ODC Form 3

ACTUAL
DELIVERY
ATENEO DE ZAMBOANGA UNIVERSITY FORM
COLLEGE OF NURSING
La Purisima Street, Zamboanga City
Recognition & Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013
CHED Memorandum No. 1 series of 2005
ACTUAL DELIVERY in AYALA HEALTH CENTER, ZAMBOANGA CITY
Hospital, Municipality/ City/ Province

Prepared by:
Printed Name of Student: TABAR, JULIUS CAEZAR GONZALES____ Signature of Student:_______________________________________

Patient’s Name
Date Performed Nurse On Duty SUPERVISED BY:
and NATURE OF DELIVERY (Name and Signature) Clinical Instructor
Time Started (Name and Signature)
Case Number

October 29, 2010 Mirafel Sevilla Vivian C. Lubaton, RN

Normal Spontaneous Vaginal Delivery Adelyna E. Gatchalian, RN, MN
7:35 AM 09-1557

Noted by: Approved by:

Ms. Flor G. Pamillaran San Luis, RN, MN Maria Lorna Bello-Paber, R.N., M.A.N.
Clinical Coordinator, Ateneo de Zamboanga University Dean, Ateneo de Zamboanga University
Highest Degree Earned: Bachelor of Science in Nursing Highest Degree Earned: Bachelor of Science in Nursing
Master in Nursing Master of Arts in Nursing
Date document is signed: _________________________ Time: _______________________ Date document is signed: _____________________ Time: _______________________
PRC I.D. No. 0062360 Valid Until: January 29, 2011 PRC I.D. No. 0059150 Valid Until: September 15, 2013
PNA I.D. No. 838751 Valid Until: October 31, 2011 PNA I.D. No. 6141 Valid Until: Lifetime Member
ANSAP I.D. No. 0655 Valid Until: December 31, 2011
 ODC Form 3
ACTUAL
DELIVERY
ATENEO DE ZAMBOANGA UNIVERSITY FORM
COLLEGE OF NURSING
La Purisima Street, Zamboanga City
Recognition & Accreditation Level: PAASCU Accredited Level III Year Granted: May 05, 2008-2013
CHED Memorandum No. 1 series of 2005
ACTUAL DELIVERY in AYALA HEALTH CENTER, ZAMBOANGA CITY
Hospital, Municipality/ City/ Province

Prepared by:
Printed Name of Student: TABAR, JULIUS CAEZAR GONZALES____ Signature of Student:_______________________________________

Patient’s Name
Date Performed Nurse On Duty SUPERVISED BY:
and NATURE OF DELIVERY (Name and Signature) Clinical Instructor
Time Started (Name and Signature)
Case Number

October 6, 2010 Evelyn Sumalinog Vivian C. Lubaton, RN

Normal Spontaneous Vaginal Delivery Adelyna E. Gatchalian, RN, MN
10:00 AM 10-0761

Noted by: Approved by:

Ms. Flor G. Pamillaran San Luis, RN, MN Maria Lorna Bello-Paber, R.N., M.A.N.
Clinical Coordinator, Ateneo de Zamboanga University Dean, Ateneo de Zamboanga University
Highest Degree Earned: Bachelor of Science in Nursing Highest Degree Earned: Bachelor of Science in Nursing
Master in Nursing Master of Arts in Nursing
Date document is signed: _________________________ Time: _______________________ Date document is signed: _____________________ Time: _______________________
PRC I.D. No. 0062360 Valid Until: January 29, 2011 PRC I.D. No. 0059150 Valid Until: September 15, 2013
PNA I.D. No. 838751 Valid Until: October 31, 2011 PNA I.D. No. 6141 Valid Until: Lifetime Member
ANSAP I.D. No. 0655 Valid Until: December 31, 2011