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ODC Form 1A
ACTUAL DELIVERY
FORM
08-15-14
11:18 AM
AM.P.A
536573
08-16-14
9:38 PM
MK.D.Q
281660
02-01-15
6:19 AM
M.N.F
830831
Case Number
SUPERVISED BY
Clinical Instructor
Name and Signature
PROCEDURE
PERFORMED
D.R. Nurse/Midwife On
Duty
LORENZA O. CAPSUYEN RN
JOYCE P. BAYENG RN
DAISY M. GODDA RN
______________________________________
University of the Cordilleras
COLLEGE OF NURSING
Gov. Pack Road, 2600 Baguio City
=========================================
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DELIVERY CASE SLIP: Actual ( / )
Assist ( )
Agency: Baguio General Hospital and Medical Center
Hospital ( / )
Home ( ) Birthing/ Lying-in ( )
Address: Baguio City
Name of Mother: Apple May P. Abrigo
Case Number: 536573
Age: 22
Type of Delivery Attended: Normal Spontaneous Delivery_______
________________________________________________________
________________________________________________________
Date of Delivery: August 15, 2014
Time of Delivery 11:18 AM
Time Placenta Out:9:48 AM
Actual Nurse: Rina B. Decalan
Assist Nurse: Madeline F. Lopez
Name of DR Nurse/ Midwife: Lorenza O. Capsuyen, RN