UNIVERSITY of PANGASINAN

PHINMA EDUCATION NETWORK

COLLEGE OF NURSING
Arellano St. Dagupan City

Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)

ACTUAL DELIVERY IN_______PANGASINAN PROVINCIAL HOSPITAL / SAN CARLOS/PANGASINAN____________

Hospital/Home/Lying-in Clinic/Municipality/City/Province D.R Form 1A
Prepared by: Actual Delivery
Printed Name with Signature of Student: DE LA CRUZ, SHAIRA Ferrer__________________ FORM

Date Performed Patient’s INITIAL only Supervised by:

And PROCEDURE PERFORMED D.R NURSE ON DUTY CLINICAL INSTRUCTOR
Time Started Case Number (Name and Signature)
(Not Applicable for
Birthing/Lying-in Clinics/Homes

December 13, 2018 A.B.B

2:32 PM NORMAL SPONTANEOUS DELIVERY JENNIFER L. DATUIN, R.M. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
257112

March 22, 2019 L.D.C

7:38 AM NORMAL SPONTANEOUS DELIVERY TERESITA DE GUZMAN, R.M. BARBIE MAE P. CABALO, R.N., R.M., M.A.N
233397

Noted by: LIZA D. FUCANAN__ ___ Approved by: __ MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean

PRC I.D No. . 0108608___________________Valid Until: January 01,2020 PRC I.D No. 0160104_____________ Valid Until: September 09, 2019
Date document is signed: ___________________Time:________________ Date document is signed: Time: ______________________________
Please Specify Degree Earned: RN, MAN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D _________________________________
 UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Arellano St. Dagupan City

Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)

ACTUAL DELIVERY IN_______ PANGASINAN PROVINCIAL HOSPITAL / SAN CARLOS/PANGASINAN___________

Hospital/Home/Lying-in Clinic/Municipality/City/Province D.R Form 1B
Prepared by: ASSISTED DELIVERY
Printed Name with Signature of Student: DE LA CRUZ, SHAIRA Ferrer__________________ FORM

Date Performed Patient’s INITIAL only Supervised by:

And PROCEDURE PERFORMED D.R NURSE ON DUTY CLINICAL INSTRUCTOR
Time Started Case Number (Name and Signature)
(Not Applicable for
Birthing/Lying-in Clinics/Homes

December 6, 2018 J.A.C

10:17 AM NORMAL SPONTANEOUS DELIVERY VIOLETA B. ESCOSIO, R.M. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
260456

March 23, 2019 S.M.G

8:19 AM NORMAL SPONTANEOUS DELIVERY ANNALIZA S. CABATCAT BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
285161

Noted by: LIZA D. FUCANAN__ ___ Approved by: __ MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean

PRC I.D No. . 0108608___________________Valid Until: January 01,2020 PRC I.D No. 0160104_____________ Valid Until: September 09, 2019
Date document is signed: ___________________Time:________________ Date document is signed: Time: ______________________________
Please Specify Degree Earned: RN, MAN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D _________________________________
 UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Arellano St. Dagupan City

Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)

ACTUAL DELIVERY IN______ _PANGASINAN PROVINCIAL HOSPITAL / SAN CARLOS/PANGASINAN___________

Hospital/Home/Lying-in Clinic/Municipality/City/Province D.R Form 1B
Prepared by: ASSISTED DELIVERY
Printed Name with Signature of Student: DE LA CRUZ, SHAIRA Ferrer__________________ FORM

Date Performed Patient’s INITIAL only Supervised by:

And PROCEDURE PERFORMED D.R NURSE ON DUTY CLINICAL INSTRUCTOR
Time Started Case Number (Name and Signature)
(Not Applicable for
Birthing/Lying-in Clinics/Homes

March 24, 2019 C.N.P

1:40 PM NORMAL SPONTANEOUS DELIVERY TERESITA DE GUZMAN, R.M. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
285478

Noted by: LIZA D. FUCANAN__ ___ Approved by: __ MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean

