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BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING AND MIDWIFERY


Don Manuel Banzon Avenue, City of Balanga, Bataan
(047) 237-5477, mail@bpsu.edu.ph

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 2
Date of Accreditation: January 01, 2014
D.R. Form
ACTUAL DELIVERY HANDLED
ACTUAL DELIVERY HANDLED IN BATAAN GENERAL HOSPITAL, CITY OF BALANGA, BATAAN
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Name of Student: TWILA SANTIAGO AZURIN
(Printed Name & Signature of Student)

Patients Initial Only D.R. Nurse on Duty Supervised by


Date Performed
Case Number PROCEDURE PEFORMED Name and Signature Clinical Instructor
and Time Started (If Midwife on Duty, Signature not Required)
(Not Applicable for Birthing/Lying-In, Clinics/Homes) Name and Signature
September 12, 2014
IR (21-91-08) Normal Spontaneous Delivery
09:03 AM Raa Estrella, R.N Ruby S. Matibag, Ed.D, R.N
September 18, 2014
MKV (21-93-84) Normal Spontaneous Delivery
07:58 AM Raa Estrella, R.N Ruby S. Matibag, Ed.D, R.N
September 18, 2014
JH (21-92-53) Normal Spontaneous Delivery
02:03 PM Raa Estrella, R.N Ruby S. Matibag, Ed.D, R.N
January 26, 2015
JC (22-52-33) Normal Spontaneous Delivery
11:25 AM April Bacala, R.N Jocelyn F. Villanueva, Ed.D, R.N
January 26, 2015
JT (22-52-46) Normal Spontaneous Delivery
02:35 PM Violeta Y. Garcia, R.N, Ph.D Jocelyn F. Villanueva, Ed.D, R.N

Noted by: Concurred: Approved by:

DR. JOCELYN FAUSTINO VILLANUEVA, RN EVELYN ROBLES RUBIA, RN, MAN, PHD DR. RUBY SANTOS MATIBAG, RM, RN
Clinical Coordinator Chief Nurse Dean
PRC I.D. no: 0177589 PRC I.D. no: 0098006 PRC I.D. no: 0285929 / 0142873
Valid until: JUNE 27, 2018 Valid until: OCTOBER 22, 2020 Valid until: FEBRUARY 26, 2019
PNA no: 16170 PNA no: 7845 PNA no: 2017-024738
Valid until: LIFETIME Valid until: LIFETIME Valid until: DECEMBER 31, 2017
Date document is signed: Date document is signed: Date document is signed:
Highest degree earned: DOCTOR OF EDUCATION Highest degree earned: DOCTOR OF PHILOSOPHY Highest degree earned: DOCTOR OF EDUCATION
BATAAN PENINSULA STATE UNIVERSITY
COLLEGE OF NURSING AND MIDWIFERY
Don Manuel Banzon Avenue, City of Balanga, Bataan
(047) 237-5477, mail@bpsu.edu.ph

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 2
Date of Accreditation: January 01, 2014
D.R. Form
ACTUAL DELIVERY ASSISTED
ACTUAL DELIVERY ASSISTED IN BATAAN GENERAL HOSPITAL, CITY OF BALANGA, BATAAN
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Name of Student: TWILA SANTIAGO AZURIN
(Printed Name & Signature of Student)

Patients Initial Only D.R. Nurse on Duty Supervised by


Date Performed
Case Number PROCEDURE PEFORMED Name and Signature Clinical Instructor
and Time Started (If Midwife on Duty, Signature not Required)
(Not Applicable for Birthing/Lying-In, Clinics/Homes) Name and Signature
September 12, 2014
MCS (21-90-41) Normal Spontaneous Delivery
10:12 AM Raa Estrella, R.N Ruby S. Matibag, Ed.D, R.N
September 18, 2014
TSM (21-93-97) Normal Spontaneous Delivery
08:22 AM Raa Estrella, R.N Ruby S. Matibag, Ed.D, R.N
September 18, 2014
JR (21-94-19) Normal Spontaneous Delivery
03:41 PM Lourdes E. Reyes, R.N Ruby S. Matibag, Ed.D, R.N
January 26, 2015
JS (15-31-89) Normal Spontaneous Delivery
09:58 PM April Bacala, R.N Jocelyn F. Villanueva, Ed.D, R.N
January 26, 2015
MIC (22-52-41) Normal Spontaneous Delivery
01:02 PM April Bacala, R.N Jocelyn F. Villanueva, Ed.D, R.N

