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    Final PRC

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    Brian
    1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

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    Attribution Non-Commercial (BY-NC)
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    Final PRC

    Uploaded by

    Brian
    158 views7 pages
    1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

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    1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    158 views7 pages

    Final PRC

    Uploaded by

    Brian
    1) The document describes surgical scrub procedures performed by nursing students at the University of Cebu - Banilad Campus College of Nursing. 2) It provides details of three surgical scrub procedures conducted on different dates at Cebu City Medical Center including patient initials and case number, surgical procedure, attending nurses and supervising instructor. 3) The forms are signed by the clinical coordinator and dean of the College of Nursing to note and approve the surgical scrub experiences of the students.

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    UNIVERSITY OF CEBU BANILAD CAMPUS

    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
    Prepared by:

    O.R. FORM 1A
    O.R. SCRUB
    FORM

    ______________________________
    LEONIDA N. MUEZ

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    SURGICAL PROCEDURE
    PERFORMED

    O.R. Nurse on Duty


    (Complete Name and
    Signature)

    May 20, 2011


    8:27 AM

    F.B.G.
    432044

    Exploratory, Laparotomy Right


    Hemicolectomy (Gastro-intestinal
    Anastomosis) with Side to Side
    Anastomosis Application of Internal
    Retraction Suture (Tumor4 Node1
    Metastasis0)

    Ms. Ofelia B. Songahid


    R.N.

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)
    Ms. Maria Flordeliz G.
    Padayao, R.N., M.A.N.

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    SURGICAL CIRCULATING in __________________________________________________
    Prepared by:

    O.R. FORM 1B
    O.R. CIRCULATING
    FORM

    _________________________________

    Date Performed
    and Time
    Started

    PATIENTS
    Initials Only
    Case Number

    SURGICAL PROCEDURE
    PERFORMED

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    O.R. Nurse on Duty


    (Complete Name and
    Signature)

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)

    Approved by: ____________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    ACTUAL DELIVERY in _______________________________________________________
    Prepared by:

    _________________________________

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    PROCEDURE
    PERFORMED

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    D.R. FORM
    ACTUAL DELIVERY
    FORM
    D.R. Nurse on Duty
    (Complete Name and
    Signature)

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    IMMEDIATE NEWBORN CORD CARE in ____________________________________________________
    Prepared by:

    __________________________________

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    IMMEDIATE NEWBORN
    CORD CARE
    PERFORMED

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS, R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    ICNB FORM
    IMMEDIATE CARE OF
    THE NEWBORN FORM

    D.R. Nurse on Duty


    (Complete Name and
    Signature)

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
    Prepared by:

    O.R. FORM 1A
    O.R. SCRUB
    FORM

    ______________________________
    RANI MAE P. VALENZONA

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    SURGICAL PROCEDURE
    PERFORMED

    O.R. Nurse on Duty


    (Complete Name and
    Signature)

    March 13, 2012


    10:00 AM

    E.S.S
    506020

    Open Reduction Internal Fixation


    (Log Screw Fixation) Medial
    Malleolus Left; Open Reduction
    Internal Fixation Plate and Screw
    Fibula Left

    Mr. Romil Galahad M.


    Blancas, R.N

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)
    Ms. Maria Flordeliz G.
    Padayao, R.N., M.A.N

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    SURGICAL SCRUB in CEBU CITY MEDICAL CENTER

    Prepared by:

    O.R. FORM 1A
    O.R. SCRUB
    FORM

    ______________________________
    RANI MAE P. VALENZONA

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    SURGICAL PROCEDURE
    PERFORMED

    O.R. Nurse on Duty


    (Complete Name and
    Signature)

    March 12, 2012


    10:07 AM

    J.L.P.E
    507081

    Abdomino-Endo Rectal Pull


    Through Take Down of Colostomy

    Mr. Jason Noel A.


    Manigos, R.N

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)
    Ms. Maria Flordeliz G.
    Padayao, R.N., M.A.N

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:___________________

    UNIVERSITY OF CEBU BANILAD CAMPUS


    College of Nursing
    Governor Cuenco Avenue, Banilad, Cebu City 6000
    (032) 233-8888; (032) 231-8613; www.uc.edu.ph
    PACUCOA Level II 3rd Reaccredited Status, June 2007
    SURGICAL SCRUB in ____________________________________________________________
    Prepared by:

    O.R. FORM 1A
    O.R. SCRUB
    FORM

    ______________________________

    Date
    Performed and
    Time Started

    PATIENTS
    Initials Only
    Case Number

    SURGICAL PROCEDURE
    PERFORMED

    Noted by: ____________________________________________


    PILUCHI VICTORINA M. VILLEGAS R.N., M.N
    Clinical Coordinator
    PRC I.D No. ___________ Valid Until ____________
    Date document is signed: _______________________
    Time: _______________________
    Highest Nursing Degree Earned:_________________

    O.R. Nurse on Duty


    (Complete Name and
    Signature)

    Supervised by Clinical
    Instructor
    (Complete Name and
    Signature)

    Approved by: _______________________________________


    DR. HELEN C. ESTRELLA
    Dean
    PRC I.D. No. ____________ Valid Until _____________
    Date document is signed: _________________________
    Time: _______________________
    Highest Nursing Degree Earned:__________________

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