PRC I.D No. . 0108608___________________Valid Until: January 01,2020 PRC I.D No. 0160104_____________ Valid Until: September 09, 2019
Date document is signed: ___________________Time:________________ Date document is signed: Time: ______________________________
Please Specify Degree Earned: RN, MAN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D _________________________________
 UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Arellano St. Dagupan City

Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)

ACTUAL DELIVERY IN_______PANGASINAN PROVINCIAL HOSPITAL / SAN CARLOS/PANGASINAN____________

Hospital/Home/Lying-in Clinic/Municipality/City/Province E.I.N.C Form
Prepared by: ESSENTIAL NEWBORN CARE FORM
Printed Name with Signature of Student: DE LA CRUZ, SHAIRA Ferrer__________________

Date Performed Patient’s INITIAL only Essential Newborn Cord Care Supervised by:
And PERFORMED D.R NURSE ON DUTY CLINICAL INSTRUCTOR
Time Started Case Number Indicate where performed e.g. D.R., (Name and Signature)
(Not Applicable for Nursery, N.I.C.U., or Home
Birthing/Lying-in Clinics/Homes

December 20, 2018 B.B.D

11:10 AM DELIVERY ROOM KRIZIA CYREEL F. REYES, R.N. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
263336

March 22, 2019 B.B.P

9:38 AM DELIVERY ROOM KRISTINE JUNE MAGALONG, R.N. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
284955

Noted by: LIZA D. FUCANAN__ ___ Approved by: __ MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean

PRC I.D No. . 0108608___________________Valid Until: January 01,2020 PRC I.D No. 0160104_____________ Valid Until: September 09, 2019
Date document is signed: ___________________Time:________________ Date document is signed: Time: ______________________________
Please Specify Degree Earned: RN, MAN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D _________________________________
 UNIVERSITY of PANGASINAN
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Arellano St. Dagupan City

Phone No. (075)522-5635-37; Fax No. (075)522-2496; E-mail: registrar@upang.edu.ph; Website: http://www.upang.edu.ph
(Date School/Program was recognized: May 19, 1976; Number 44; Year: 1976)
(Level I PACUCOA; Year Granted: March 05, 2007)

ACTUAL DELIVERY IN_______PANGASINAN PROVINCIAL HOSPITAL / SAN CARLOS/ PANGASINAN____________

Hospital/Home/Lying-in Clinic/Municipality/City/Province E.I.N.C Form
Prepared by: ESSENTIAL NEWBORN CARE FORM
Printed Name with Signature of Student: DE LA CRUZ, SHAIRA Ferrer__________________

Date Performed Patient’s INITIAL only Essential Newborn Cord Care Supervised by:
And PERFORMED D.R NURSE ON DUTY CLINICAL INSTRUCTOR
Time Started Case Number Indicate where performed e.g. D.R., (Name and Signature)
(Not Applicable for Nursery, N.I.C.U., or Home
Birthing/Lying-in Clinics/Homes

March 22, 2019 B.B.T

2:48 PM DELIVERY ROOM KRISTINE JUNE MAGALONG, R.N. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
284977

March 23, 2019 B.B.M

8:07 AM DELIVERY ROOM KRIZIA CYREEL F. REYES, R.N. BARBIE MAE P. CABALO, R.N., R.M., M.A.N.
285155

Noted by: LIZA D. FUCANAN__ ___ Approved by: __ MARIA TERESA R. FAJARDO_________
Clinical Coordinator College Dean

PRC I.D No. . 0108608___________________Valid Until: January 01,2020 PRC I.D No. 0160104_____________ Valid Until: September 09, 2019
Date document is signed: ___________________Time:________________ Date document is signed: Time: ______________________________
Please Specify Degree Earned: RN, MAN___________________________ Please Specify Degree Earned: RN, MAN, Ed.D _________________________________