Noted by: Concurred: Approved by:

DR. JOCELYN FAUSTINO VILLANUEVA, RN EVELYN ROBLES RUBIA, RN, MAN, PHD DR. RUBY SANTOS MATIBAG, RM, RN
Clinical Coordinator Chief Nurse Dean
PRC I.D. no: 0177589 PRC I.D. no: 0098006 PRC I.D. no: 0285929 / 0142873
Valid until: JUNE 27, 2018 Valid until: OCTOBER 22, 2020 Valid until: FEBRUARY 26, 2019
PNA no: 16170 PNA no: 7845 PNA no: 2017-024738
Valid until: LIFETIME Valid until: LIFETIME Valid until: DECEMBER 31, 2017
Date document is signed: Date document is signed: Date document is signed:
Highest degree earned: DOCTOR OF EDUCATION Highest degree earned: DOCTOR OF PHILOSOPHY Highest degree earned: DOCTOR OF EDUCATION
BATAAN PENINSULA STATE UNIVERSITY
COLLEGE OF NURSING AND MIDWIFERY
Don Manuel Banzon Avenue, City of Balanga, Bataan
(047) 237-5477, mail@bpsu.edu.ph

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 2
Date of Accreditation: January 01, 2014
ICNB Form
IMMEDIATE CARE OF THE
IMMEDIATE NEWBORN CARE IN BATAAN GENERAL HOSPITAL, CITY OF BALANGA, BATAAN NEWBORN FORM
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Name of Student: TWILA SANTIAGO AZURIN
(Printed Name & Signature of Student)

Patients Initial Only IMMEDIATE NEWBORN CORD CARE Nurse on Duty Supervised by
Date Performed
Case Number Performed Name and Signature Clinical Instructor
and Time Started (If Midwife on Duty, Signature not Required)
(Not Applicable for Birthing/Lying-In, Clinics/Homes) Indicate where Performed (e.g. D.R., Nursery, NICU, or Home) Name and Signature
September 04, 2014
Boy G (21-86-64) Delivery Room
08:45 AM Marivic C. Pulido, R.N Rachel D. Castillo, RN, MAN
September 04, 2014
Boy I (21-87-45) Delivery Room
12:35 PM Marivic C. Pulido, R.N Rachel D. Castillo, RN, MAN
September 05, 2014
Boy M (37-83-27) Cesarean Section
10:29 AM April P. Flores, R.N Rachel D. Castillo, RN, MAN
September 05, 2014
Boy R (21-87-86) Delivery Room
12:13 PM April P. Flores, R.N Rachel D. Castillo, RN, MAN
September 11, 2014
Boy A (21-90-55) Delivery Room
09:20 AM April P. Flores, R.N Rachel D. Castillo, RN, MAN

Noted by: Concurred: Approved by:

DR. JOCELYN FAUSTINO VILLANUEVA, RN EVELYN ROBLES RUBIA, RN, MAN, PHD DR. RUBY SANTOS MATIBAG, RM, RN
Clinical Coordinator Chief Nurse Dean
PRC I.D. no: 0177589 PRC I.D. no: 0098006 PRC I.D. no: 0285929 / 0142873
Valid until: JUNE 27, 2018 Valid until: OCTOBER 22, 2020 Valid until: FEBRUARY 26, 2019
PNA no: 16170 PNA no: 7845 PNA no: 2017-024738
Valid until: LIFETIME Valid until: LIFETIME Valid until: DECEMBER 31, 2017
Date document is signed: Date document is signed: Date document is signed:
Highest degree earned: DOCTOR OF EDUCATION Highest degree earned: DOCTOR OF PHILOSOPHY Highest degree earned: DOCTOR OF EDUCATION

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