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    Procedure Performed: Benguet State University College of Nursing

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    Audi Kyle Saydoven
    This document is an O.R. scrub form from Benguet State University College of Nursing. It contains fields for a student's name, date and time of a procedure, patient name and case number, procedure performed, supervising nurse, and signatures of approving nurses and administrators. The form is used to document surgical scrubs performed by students in Benguet General Hospital and Baguio General Hospital and Medical Center under supervision of registered nurses.

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    Attribution Non-Commercial (BY-NC)
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    Procedure Performed: Benguet State University College of Nursing

    Uploaded by

    Audi Kyle Saydoven
    158 views3 pages
    This document is an O.R. scrub form from Benguet State University College of Nursing. It contains fields for a student's name, date and time of a procedure, patient name and case number, procedure performed, supervising nurse, and signatures of approving nurses and administrators. The form is used to document surgical scrubs performed by students in Benguet General Hospital and Baguio General Hospital and Medical Center under supervision of registered nurses.

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    PRC Major

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    © Attribution Non-Commercial (BY-NC)

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    This document is an O.R. scrub form from Benguet State University College of Nursing. It contains fields for a student's name, date and time of a procedure, patient name and case number, procedure performed, supervising nurse, and signatures of approving nurses and administrators. The form is used to document surgical scrubs performed by students in Benguet General Hospital and Baguio General Hospital and Medical Center under supervision of registered nurses.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    158 views3 pages

    Procedure Performed: Benguet State University College of Nursing

    Uploaded by

    Audi Kyle Saydoven
    This document is an O.R. scrub form from Benguet State University College of Nursing. It contains fields for a student's name, date and time of a procedure, patient name and case number, procedure performed, supervising nurse, and signatures of approving nurses and administrators. The form is used to document surgical scrubs performed by students in Benguet General Hospital and Baguio General Hospital and Medical Center under supervision of registered nurses.

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    Attribution Non-Commercial (BY-NC)
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    ODC Form 2A

    O.R. SCRUB FORM


    BENGUET STATE UNIVERSITY Major
    College of Nursing
    La Trinidad, Benguet, 2601 Philippines
    Phone number: 309-3882; Fax number: 422-2281; E-mail:ents3@yahoo.com; Web site:www.bsu.edu.ph
    LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- November 3, 2011

    SURGICAL SCRUB in BENGUET GENERAL HOSPITAL

    Name of Student: Signature of student:


    Date Performed Patient Name
    and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY:
    Case Number
    Time Started

    Noted by: LAWRENCE C. CARANTO,RN Concurred by: VIRGINIA B. SAGUIDIC, RN


    Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 003986 Valid until: January 15,2012
    PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 02806 Valid until: Lifetime
    Date signed: Time signed : ANSAP No.: 01376 Valid until: December 31,2010
    Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
    Highest Nursing degree earned: Master of arts in Nursing (MAN) ODC Form 2A
    O.R. SCRUB FORM
    BENGUET STATE Major
    UNIVERSITY
    Approved by: VICENTE G.PANAGAN JR.,RN
    College of Nursing
    La Trinidad, Benguet, 2601 Philippines Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
    Phone number: 309-3882; Fax number: 422-2281; E- PNA No.: 063313 Valid Until:December 31,2010 mail:ents3@yahoo.com; Web site:www.bsu.edu.ph
    LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- November ADPCN NO.: 0838 Valid Until: December 31,2010 3, 2011
    Date signed: Time signed:
    SURGICAL SCRUB in BAGUIO GENERAL HOSPITAL AND MEDICAL CENTER, Baguio City
    Specify Highest Nursing Degree Earned:
    Name of Student: Signature of student:
    Date Performed Patient Name
    and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY:
    Case Number
    Time Started

    Noted by: LAWRENCE C. CARANTO,RN Concurred by: ELENA B. TAMPICAN,RN


    Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 004369 Valid until: January 27,2011
    PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 04718 Valid until: Lifetime
    Date signed: Time signed : ANSAP No.: 01036 Valid until: December 31,2010
    Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
    Highest Nursing degree earned: Master of arts in Nursing (MAN)

    Approved by: VICENTE G.PANAGAN JR.,RN


    Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
    PNA No.: 063313 Valid Until:December 31,2010
    ADPCN NO.: 0838 Valid Until: December 31,2010
    Date signed: Time signed:
    Specify Highest Nursing Degree Earned:

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