BATAAN PENINSULA STATE UNIVERSITY

COLLEGE OF NURSING & MIDWIFERY

Don Manuel Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 3
Date of Accreditation: January 1, 2014
ICNB Form
IMMEDIATE CARE OF THE NEWBORN
Bataan General Hospital, Balanga City, Bataan
IMMEDIATE NEWBORN CARE in ______________________________________________________________ FORM
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Arra Beatriz G. Cubebe
Name of Student: _____________________________________________________
(Printed Name & Signature of Student)

Date Performed and Patients INITIAL Only Immediate Newborn Cord Care Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
(not applicable for Birthing/Lying-In, Clinics/Homes Indicate where performed e.g. D.R., Nursery, NICU, or Home (If Midwife on Duty, Signature not required) Name & Signature

02-24-2015| 10:30AM 22-64-70| M.J. A. (Girl) Delivery Room Clarissa Santos Jocelyn Villanueva, RN, Ed.D

03-10-2015| 11:57AM 22-70-28| J.B.E. (Girl) Delivery Room Clarissa Santos Ma. Elinor Soriano, MAN

03-09-2015| 4:38PM 22-69-96| P.J.R. (Girl) Delivery Room Karen Gomez Ma. Elinor Soriano, MAN

03-27-2015| 12:06PM 16-37-33| R.D.G. (Boy) Delivery Room Hazel Adap Ma. Elinor Soriano, MAN

03-31-2015| 7:50AM 19-73-91 | M.O. (Girl) Delivery Room Jennifer Mallari Jocelyn Villanueva, RN, Ed.D

Noted by: Concurred: Approved by:

_________JOCELYN F. VILLANUEVA________________ _______________________________________________ _____________ MA. FLORINDA O. RUBIANO_____________

Clinical Coordinator Chief Nurse Dean
PRC I.D. No: ________0177589_________ PRC I.D. No: ___________________________ PRC I.D. No: ______________ __ _______
Valid Until: ______June 27, 2015_______ Valid Until: _____________________ ______ Valid Until: _____________________ ______
PNA No: _________16170__________ PNA No: __________________________ PNA No: __________________________
Valid Until: ________Lifetime________ Valid Until: ________________________ Valid Until: ________________________
Date document is signed: ________________________ Date document is signed: __________________________ Date document is signed: __________________________
Highest Degree Earned: ____Doctor of Education____ Highest Degree Earned: ________________________ ___ Highest Degree Earned: ____Master of Arts in Nursing____ _
 BATAAN PENINSULA STATE UNIVERSITY
COLLEGE OF NURSING & MIDWIFERY
Don Manuel Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 3
Date of Accreditation: January 1, 2014
D. R. Form
Bataan General Hospital, Balanga City, Bataan ACTUAL DELIVERY HANDLED
ACTUAL DELIVERY HANDLED in __________________________________________________________________
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Arra Beatriz G. Cubebe
Name of Student: _____________________________________________________
(Printed Name & Signature of Student)

Date Performed and Patients INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
(not applicable for Birthing/Lying-In, (If Midwife on Duty, Signature not required) Name & Signature
Clinics/Homes

10-02-2014| 1:51PM 22-00-82| M.A. Normal Spontaneous Delivery Francisca Lima Jocelyn Villanueva, RN, Ed.D

02-17-2015| 1:45PM 15-62-80| D.M.M. Normal Spontaneous Delivery Ma. Cecilia Sabado Jocelyn Villanueva, RN, Ed.D

02-17-2015| 3:05PM 22-61-98| L.M. Normal Spontaneous Delivery Ma. Cecilia Sabado Jocelyn Villanueva, RN, Ed.D

02-24-2015| 1:39PM 22-64-71| P.J.O. Normal Spontaneous Delivery Francisca Lima Jocelyn Villanueva, RN, Ed.D

