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    PRC Cases Form

    Uploaded by

    Vanessa Kyla Umiten
    The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

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    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    PRC Cases Form

    Uploaded by

    Vanessa Kyla Umiten
    65 views3 pages
    The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

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    The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

    Copyright:

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

    PRC Cases Form

    Uploaded by

    Vanessa Kyla Umiten
    The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
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    Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City Tel. No. (02)859-0812/ Fax No.

    (02) 859-0875 PAASCU Level II Re-Accredited Status, November 2011 - November 2016
    SURGICAL SCRUB IN JUSTICE JOSE ABAD SANTOS GENERAL HOSPITAL Hospital, Municipality/City/Province

    O.R. Form 1A
    Prepared by: Printed Name with Signature of Student: VANESSA KYLA C. UMITEN
    Date Performed and Time Started Patients INITIAL (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)
    O.R. SCRUB FORM Major

    SUPERVISED BY: Clinical Instructor Name and Signature

    JULY 13, 2012 10:45 am

    R.L.M 552448

    ELECTIVE FUNCTIONAL ENDOSCOPIC SINUS SX

    MARIE KATHLEEN D. CASTRO, RN

    SHIELA S. TORRES RN, MAN

    O.R. Form 1A
    Prepared by: Printed Name with Signature of Student _______________________________________________
    Date Performed and Time Started Patients INITIAL (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)
    O.R. CIRCULATING FORM

    SUPERVISED BY: Clinical Instructor Name and Signature

    (STRICTLY NO DESIGNATES) (This Forms must be printed at the back of the 1st page of the Competency-Based Performance Evaluation Checklist prescribed by the BoN)

    Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City Tel. No. (02)859-0812/ Fax No. (02) 859-0875 PAASCU Level II Re-Accredited Status, November 2011 - November 2016
    ACTUAL DELIVERY IN ______________________________________________________________________________________ Hospital/Home/Lying-In Clinic, Municipality/City/Province D.R. FORM
    ACTUAL DELIVERY FORM

    Prepared by: Printed Name with Signature of Student _______________________________________________


    Date Performed and Time Started Patients INITIAL (only) Case Number (not applicable for
    Birthing/Lying-in Clinics/Home)

    PROCEDURE PERFORMED

    D.R. Nurse on Duty (Name and Signature)


    (If Midwife on Duty, Signature Not Required)

    SUPERVISED BY: Clinical Instructor Name and Signature

    IMMEDIATE NEWBORN CORD CARE IN ______________________________________________________________________________________ Hospital/Home/Lying-In Clinic, Municipality/City/Province ICNB FORM Prepared by: IMMEDIATE CARE OF THE NEWBORN FORM Printed Name with Signature of Student _______________________________________________
    Date Performed and Time Started Patients INITIAL (only) Case Number (not applicable for
    Birthing/Lying-in Clinics/Home)

    IMMEDIATE NEWBORN CORD CARE PERFORMED


    Performed e.g. DR, Nursery , NICU Or Home

    D.R. Nurse on Duty (Name and Signature)


    (If Midwife on Duty, Signature Not Required)

    SUPERVISED BY: Clinical Instructor Name and Signature

    (STRICTLY NO DESIGNATES) (This Forms must be printed at the back of the 1st page of the Competency-Based Performance Evaluation Checklist prescribed by the BoN)

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