Christ the King College of Calbayog City, Inc.
MAGSAYSAY BOULEVARD, CALBAYOG CITY, 6710 SAMAR, PHILIPPINES
Tel. No. (055) 209-3913, Fax No. (055) 533-9526
IMMEDIATE NEWBORN CARE IN CALBAYOG DISTRICT HOSPITAL
BRGY. EAST AWANG, BURGOS ST, CALBAYOG CITY, 6710 SAMAR
Prepared by: JEFF MANUEL MENSORADO SALOMON Signature of Student: __________________
IMMEDIATE NEWBORN CARE
Patient’s Complete Final Diagnosis
SUPERVISED BY
Date Performed and Name Nurse on Duty
Clinical Instructor
Time Started IMMEDIATE NEWBORN CARE (Name and Signature)
Name and Signature
Case Number PERFORMED
LIVE TERM BABY GIRL TO A GRAVIDA 1
PARA 1 VIA NORMAL SPONTANEOUS
DELIVERY, APGAR SCORE=8,9, SHARON D. TALAHIBAN, RN, MSN (c)
AMNIOTIC FLUID CLEAR, Date Signed: _______________
FEBRUARY 16, 2023 BG. S. BIRTH WEIGHT= 2959 GRAMS PRC Number: 0487242
12:15 PM 31-33-80A SALOME M. JUMANTOC, RN, RM Valid Until: AUGUST 10, 2026
DELIVERY ROOM PNA Number: M-73499
Valid Until: DECEMBER 31, 2024
Home Address: BRGY. OQUENDO POBLACION,
OQUENDO DISTRICT, CALBAYOG CITY
Noted by: GLORIMAE S. RIZABAL, RN, MAN Approved by: GERALD B. FIEL, RN, MAN-MSN, DNM
Program Head Dean
PRC ID No.: 0487208 Valid Until: MAY 12, 2026 PRC ID No.: 0831809 Valid Until: MAY 22, 2026
PNA No.: M-33414 Valid Until: DECEMBER 31, 2024 PNA No.: M-76525 Valid Until: DECEMBER 31, 2024
Date Document is Signed: _____________________ Time:___________ ADPCN No.: _________________ Valid Until: ________________
Please Specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING Date Document is signed: _________________ Time: _________
Please Specify Highest Nursing Degree Earned: DOCTOR IN NURSING MANAGEMENT