03-10-2015| 9:07AM 22-70-28| S.S. Normal Spontaneous Delivery Ma. Cecilia Sabado Jocelyn Villanueva, RN, Ed.D

Noted by: Concurred: Approved by:

_________JOCELYN F. VILLANUEVA________________ _______________________________________________ _____________ MA. FLORINDA O. RUBIANO_____________

Clinical Coordinator Chief Nurse Dean
PRC I.D. No: ________0177589_________ PRC I.D. No: ___________________________ PRC I.D. No: ______________ _ _______
Valid Until: ______June 27, 2015_______ Valid Until: _____________________ ______ Valid Until: _____________________ ______
PNA No: _________16170__________ PNA No: __________________________ PNA No: __________________________
Valid Until: ________Lifetime________ Valid Until: ________________________ Valid Until: ________________________
Date document is signed: ________________________ Date document is signed: __________________________ Date document is signed: __________________________
Highest Degree Earned: ____Doctor of Education____ Highest Degree Earned: ________________________ ___ Highest Degree Earned: ____Master of Arts in Nursing____ _
 BATAAN PENINSULA STATE UNIVERSITY
COLLEGE OF NURSING & MIDWIFERY
Don Manuel Banzon Avenue, Balanga City, Bataan
(047) 237-5477, [email protected]

Accredited by: ACCREDITING AGENCY OF CHARTERED COLLEGES & UNIVERSITIES IN THE PHILIPPINES, INC. (AACCUP)
Level: 3
Date of Accreditation: January 1, 2014
D. R. Form
Bataan General Hospital, Balanga City, Bataan ACTUAL DELIVERY ASSISTED
ACTUAL DELIVERY ASSISTED in ___________________________________________________________________
(Hospital / Home / Lying In Clinic, Municipality / City / Province)
Prepared by:
Name of Student:
Arra Beatriz G. Cubebe
_____________________________________________________
(Printed Name & Signature of Student)

Date Performed and Patients INITIAL Only PROCEDURE D.R. Nurse on Duty SUPERVISED BY
Time Started Case Number PERFORMED (Name & Signature) Clinical Instructor
(not applicable for Birthing/Lying-In, Clinics/Homes (If Midwife on Duty, Signature not required) Name & Signature

10-02-2014| 9:40AM 22-00-63| C.J.D. Normal Spontaneous Delivery Francisca Lima Jocelyn Villanueva, RN, Ed.D

02-17-2015| 10:18AM 22-61-86| J.J.C. Normal Spontaneous Delivery Ma. Cecilia Sabado Jocelyn Villanueva, RN, Ed.D

02-23-2015| 11:35AM 22-63-53| E.B.M. Normal Spontaneous Delivery Nelia Bautista Jocelyn Villanueva, RN, Ed.D

02-24-2015| 9:15AM 22-64-67| J.D. Normal Spontaneous Delivery Francisca Lima Jocelyn Villanueva, RN, Ed.D

03-02-2015| 12:36PM 15-87-40| J.C.G. Normal Spontaneous Delivery Francisca Lima Jocelyn Villanueva, RN, Ed.D

Noted by: Concurred: Approved by:

_________JOCELYN F. VILLANUEVA________________ _______________________________________________ _____________ MA. FLORINDA O. RUBIANO_____________

Clinical Coordinator Chief Nurse Dean
PRC I.D. No: ________0177589_________ PRC I.D. No: ___________________________ PRC I.D. No: ______________ _ _______
Valid Until: ______June 27, 2015_______ Valid Until: _____________________ ______ Valid Until: _____________________ ______
PNA No: _________16170__________ PNA No: __________________________ PNA No: __________________________
Valid Until: ________Lifetime________ Valid Until: ________________________ Valid Until: ________________________
Date document is signed: ________________________ Date document is signed: __________________________ Date document is signed: __________________________
Highest Degree Earned: ____Doctor of Education____ Highest Degree Earned: ________________________ ___ Highest Degree Earned: ____Master of Arts in Nursing____ _