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    PRBSEC-47 Internal Examination Form

    Uploaded by

    Raven Orlino
    The document is a record form from the Professional Regulation Commission to be filled out by graduate midwives or registered nurses. It records internal examinations conducted under supervision. The form includes spaces to record patient information and examination details for up to 20 patients, including name, case number, findings of the internal exam like cervical dilation and station of the baby, date and time of exam, and information about the supervising clinical instructor or registered midwife. The supervisor must sign off on the form to verify competence in internal exams.

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    PRBSEC-47 Internal Examination Form

    Uploaded by

    Raven Orlino
    170 views2 pages
    The document is a record form from the Professional Regulation Commission to be filled out by graduate midwives or registered nurses. It records internal examinations conducted under supervision. The form includes spaces to record patient information and examination details for up to 20 patients, including name, case number, findings of the internal exam like cervical dilation and station of the baby, date and time of exam, and information about the supervising clinical instructor or registered midwife. The supervisor must sign off on the form to verify competence in internal exams.

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    The document is a record form from the Professional Regulation Commission to be filled out by graduate midwives or registered nurses. It records internal examinations conducted under supervision. The form includes spaces to record patient information and examination details for up to 20 patients, including name, case number, findings of the internal exam like cervical dilation and station of the baby, date and time of exam, and information about the supervising clinical instructor or registered midwife. The supervisor must sign off on the form to verify competence in internal exams.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    170 views2 pages

    PRBSEC-47 Internal Examination Form

    Uploaded by

    Raven Orlino
    The document is a record form from the Professional Regulation Commission to be filled out by graduate midwives or registered nurses. It records internal examinations conducted under supervision. The form includes spaces to record patient information and examination details for up to 20 patients, including name, case number, findings of the internal exam like cervical dilation and station of the baby, date and time of exam, and information about the supervising clinical instructor or registered midwife. The supervisor must sign off on the form to verify competence in internal exams.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 2

    Professional Regulation Commission

    RECORD OF CONDUCTED INTERNAL EXAMINATION BEFORE DELIVERY


    Please Check:
    Graduate Midwife Registered Nurse

    Name of Applicant: ________________________________________ School: ______________________________________

    Internal Examination Supervised by:


    Name and Address of Case (Cervical Dilation, Date & Full Name, License No./
    Patient No. Effacement, BOW, Time Address of Facility Printed Name & Position/ Signature Expiration
    Presentation & Station) Performed & Contact Number Contact No. Designation Date
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    (Continued at the Back)

    Internal Examination Supervised by:


    Date & Full Name,
    Name and Address of Case (Cervical Dilation, License No./
    Time Address of Facility Printed Name Position/
    PRBSEC-47
    Rev. 00
    January 24, 2020
    Page 1 of 1
    Patient No. Effacement, BOW, Signature Expiration
    Performed & Contact Number & Contact Designatio
    Presentation & Station) Date
    No. n
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    Note: 1) The Clinical Instructor should ensure the competence of the students in the performance of internal examinations before signing this form.
    2) Registered Midwives/Clinical Instructors who supervise Students/Graduate Midwives/Registered Nurses and affix their signature in this Form must present a
    Certificate of Training on the Expanded Functions of Midwife (R.A. 7392) pursuant to Board Resolution No. 07, Series of 2017, dated September 8, 2017.

    CERTIFIED CORRECT:

    Signature: Date:
    Printed Name:
    Affix Designation: _______________________________
    Documentary Stamp License Number: Expiry Date:
    (to be posted on the last page)

    PRBSEC-47
    Rev. 00
    January 24, 2020
    Page 1 of 2

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