ODC Form 1A

OUR LADY OF GUADALUPE COLLEGES, INC. ACTUAL DELIVERY

Sierra Madre cor. I. Esteban Sts., Mandaluyong City FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

ACTUAL DELIVERY in MUNTINLUPA LYING-IN, National Road, Brgy. Putatan, Muntinlupa City
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

February 18, 2010 Ms. S Normal Spontaneous Delivery Marilyn N. Asantor, RM Madolin B. Hernaez, RN, MAN
5:00 p.m. 25197

----- NOTHING FOLLOWS -----

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 ODC Form 2A
OUR LADY OF GUADALUPE COLLEGES, INC. O.R. SCRUB FORM
Sierra Madre cor. I. Esteban Sts., Mandaluyong City MAJOR
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

SURGICAL SCRUB in OSPITAL NG SAMPALOC, Sampaloc, Manila

Hospital, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

April 21, 2010 Ms. A Right total thyroidectomy with isthmusectomy, Nenita V. Cuevas, RN Hilda S.Vallesteros RN, MAN
10:13 a.m. 454201 Left subtotal thyroidectomy

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 ODC Form 1B
OUR LADY OF GUADALUPE COLLEGES, INC. ASSISTED DELIVERY
Sierra Madre cor. I. Esteban Sts., Mandaluyong City FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

ACTUAL DELIVERY in MUNTINLUPA LYING-IN, National Road, Brgy. Putatan, Muntinlupa City
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

PROCEDURE PERFORMED
Date Performed D.R. Nurse On Duty SUPERVISED BY
and (Name and Signature) (If Midwife on Clinical Instructor
Time Started Case Number Duty, Signature Not Required) Name and Signature
(not applicable for Birthing/Lying-In ASSISTED DELIVERY
Clinics/Homes)

February 20, 2010 Ms. C Normal Spontaneous Delivery Marilyn N. Asantor, RM Madolin B. Hernaez, RN, MAN
3:45 p.m. 25202

----- NOTHING FOLLOWS -----

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 ODC Form 2B
OUR LADY OF GUADALUPE COLLEGES, INC. O.R. CIRCULATING
Sierra Madre cor. I. Esteban Sts., Mandaluyong City FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

SURGICAL SCRUB in MANDALUYONG CITY MEDICAL CENTER, Boni Avenue, Mandaluyong City
Hospital, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

April 26, 2010 Ms. P Dilation and Curettage Jhoan B. Villanueva, RN Galileo F. Sumulong, RN,MAN
11:30 p.m. 533111

June 17, 2010 Mr. R Disarticulation of 3rd digit left foot Jonathan Dolot, RN Margarita P. Tamano, RN, MAN
9:35 a.m. 534762

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 OUR LADY OF GUADALUPE COLLEGES, INC. ODC Form 1C
Sierra Madre cor. I. Esteban Sts., Mandaluyong City CORD CARE FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

IMMEDIATE NEWBORN CORD CARE in DR. VICTOR R. POTENCIANO MEDICAL CENTER, EDSA, Mandaluyong City
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

January 15, 2010 Baby Boy B. Nursery MJ L. Chua, RN Julita Y. Dayandayan, RN, MAN
3:30 p.m. 133800

January 16, 2010 Baby Girl F. Nursery MJ L. Chua, RN Julita Y. Dayandayan, RN, MAN
8:30 p.m. 133805

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 OUR LADY OF GUADALUPE COLLEGES, INC. ODC Form 1A
Sierra Madre cor. I. Esteban Sts., Mandaluyong City ACTUAL DELIVERY
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph FORM

ACTUAL DELIVERY in MANDALUYONG CITY MEDICAL CENTER, Boni Avenue, Mandaluyong City
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

May 04, 2010 Ms. L Normal Spontaneous Delivery Jhoan B. Villanueva, RN Galileo F. Sumulong, RN, MAN
10:35 p.m. 53374

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 ODC Form 2A
OUR LADY OF GUADALUPE COLLEGES, INC. O.R. SCRUB FORM
Sierra Madre cor. I. Esteban Sts., Mandaluyong City MAJOR
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

SURGICAL SCRUB in MANDALUYONG CITY MEDICAL CENTER, Boni Avenue,Mandaluyong City

Hospital, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

June 19, 2010 Ms. M Emergency Explore Laparoscopy John Dominick Balanon, RN Margarita P. Tamano, RN, MAN
9:34 a.m. 534853 Left Salpingectomy

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 ODC Form 2B
OUR LADY OF GUADALUPE COLLEGES, INC. O.R. CIRCULATING
Sierra Madre cor. I. Esteban Sts., Mandaluyong City FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

SURGICAL SCRUB in GAT ANDRES BONIFACIO MEMORIAL MEDICAL CENTER, Tondo, Manila
Hospital, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

May 19, 2010 Ms. M Suturing of lacerated wound at head part Margarita P. Tamano, RN, MAN Virginia H. Isidro, RN, MSN
9:45 a.m. 10-30868 (parietal)

May 19, 2010 Mr. H Suturing of lacerated wound at foot part Margarita P. Tamano, RN, MAN Virginia H. Isidro, RN, MSN
10:00 a.m. 10-30070 (dorsum)

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 OUR LADY OF GUADALUPE COLLEGES, INC. ODC Form 1C
Sierra Madre cor. I. Esteban Sts., Mandaluyong City CORD CARE FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

IMMEDIATE NEWBORN CORD CARE in MUNTINLUPA LYING-IN, National Road, Brgy. Putatan, Muntinlupa City
Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

February 20, 2010 Baby Boy B Nursery Marilyn N. Asantor, RM Madolin B. Hernaez, RN, MAN
8:49 p.m. 25201

----- NOTHING FOLLOWS -----

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C. LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)
 OUR LADY OF GUADALUPE COLLEGES, INC. ODC Form 1C
Sierra Madre cor. I. Esteban Sts., Mandaluyong City CORD CARE FORM
Tel. Nos. 5355885 to 86 / Telefax No.: 535-5885 / www.olgc.edu.ph

IMMEDIATE NEWBORN CORD CARE in OSPITAL NG SAMPALOC, Sampaloc, Manila

Hospital/Home/Lying-In Clinic, Municipality/City/Province

Prepared by:
Printed Name and Signature of Student BERNARDO, GENEVA JOY F.

Patient’s INITIAL Only

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

April 19, 2010 Baby Boy P Nursery Nenita V. Cuevas, RN Hilda S. Vallesteros, RN, MAN
10:36 a.m 394101

Noted by: ROSENDA N. JARAMILLO, RN, MAN Approved by: MYRAFLOR C LAVA, RN, MAN
(Printed Name and Signature) (Printed Name and Signature)
Clinical Coordinator, PRC I.D No. 0320953 Valid Until May 01, 2014 Dean, PRC I.D No. 0184160 Valid Until November 05, 2013
Date document is signed: ____________________ Time: __________ Date document is signed: ____________________ Time: __________
Please specify Highest Nursing Degree Earned: RN, MAN Please specify Highest Nursing Degree Earned: RN, MAN

(STRICTLY NO DESIGNATES)