALS (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature
Mr. Dexter Dave D. Origines RN, MN/

March 22, 2012 8:35 am

EB 557006

Atrio-Ventricular Fistula Set

Ms. Leni I. Gestuveo, RN MN

Mr. Lemuel G. Salvaa RN, MN

Noted by: MS. MELANIE JOY M. BUSTAMANTE RN, MAN Clinical Coordinator PRC I.D. No. 0308226 Valid Until: February 6, 2017 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing

Approved by: DR. RAMONA HEIDI C. PALAD RN, MAN College Dean PRC I.D. No. 0053722 Valid Until: _August 31, 2015 Date document is signed: _______________ Time: __________________ Please specify Highest Nursing Degree Earned: Master of Arts in Nursing